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Casey C, Buckley CM, Kearney PM, Griffin MD, Dinneen SF, Griffin TP. Social deprivation and diabetic kidney disease: A European view. J Diabetes Investig 2024; 15:541-556. [PMID: 38279774 PMCID: PMC11060165 DOI: 10.1111/jdi.14156] [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: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community-based care.
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Affiliation(s)
- Caoimhe Casey
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of Public HealthUniversity College CorkCorkIreland
| | | | | | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices, School of MedicineUniversity of GalwayGalwayIreland
- Department of NephrologyGalway University HospitalGalwayIreland
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
| | - Tomás P Griffin
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
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Burton E, Quinn R, Crosbie-Staunton K, Deasy C, Masterson S, O'Donnell C, Merwick Á, Willis D, Kearney PM, Mc Carthy VJC, Buckley CM. Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study. BMJ Open 2024; 14:e078168. [PMID: 38508613 PMCID: PMC10961584 DOI: 10.1136/bmjopen-2023-078168] [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: 07/26/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Time is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021. DESIGN We conducted a secondary data analysis with a quasi-experimental design. SETTING We used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as '1 March 2020-31 December 2021' and the pre-COVID-19 period '1 January 2018-29 February 2020'. PRIMARY AND SECONDARY OUTCOME MEASURES We compared five ambulance time intervals: 'allocation performance', 'mobilisation performance', 'response time', 'on scene time' and 'conveyance time' between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis. PARTICIPANTS We included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021. RESULTS 40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001). CONCLUSIONS A 'shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork, Ireland
| | - Rory Quinn
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | | | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Áine Merwick
- Neurology Department, Cork University Hospital, Cork, Ireland
| | - David Willis
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Fulham-McQuillan H, O’Donovan R, Buckley CM, Crowley P, Gilmore B, Martin J, McAuliffe E, Martin G, Moore G, Morrissey M, Ní Shé É, O’Hara MC, Sweeney MR, Wall P, De Brún A. Exploring the needs and experiences of contact tracing staff during the COVID-19 pandemic in Ireland. PLoS One 2024; 19:e0298799. [PMID: 38457452 PMCID: PMC10923454 DOI: 10.1371/journal.pone.0298799] [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: 01/26/2023] [Accepted: 01/29/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Contact tracing is a key component in controlling the spread of COVID-19, however little research has focused on learning from the experiences of contact tracing staff. Harnessing learning from those in this role can provide valuable insights into the process of contact tracing and how best to support staff in this crucial role. METHODS Thematic analysis was used to analyse 47 semi-structured interviews conducted with contact tracing staff via telephone or Zoom at three time points in 2021: March, May and September-October. RESULTS Six themes related to the contact tracing role were identified, including training, workforce culture, systems issues, motivation and support. While initially nervous in the role, participants were motivated to contribute to the pandemic response and believed the role provided them with valuable transferable skills. Participants described the training as having improved over time while desiring more proactive training. Sources of frustration included a perceived lack of opportunity for feedback and involvement in process changes, feelings of low autonomy, and a perception of high staff turnover. Participants expressed a need for improved communication of formal emotional supports. Increased managerial support and provision of opportunities for career advancement may contribute to increased motivation among staff. CONCLUSIONS These findings identify the experiences of contact tracing staff working during the COVID-19 pandemic, and have important implications for the improvement of the contact tracing system. Recommendations based on learning from participants offer suggestions as to how best to support the needs of contact tracing staff during a pandemic response.
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Affiliation(s)
- Hugh Fulham-McQuillan
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Róisín O’Donovan
- Centre for Positive Psychology and Health, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | | | - Philip Crowley
- Team Strategy and Research Directorate, Health Service Executive, Dublin, Ireland
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Jennifer Martin
- National Quality and Patient Safety Directorate, Health Service Executive, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Gregory Martin
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Gemma Moore
- Team Strategy and Research Directorate, Health Service Executive, Dublin, Ireland
| | - Mary Morrissey
- National Health Intelligence Unit, Research & Evidence, Health Service Executive, Dublin, Ireland
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Mary Clare O’Hara
- Research and Development, Strategy and Research, Health Service Executive, Dublin, Ireland
| | - Mary Rose Sweeney
- Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Patrick Wall
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Stamenic D, Fitzgerald AP, Gajewska KA, O'Neill KN, Bermingham M, Cronin J, Lynch BM, O'Brien SM, McHugh SM, Buckley CM, Kavanagh PM, Kearney PM, O'Keeffe LM. Health care utilization and the associated costs attributable to cardiovascular disease in Ireland: a cross-sectional study. Eur Heart J Qual Care Clin Outcomes 2024:qcae014. [PMID: 38383606 DOI: 10.1093/ehjqcco/qcae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality and disability globally. We examined healthcare service utilization and costs attributable to CVD in Ireland in the period before the introduction of a major healthcare reform in 2016. METHODS Secondary analysis of data from 8 113 participants of the first wave of The Irish Longitudinal Study on Ageing. CVD was defined as having a self-reported doctor's diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Participants self-reported the utilization of healthcare services in the year preceding the interview. Negative binomial regression with average marginal effects (AME) was used to estimate the incremental number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department attendances and hospitalisations in population with CVD relative to population without CVD. We calculated the corresponding costs at individual and population levels, by gender and age groups. RESULTS The prevalence of CVD was 18.2% (95% CI: 17.3, 19.0) Participants with CVD reported higher utilization of all healthcare services. In adjusted models, having CVD was associated with incremental 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits. There were twice as many incremental hospitalisations in males with CVD compared to females with CVD (AME (95% CI): 0.20 (0.16, 0.23) vs 0.10 (0.07, 0.14)). The incremental cost of healthcare service use in population with CVD was an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. CONCLUSION We identified substantially increased use of healthcare services attributable to CVD in Ireland. Continued efforts aimed at CVD primary prevention and management are required.
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Affiliation(s)
- Danko Stamenic
- School of Public Health, University College Cork, Cork, Ireland
| | - Anthony P Fitzgerald
- School of Public Health, University College Cork, Cork, Ireland
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - Katarzyna A Gajewska
- School of Public Health, University College Cork, Cork, Ireland
- Diabetes Ireland, Dublin, Ireland
| | - Kate N O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Margaret Bermingham
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Jodi Cronin
- Centre for Policy Studies, Cork University Business School, Cork, Ireland
| | - Brenda M Lynch
- Centre for Policy Studies, Cork University Business School, Cork, Ireland
| | - Sarah M O'Brien
- Office of the National Clinical Advisor and Programme Group Lead for Chronic Disease, Clinical Design & Innovation, Office of the Chief Clinical Officer, HSE South, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork, Ireland
- National Office of Public Health, HSE, Ireland
| | - Paul M Kavanagh
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Public Health and Epidemiology, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Ireland
- National Office of Public Health, HSE, Ireland
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Chen Y, Ingram C, Downey V, Roe M, Sripaiboonkij P, Buckley CM, Alvarez E, Perrotta C, Buggy C. Pandemic preparedness from the perspective of Occupational Health professionals. Occup Med (Lond) 2024; 74:93-98. [PMID: 38085666 PMCID: PMC10875927 DOI: 10.1093/occmed/kqad119] [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] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Prior to any infectious disease emergence as a public health concern, early occupational preparedness is crucial for protecting employees from novel pathogens- coronavirus disease 2019 (COVID-19) is no different. AIMS This study ascertains how occupational safety and health (OSH)/Human Resource (HR) professionals in the Republic of Ireland had managed to prepare their workplaces prior to the advent of COVID-19. METHODS As part of a larger COVID-19 workplace study, online focus groups were conducted with OSH/HR professionals. Collected data were transcribed verbatim and entered into NVivo for thematic analysis incorporating intercoder reliability testing. RESULTS Fifteen focus groups were conducted with OSH/HR professionals (n = 60) from various occupational settings. Three levels of organizational preparedness were identified: 'early awareness and preparation'; 'unaware and not ready' and 'aware, but not ready'. Most organizations were aware of the COVID-19 severity, but not fully prepared for the pandemic, especially stand-alone enterprises that may not have sufficient resources to cope with an unanticipated crisis. The experiences shared by OSH professionals illustrate their agility in applying risk management and control skills to unanticipated public/occupational health crises that arise. CONCLUSIONS General pandemic preparedness such as the availability of work-from-home policies, emergency scenario planning and prior experience in workplace outbreaks of infectious diseases were helpful for workplace-associated COVID-19 prevention. This is the first study conducted with OSH/HR professionals in Ireland regarding COVID-19 preparedness in workplaces, which provides valuable insights into research literature, as well as empirical experience for the preparation of future public health emergencies.
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Affiliation(s)
- Y Chen
- Applied Aviation Science Department, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA
| | - C Ingram
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - V Downey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - M Roe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - P Sripaiboonkij
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, Dublin, Ireland
| | - C M Buckley
- Health Service Executive, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - E Alvarez
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - C Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - C Buggy
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, Dublin, Ireland
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Bambury N, O'Neill K, Buckley CM, Kearney PM. Trends in incidence of ischaemic stroke in people with and without diabetes in Ireland 2005-2015. Diabet Med 2023; 40:e15127. [PMID: 37140385 DOI: 10.1111/dme.15127] [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: 03/08/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/05/2023]
Abstract
AIMS We aim to describe the epidemiology of ischaemic stroke and in-hospital mortality associated with stroke among men and women with and without diabetes from 2005 to 2015. METHODS Secondary data analysis of national hospital discharge data from the Hospital Inpatient Enquiry database. Stroke incidence and in-hospital mortality rates in people with and without diabetes were calculated. Poisson regression models were used to estimate the incidence rate ratio (IRR) and assess trends over time. RESULTS The age-adjusted incidence of stroke was twice as high in people with diabetes compared to those without diabetes (men IRR 2.0 [95% CI 1.95-2.06] and women IRR 2.2 [95% CI 2.12-2.27]). The incidence of ischaemic stroke decreased by an average 1.7% per year in men with diabetes and 3.3% per year in women with diabetes. In people without diabetes, the average annual reduction was smaller (0.2% per year in men and 1% per year in women). In-hospital mortality associated with admission with ischaemic stroke was approximately twice as high in those with diabetes compared to those without diabetes among men [IRR 1.81 (1.67-1.97)] and women [IRR 2 (95% CI 1.84-2.18)]. CONCLUSION Despite decreases in incidence of ischaemic stroke and associated in-hospital mortality, there remains a twofold increased risk of ischaemic stroke and mortality in people with diabetes. Therefore, priority must be given to management of risk factors for ischaemic stroke in people with diabetes as well as continued development of targeted stroke prevention strategies.
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Affiliation(s)
- Niamh Bambury
- Department of Public Health, HSE South (Cork and Kerry), Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Kate O'Neill
- School of Public Health, University College Cork, Cork, Ireland
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Pallin JA, Buckley-O'Farrell K, Riordan F, McGrath N, O'Neill K, MacLoughlin D, Dinneen SF, Buckley CM, McHugh S, Kearney PM. Implementing an integrated diabetic foot care programme in Ireland: podiatrists' experience. BMC Health Serv Res 2023; 23:1157. [PMID: 37884981 PMCID: PMC10601248 DOI: 10.1186/s12913-023-10144-z] [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: 06/26/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND International evidence suggests that an integrated multidisciplinary approach to diabetic foot management is necessary to prevent ulceration and progression to amputation. Many health systems have introduced policies or models of care supporting the introduction of this evidence into practice, but little is known about the experiences of those involved in implementation. This study addresses this gap by examining the experiences of podiatrists providing integrated diabetic foot care. METHODS Between October 2017 and April 2018, an online survey comprising closed and open-ended questions on podiatrists' demographics, clinical activity, links with other services, continuous professional development activities and experiences of implementing the Model of Care was administered to podiatrists (n = 73) working for Ireland's Health Service Executive in the community and hospital setting. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS The response rate was 68% (n = 50), with 46% (n = 23), 38% (n = 19) and 16% (n = 8) working across hospital, community and both settings, respectively. Most reported treating high-risk patients (66%), those with active foot disease (61%) and educating people about the risk of diabetes to the lower limb (80%). Reported challenges towards integrated diabetic foot care include a perceived lack of awareness of the role of podiatry amongst other healthcare professionals, poor integration between hospital and community podiatry services, especially where new services had been developed, and insufficient number of podiatrists to meet service demands. CONCLUSION Previous evidence has shown that there is often a gap between what is set out by a policy and what it looks like when delivered to service users. Results from the current study support this, highlighting that while most podiatrists work in line with national recommendations, there are specific gaps and challenges that need to be addressed to ensure successful policy implementation.
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Affiliation(s)
| | | | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Niamh McGrath
- HRB Evidence Centre, Health Research Board, Grattan House, 67-72 Lower Mount Street, Dublin 2, Ireland
| | - Kate O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Sean F Dinneen
- School of Medicine, University of Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | | | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Fulham-McQuillan H, O'Donovan R, Buckley CM, Crowley P, Gilmore B, Martin J, McAuliffe E, Martin G, Moore G, Morrissey M, Nicholson E, Shé ÉN, O'Hara MC, Segurado R, Sweeney MR, Wall P, De Brún A. Exploring the psychological impact of contact tracing work on staff during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:602. [PMID: 37291553 DOI: 10.1186/s12913-023-09566-6] [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] [Received: 09/23/2022] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Contact tracing is a key control measure in the response to the COVID-19 pandemic. While quantitative research has been conducted on the psychological impact of the pandemic on other frontline healthcare workers, none has explored the impact on contact tracing staff. METHODS A longitudinal study was conducted using two repeated measures with contact tracing staff employed in Ireland during the COVID-19 pandemic using two-tailed independent samples t tests and exploratory linear mixed models. RESULTS The study sample included 137 contact tracers in March 2021 (T1) and 218 in September 2021 (T3). There was an increase from T1 to T3 in burnout related exhaustion (p < 0·001), post-traumatic stress disorder (PTSD) symptom scores (p < 0·001), mental distress (p < 0·01), perceived stress (p < 0·001) and tension and pressure (p < 0·001). In those aged 18-30, there was an increase in exhaustion related burnout (p < 0·01), PTSD symptoms (p < 0·05), and tension and pressure scores (p < 0·05). Additionally, participants with a background in healthcare showed an increase in PTSD symptom scores by T3 (p < 0·001), reaching mean scores equivalent to those of participants who did not have a background in healthcare. CONCLUSIONS Contact tracing staff working during the COVID-19 pandemic experienced an increase in adverse psychological outcomes. These findings highlight a need for further research on psychological supports required by contact tracing staff with differing demographic profiles.
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Affiliation(s)
- Hugh Fulham-McQuillan
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
| | - Róisín O'Donovan
- Centre for Positive Psychology and Health, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | | | - Philip Crowley
- Team Strategy and Research Directorate, Health Service Executive, Dublin, Ireland
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Jennifer Martin
- National Quality and Patient Safety Directorate, Health Service Executive, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Gregory Martin
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - Gemma Moore
- Team Strategy and Research Directorate, Health Service Executive, Dublin, Ireland
| | - Mary Morrissey
- National Health Intelligence Unit, Research & Evidence, Health Service Executive, Dublin, Ireland
| | - Emma Nicholson
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Mary Clare O'Hara
- Research and Development, Strategy and Research, Health Service Executive, Dublin, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Patrick Wall
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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9
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Burton E, Aladkhen J, O'Donnell C, Masterson S, Merwick Á, McCarthy VJ, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A systematic review and meta-analysis. PREHOSP EMERG CARE 2023:1-42. [PMID: 37261801 DOI: 10.1080/10903127.2023.2219729] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
IntroductionCOVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischaemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions.ObjectivesTo synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA.MethodsFollowing a published protocol, we conducted a systematic search of six databases up to 31st May 2022. We re-ran this search on 14th April 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance times (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review.ResultsOf 4083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 minutes (-2.19 to -0.38)) and mean total prehospital interval (-6.42 minutes (-10.60 to -2.25)) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 (0.02 to 0.33)). Ambulance response interval definitions and terminology varied between regions and countries.ConclusionsOur review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimise delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork City, Cork, T12XF62, Ireland
| | - Johnny Aladkhen
- School of Public Health, University College Cork, Cork City, Cork, T12XF62, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, D24 XNP2, Ireland
| | - Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dublin, D24 XNP2, Ireland
- Discipline of General Practice, University of Galway, Galway, H91 TK33, Ireland
| | - Áine Merwick
- Department of Neurology, Cork University Hospital, Cork City, Cork, T12 V8KC, Ireland
| | - Vera Jc McCarthy
- School of Nursing and Midwifery, University College Cork, Cork City, Cork, T12 AK54, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork City, Cork, T12XF62, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork City, Cork, T12XF62, Ireland
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10
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Kearney PM, Stamenic D, Gajewska K, O'Sullivan MB, Doyle S, O'Reilly O, Buckley CM. Cross-sectional survey of compliance behaviour, knowledge and attitudes among cases and close contacts during COVID-19 pandemic. Public Health Pract (Oxf) 2023; 5:100370. [PMID: 36817733 PMCID: PMC9930406 DOI: 10.1016/j.puhip.2023.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Objectives A key public health intervention is self-isolation for cases and restriction of movement for contacts. This study aimed to identify predictors of compliance behaviour and describe knowledge and attitudes among cases and contacts identified by the national Contact Management Programme to inform the global public health response. Study design Secondary data analysis of anonymised cross-sectional survey data on national sample of cases and close contacts. Methods A sample of 1000 cases and 1000 contacts was calculated to estimate compliance within a margin of error of 3% with 95% confidence. A telephone survey administered by trained interviewers collected information on socio-demographics, compliance behaviours, knowledge, and attitudes to COVID-19 from cases and close contacts. Data analysis included chi-squared statistics and multivariable logistic regression. Results Most cases and contacts complied with public health guidance with similar characteristics in those who did and did not comply. Reasons for non-compliance included exercise, medical appointment, shopping, and work. Cases and contacts reported high levels of understanding about symptoms of COVID-19 and satisfaction with available information. Conclusion Achieving high compliance with public health guidance is feasible and requires political leadership, policy changes and practical solutions.
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Affiliation(s)
- Patricia M. Kearney
- School of Public Health, University College Cork, Ireland,Corresponding author
| | - Danko Stamenic
- School of Public Health, University College Cork, Ireland
| | | | | | - Sarah Doyle
- Department of Public Health, Health Services Executive, HSE South, Ireland
| | - Orlaith O'Reilly
- Clinical Design and Innovation, Health Services Executive, Ireland
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11
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Stamenic D, Harrington JM, Millar SR, Delaney L, Gajewska KA, Buckley CM, McHugh SM, Perry IJ, Kearney PM. Cohort profile update: The Cork and Kerry Diabetes and Heart Disease Study. HRB Open Res 2023; 6:25. [PMID: 37601818 PMCID: PMC10435920 DOI: 10.12688/hrbopenres.13626.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 08/22/2023] Open
Abstract
Background: The Cork and Kerry Diabetes and Heart Disease Study was established to investigate the prevalence of diabetes and cardiovascular disease among middle-aged adults in Ireland. The Mitchelstown cohort was recruited from a single large primary care centre between 2010-2011. A rescreen of this cohort was conducted in 2015. Methods: Data were collected on cardiovascular health and associated risk factors. In addition, the rescreen incorporated new measures which included information on cognition and frailty, medication adherence, dietary factors and the collection of stool samples with RNA sequencing of the gut microbiome. Results: Of 2047 participants in the original cohort, 237 (11.6%) were deceased, too ill to participate or were lost to follow-up. Of the remaining 1810 baseline study participants, 1378 men and women aged 51-77 years agreed to take part in the rescreen (response rate of 76.1%). The prevalence of hypertension was high, ranging from 50% to 64% depending on the measurement method. An investigation of the association of gut microbiota with metabolic syndrome and obesity indicated greater microbiome diversity in metabolically healthy non-obese individuals relative to their unhealthy counterparts. Analysis of prescribing data over time demonstrated a high prevalence of potentially inappropriate prescribing among older-aged people in primary care which increased as they progressed to more advanced old age. Conclusions: The rescreen has provided new insights into cardiovascular health. In addition, this study is embedded in a single primary care centre, enabling passive follow-up of study participants through electronic health records. All data collected at baseline and rescreen are maintained and stored at the School of Public Health, University College Cork and specific proposals for future collaborations are welcome.
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Affiliation(s)
- Danko Stamenic
- School of Public Health, University College Cork, Cork, Co. Cork, Ireland
| | | | - Seán R. Millar
- School of Public Health, University College Cork, Cork, Co. Cork, Ireland
| | - Lisa Delaney
- School of Public Health, University College Cork, Cork, Co. Cork, Ireland
| | | | - Claire M. Buckley
- School of Public Health, University College Cork, Cork, Co. Cork, Ireland
| | - Sheena M. McHugh
- School of Public Health, University College Cork, Cork, Co. Cork, Ireland
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Co. Cork, Ireland
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12
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Kelly C, White P, Kennedy E, O'Flynn D, Colgan A, Ward M, O'Sullivan MB, Buckley CM, Cosgrove B, Canny M, Harkin K, McGuire F, Lynch C, Ryan A, Denyer S, Kelleher K, Collins A. Limited transmission of SARS-CoV-2 in schools in Ireland during the 2020-2021 school year. Euro Surveill 2023; 28. [PMID: 37052681 PMCID: PMC10103549 DOI: 10.2807/1560-7917.es.2023.28.15.2200554] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BackgroundThe role of schools in SARS-CoV-2 transmission has been a debated topic since the beginning of the COVID-19 pandemic.AimTo examine SARS-CoV-2 transmission in all schools in Ireland during the 2020-21 school year.MethodsIn a national descriptive cross-sectional study, we investigated PCR-confirmed cases of COVID-19 among students (aged < 20 years) and staff (aged ≥ 20 years) who attended school during their infectious period to identify school close contacts. SARS-CoV-2 PCR test results of all school close contacts were pooled to obtain an overall positivity rate and to stratify positivity rate by school setting and role (i.e. student or staff).ResultsIn total, 100,474 individuals were tested as close contacts in 1,771 schools during the 2020-21 school year. An overall close contact positivity rate of 2.4% was observed across all schools (n = 2,373 secondary cases). The highest positivity rate was seen in special schools (3.4%), followed by primary (2.5%) and post-primary schools (1.8%) (p < 0.001). Of the close contacts identified, 90.5% (n = 90,953) were students and 9.5% (n = 9,521) were staff. Overall, students had a significantly higher positivity rate than staff (2.4% vs 1.8%, p < 0.001).ConclusionThis study demonstrated that a low level of SARS-CoV-2 transmission occurred in Irish schools during the 2020-21 academic year. In the event of future pandemics, and as the COVID-19 pandemic continues, there is a need to carefully weigh up the harms and benefits associated with disrupted education to mitigate infectious disease transmission before reflexively closing classes or schools.
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Affiliation(s)
- Ciara Kelly
- Department of Public Health, HSE West, Merlin Park Hospital, Galway, Ireland
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Philippa White
- Department of Public Health, HSE South, St. Finbarr's Hospital, Cork, Ireland
| | - Elizabeth Kennedy
- Department of Public Health, HSE East, Dr Steeven's Hospital, Dublin, Ireland
| | - Dearbhail O'Flynn
- Department of Public Health, HSE East, Dr Steeven's Hospital, Dublin, Ireland
| | - Aoife Colgan
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Mary Ward
- Department of Public Health, HSE East, Dr Steeven's Hospital, Dublin, Ireland
| | | | - Claire M Buckley
- School of Public Health, University College Cork, Cork, Ireland
- Contact Management Programme, Health Service Executive, Ireland
| | - Breda Cosgrove
- Department of Public Health, HSE Mid-West, Mount Kennett House, Henry Street, Limerick, Ireland
| | - Melissa Canny
- Department of Public Health, HSE West, Merlin Park Hospital, Galway, Ireland
| | - Katharine Harkin
- Department of Public Health, HSE Midlands, HSE Area Offices, Arden Road, Tullamore, Co. Offaly, Ireland
| | - Fiona McGuire
- Department of Public Health, HSE Midlands, HSE Area Offices, Arden Road, Tullamore, Co. Offaly, Ireland
| | - Catherine Lynch
- Department of Public Health, HSE South-East, The Tower, Dublin Road, Lacken, Kilkenny, Ireland
| | - Aidan Ryan
- Department of Public Health, HSE North-West, Iona House, Upper Main Street, Ballyshannon, Co. Donegal, Ireland
| | - Sean Denyer
- Department of Public Health, HSE North-East, Railway Street, Navan, Co. Meath, Ireland
| | - Kevin Kelleher
- Office of Chief Clinical Officer, Public Health and Child Health HSE, Mount Kennett House, Mount Kennett Place, Henry Street, Limerick, Ireland
| | - Abigail Collins
- Child Health Public Health HSE, HSE Area Offices, Arden Road, Tullamore, Co. Offaly, Ireland
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13
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Callanan A, Bayat F, Quinlan D, Kearney PM, Buckley CM, Smith SM, Bradley CP. Facilitators and barriers to the introduction of atrial fibrillation screening in primary care: a qualitative descriptive study of general practitioners in primary care. Rural Remote Health 2023; 23:8135. [PMID: 36802646 DOI: 10.22605/rrh8135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. AF is often asymptomatic and, if identified, treatment can be offered that can reduce stroke risk by up to two thirds. AF screening meets many of the Wilson Jungner criteria for screening. While AF screening is recommended in clinical practice and internationally, the optimal mode and location for AF screening remains under investigation. Primary care has been identified as a potential setting. This study aimed to identify facilitators and barriers to AF screening from the perspective of GPs. METHODS The study adopted a qualitative descriptive design conducted in the south of Ireland. 58 GPs were invited from the north Cork region to participate in individual interviews at their practices, rural and urban, with a view to recruiting a purposive sample of up to 12 GPs. The interviews were audio-recorded, transcribed verbatim and analysed using a framework analysis. RESULTS Eight GPs (four male, four female) from five practices participated. Five GPs were from urban practices and three were from rural practices. Facilitators and barriers were sub-categorised into patient facilitators, practice facilitators, GP facilitators, patient barriers, practice barriers, GP barriers, attitudes to AF screening, willingness to facilitate and priority ranking. All eight participants expressed a willingness to engage in AF screening. Time was the barrier discussed most frequently by all participants along with the need for additional staff. Programme structure was the most discussed facilitator by all participants and patient awareness campaigns. DISCUSSION Despite barriers to AF screening identified by GPs, there was a significant willingness to engage and identify potential facilitators to support such screening.
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Affiliation(s)
- Aileen Callanan
- School of Public Health, University College Cork, Cork, Ireland
| | - Farshid Bayat
- Department of General Practice, University College Cork, Cork, Ireland
| | | | | | | | | | - Colin P Bradley
- School of Public Health, University College Cork, Cork, Ireland
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14
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Pallin JA, Van Netten JJ, Kearney PM, Dinneen SF, Buckley CM. Do we screen, examine or assess to identify the "at-risk" foot in diabetes-time for agreed terms and definitions? Diabet Med 2023; 40:e14976. [PMID: 36251428 PMCID: PMC10092276 DOI: 10.1111/dme.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Jaap J Van Netten
- Amsterdam UMC Location University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, the Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Sean F Dinneen
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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15
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Vermunicht P, Grecu M, Deharo JC, Buckley CM, Palà E, Mairesse GH, Farkowski MM, Bergonti M, Pürerfellner H, Hanson CL, Neubeck L, Freedman B, Witt H, Hills MT, Lund J, Giskes K, Engler D, Schnabel RB, Heidbuchel H, Desteghe L. General practitioners' perceptions on opportunistic single-time point screening for atrial fibrillation: A European quantitative survey. Front Cardiovasc Med 2023; 10:1112561. [PMID: 36873407 PMCID: PMC9975716 DOI: 10.3389/fcvm.2023.1112561] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023] Open
Abstract
Background There is no clear guidance on how to implement opportunistic atrial fibrillation (AF) screening in daily clinical practice. Objectives This study evaluated the perception of general practitioners (GPs) about value and practicalities of implementing screening for AF, focusing on opportunistic single-time point screening with a single-lead electrocardiogram (ECG) device. Methods A descriptive cross-sectional study was conducted with a survey developed to assess overall perception concerning AF screening, feasibility of opportunistic single-lead ECG screening and implementation requirements and barriers. Results A total of 659 responses were collected (36.1% Eastern, 33.4% Western, 12.1% Southern, 10.0% Northern Europe, 8.3% United Kingdom & Ireland). The perceived need for standardized AF screening was rated as 82.7 on a scale from 0 to 100. The vast majority (88.0%) indicated no AF screening program is established in their region. Three out of four GPs (72.1%, lowest in Eastern and Southern Europe) were equipped with a 12-lead ECG, while a single-lead ECG was less common (10.8%, highest in United Kingdom & Ireland). Three in five GPs (59.3%) feel confident ruling out AF on a single-lead ECG strip. Assistance through more education (28.7%) and a tele-healthcare service offering advice on ambiguous tracings (25.2%) would be helpful. Preferred strategies to overcome barriers like insufficient (qualified) staff, included integrating AF screening with other healthcare programs (24.9%) and algorithms to identify patients most suitable for AF screening (24.3%). Conclusion GPs perceive a strong need for a standardized AF screening approach. Additional resources may be required to have it widely adopted into clinical practice.
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Affiliation(s)
- Paulien Vermunicht
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.,Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Mihaela Grecu
- Electrophysiology Department, Cardiovascular Diseases Institute, Iasi, Romania
| | - Jean-Claude Deharo
- Assistance Publique - Hôpitaux de Marseille and Aix Marseille Université, C2VN, Marseille, France
| | | | - Elena Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR) - Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Warszawa, Poland
| | - Marco Bergonti
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.,Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | | | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Ben Freedman
- Heart Research Institute, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre and Concord Hospital Cardiology, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Jenny Lund
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Katrina Giskes
- Heart Research Institute, The University of Sydney, Sydney, NSW, Australia.,Department of General Practice, School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Daniel Engler
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.,Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - Lien Desteghe
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.,Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.,Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
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16
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Schnabel RB, Marinelli EA, Arbelo E, Boriani G, Boveda S, Buckley CM, Camm AJ, Casadei B, Chua W, Dagres N, de Melis M, Desteghe L, Diederichsen SZ, Duncker D, Eckardt L, Eisert C, Engler D, Fabritz L, Freedman B, Gillet L, Goette A, Guasch E, Svendsen JH, Hatem SN, Haeusler KG, Healey JS, Heidbuchel H, Hindricks G, Hobbs FDR, Hübner T, Kotecha D, Krekler M, Leclercq C, Lewalter T, Lin H, Linz D, Lip GYH, Løchen ML, Lucassen W, Malaczynska-Rajpold K, Massberg S, Merino JL, Meyer R, Mont L, Myers MC, Neubeck L, Niiranen T, Oeff M, Oldgren J, Potpara TS, Psaroudakis G, Pürerfellner H, Ravens U, Rienstra M, Rivard L, Scherr D, Schotten U, Shah D, Sinner MF, Smolnik R, Steinbeck G, Steven D, Svennberg E, Thomas D, True Hills M, van Gelder IC, Vardar B, Palà E, Wakili R, Wegscheider K, Wieloch M, Willems S, Witt H, Ziegler A, Daniel Zink M, Kirchhof P. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference. Europace 2022; 25:6-27. [PMID: 35894842 PMCID: PMC9907557 DOI: 10.1093/europace/euac062] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.
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Affiliation(s)
- Renate B Schnabel
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy
| | - Serge Boveda
- Cardiology—Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | - Barbara Casadei
- RDM, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mirko de Melis
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars Eckardt
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany
| | | | - Daniel Engler
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Larissa Fabritz
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,University Center of Cardiovascular Science Hamburg, Hamburg, Germany
| | - Ben Freedman
- Heart Research Institute, The University of Sydney, Sydney, Australia
| | | | - Andreas Goette
- Atrial Fibrillation Network (AFNET), Muenster, Germany,St Vincenz Hospital, Paderborn, Germany
| | - Eduard Guasch
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Karl Georg Haeusler
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jeff S Healey
- Population Health Research Institute, McMaster University Hamilton, ON, Canada
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Gerhard Hindricks
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Dipak Kotecha
- University of Birmingham & University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Thorsten Lewalter
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Hospital Munich South, Department of Cardiology, Munich, Germany,Department of Cardiology, University of Bonn, Bonn, Germany
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maja Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Wim Lucassen
- Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands
| | | | - Steffen Massberg
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Jose L Merino
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain
| | | | - Lluıs Mont
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | | | - Lis Neubeck
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain
| | - Teemu Niiranen
- Medtronic, Dublin, Ireland,Centre for Cardiovascular Health Edinburgh Napier University, Edinburgh, UK
| | - Michael Oeff
- Atrial Fibrillation Network (AFNET), Muenster, Germany
| | - Jonas Oldgren
- University of Turku and Turku University Hospital, Turku, Finland
| | | | - George Psaroudakis
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helmut Pürerfellner
- School of Medicine, Belgrade University, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ursula Ravens
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Bayer AG, Leverkusen, Germany
| | - Michiel Rienstra
- Ordensklinikum Linz, Elisabethinen, Cardiological Department, Linz, Austria
| | - Lena Rivard
- Institute of Experimental Cardiovascular Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Daniel Scherr
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ulrich Schotten
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - Dipen Shah
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Moritz F Sinner
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands,Royal Brompton Hospital, London, UK
| | | | - Gerhard Steinbeck
- Atrial Fibrillation Network (AFNET), Muenster, Germany,MUMC+, Maastricht, The Netherlands
| | - Daniel Steven
- Atrial Fibrillation Network (AFNET), Muenster, Germany,University Hospital of Geneva, Cardiac Electrophysiology Unit, Geneva, Switzerland
| | - Emma Svennberg
- Center for Cardiology at Clinic Starnberg, Starnberg, Germany
| | - Dierk Thomas
- Atrial Fibrillation Network (AFNET), Muenster, Germany,University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany,Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden,Department of Cardiology, Medical University Hospital, Heidelberg, Germany
| | - Mellanie True Hills
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Isabelle C van Gelder
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Burcu Vardar
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Elena Palà
- StopAfib.org, American Foundation for Women’s Health, Decatur, TX, USA
| | - Reza Wakili
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Karl Wegscheider
- Atrial Fibrillation Network (AFNET), Muenster, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Mattias Wieloch
- Department of Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Willems
- Atrial Fibrillation Network (AFNET), Muenster, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Department of Coagulation Disorders, Skane University Hospital, Lund University, Malmö, Sweden
| | | | | | - Matthias Daniel Zink
- Asklepios Hospital St Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Corresponding author. Tel: +49 40 7410 52438; Fax: +49 40 7410 55862. E-mail address:
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17
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Pallin JA, McIntosh C, Kavanagh P, Dinneen SF, Kearney PM, Buckley CM. A scoping review protocol to map the evidence on the risks and benefits of population based diabetic foot screening. HRB Open Res 2022; 5:50. [PMID: 37601115 PMCID: PMC10432895 DOI: 10.12688/hrbopenres.13585.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 08/22/2023] Open
Abstract
Background: Diabetic foot ulcers are one of the most common lower extremity complications of diabetes, with the lifetime risk of a person developing a DFU estimated to be as high as 34%. It is recommended that those with diabetes receive an annual review of their feet, by a trained healthcare professional, to identify risk factors for ulceration and allow for subsequent risk stratification, patient education and provision of appropriate care to prevent ulceration and amputation. Internationally, while many countries have a diabetic foot care pathway, it is not a structured population health screening programme unlike other areas of preventive care for people with diabetes such as retinopathy screening. A structured diabetic foot screening pathway could allow for earlier identification of the at-risk foot. However, the introduction of any population screening programme should meet the Wilson and Jungner principles of screening. This paper presents a protocol for a scoping review of existing evidence on screening for the at-risk-foot against the Wilson and Junger principles. Methods: The scoping review will be conducted in line with the six-stage methodological framework by Arksey & O'Mally and the Joanna Briggs Institute (JBI) scoping review methodology. Medline (EBSCO), Scopus, ScienceDirect and EMBASE databases will be searched. Studies relating to the burden of diabetic foot ulcers, their pathophysiology and screening tests for peripheral neuropathy and peripheral artery disease, and screening programmes will be included. A data extraction tool will be used to facilitate a chronological narrative synthesis of results. Results: These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Conclusion: This scoping review will evaluate and map the evidence surrounding diabetic foot ulcers using the Wilson and Jungner principles of screening as a framework.
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Affiliation(s)
- Jennifer A. Pallin
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, National University of Ireland, Galway, Galway City, Galway, H91 TK33, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis Street, Health Service Executive, Dublin 1, D01 W596, Ireland
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland Galway, Galway City, Galway, H91 TK33, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, University College Hospital, Galway, Galway, H91 YR71, Ireland
| | - Patricia M. Kearney
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
| | - Claire M. Buckley
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
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18
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Burton E, Aladkhen J, O’Donnell C, Masterson S, Merwick A, McCarthy VJC, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [PMID: 35859688 PMCID: PMC9266003 DOI: 10.12688/hrbopenres.13534.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results: Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions: This review will identify existing evidence reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Johnny Aladkhen
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Cathal O’Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Aine Merwick
- Department of Neurology, Cork University Hospital, Cork City, Cork, Ireland
| | - Vera JC McCarthy
- School of Nursing and Midwifery, University College Cork, Cork City, Cork, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork City, Cork, Ireland
- Office of the NCAGL for Chronic Disease, Health Service Executive South East, Lacken, Dublin Road, Kilkenny, R95 NV08, Ireland
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19
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Prigge R, McKnight JA, Wild SH, Haynes A, Jones TW, Davis EA, Rami-Merhar B, Fritsch M, Prchla C, Lavens A, Doggen K, Chao S, Aronson R, Brown R, Ibfelt EH, Svensson J, Young R, Warner JT, Robinson H, Laatikainen T, Rautiainen P, Delemer B, Souchon PF, Diallo AM, Holl RW, Schmid SM, Raile K, Tigas S, Bargiota A, Zografou I, Luk AOY, Chan JCN, Dinneen SF, Buckley CM, Kgosidialwa O, Cherubini V, Gesuita R, Strele I, Pildava S, Veeze H, Aanstoot HJ, Mul D, Jefferies C, Cooper JG, Løvaas KF, Battelino T, Dovc K, Bratina N, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Globa E, Zelinska N. International comparison of glycaemic control in people with type 1 diabetes: an update and extension. Diabet Med 2022; 39:e14766. [PMID: 34890078 DOI: 10.1111/dme.14766] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 05/11/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS To update and extend a previous cross-sectional international comparison of glycaemic control in people with type 1 diabetes. METHODS Data were obtained for 520,392 children and adults with type 1 diabetes from 17 population and five clinic-based data sources in countries or regions between 2016 and 2020. Median HbA1c (IQR) and proportions of individuals with HbA1c < 58 mmol/mol (<7.5%), 58-74 mmol/mol (7.5-8.9%) and ≥75 mmol/mol (≥9.0%) were compared between populations for individuals aged <15, 15-24 and ≥25 years. Logistic regression was used to estimate the odds ratio (OR) of HbA1c < 58 mmol/mol (<7.5%) relative to ≥58 mmol/mol (≥7.5%), stratified and adjusted for sex, age and data source. Where possible, changes in the proportion of individuals in each HbA1c category compared to previous estimates were calculated. RESULTS Median HbA1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups so a pooled estimate was deemed inappropriate. OR (95% CI) for HbA1c < 58 mmol/mol (<7.5%) were 0.91 (0.90-0.92) for women compared to men, 1.68 (1.65-1.71) for people aged <15 years and 0.81 (0.79-0.82) aged15-24 years compared to those aged ≥25 years. Differences between populations persisted after adjusting for sex, age and data source. In general, compared to our previous analysis, the proportion of people with an HbA1c < 58 mmol/l (<7.5%) increased and proportions of people with HbA1c ≥ 75 mmol/mol (≥9.0%) decreased. CONCLUSIONS Glycaemic control of type 1 diabetes continues to vary substantially between age groups and data sources. While some improvement over time has been observed, glycaemic control remains sub-optimal for most people with Type 1 diabetes.
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Affiliation(s)
- Regina Prigge
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John A McKnight
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Metabolic Unit and Acute Receiving Unit, Western General Hospital, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aveni Haynes
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Birgit Rami-Merhar
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Fritsch
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christine Prchla
- Klinik Donaustadt, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
| | | | | | | | | | - Ruth Brown
- LMC Diabetes & Endocrinology, Toronto, Canada
| | | | - Jannet Svensson
- Department of Paediatrics, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | | | - Holy Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Uusimaa, Finland
- Joint municipal authority for North Karelia social and health services (Siunsote), Joensuu, Finland
| | - Päivi Rautiainen
- Joint municipal authority for North Karelia social and health services (Siunsote), Joensuu, Finland
| | - Brigitte Delemer
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Pierre François Souchon
- Department of Paediatrics, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Alpha M Diallo
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Sebastian M Schmid
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetology, University Medicine Berlin, CharitéBerlin, Germany
| | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Volos, Greece
| | - Ioanna Zografou
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Andrea O Y Luk
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China
| | - Juliana C N Chan
- The Chinese University of Hong Kong, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
- NUI Galway, Galway, Ireland
| | | | - Oratile Kgosidialwa
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | | | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy, Italy
| | - Ieva Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - Santa Pildava
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Henk Veeze
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Dick Mul
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Craig Jefferies
- Department of Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - John G Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne Fjeld Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovc
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Centre of Registers in Region VästraGötaland, Göteborg, Sweden
| | - Soffia Gudbjornsdottir
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Centre of Registers in Region VästraGötaland, Göteborg, Sweden
| | - Evgenia Globa
- Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
| | - Nataliya Zelinska
- Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
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20
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Kelly DM, Stamenic D, Mullane P, Ni Bhuachalla C, Conway R, Carroll C, O'Connor L, Doyle SM, Buckley CM, Kearney PM. COVID-19 pandemic in Ireland: Epidemiology, public health restrictions and vaccination uptake. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13517.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The first wave of COVID-19 pandemic in Ireland was managed by a prolonged national lockdown. The second and third waves were managed by continued non-pharmaceutical interventions (NPIs) and deployment of a national vaccination programme. This paper aims to describe the epidemiological trends, Public Health restrictions and vaccination uptake during the first three waves of the pandemic. Methods: Data on confirmed cases of COVID-19 from 1 March 2020 to 27 March 2021 were extracted from the national COVID-19 data hub, the Health Protection Surveillance Centre (HPSC) and the National Contact Management Programme. Vaccine uptake and epidemiological data from European Centre for Disease Prevention and Control were reported from four other EU states. Results: Ireland experienced three distinct waves of COVID-19; first wave occurred March to August 2020, second August to November 2020 and third from November 2020 onwards. The third wave was attributable to emergence of the Alpha variant of concern (B.1.1.7 strain) and relaxation of public health restrictions in December 2020, when weekly mean number of close contacts per case peaked at 5.2. A similar epidemiological trajectory was observed across four other EU states. Conclusions: Surges of COVID-19 continue to occur despite increasing vaccine coverage in the EU, due to the emergence of novel variants of concern and relaxation of Public Health restrictions. A “vaccine plus policy” is needed.
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21
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Burton E, McCarthy VJC, Merwick A, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [DOI: 10.12688/hrbopenres.13534.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance response times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance response times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions This review will identify existing literature reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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22
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Carroll C, Conway R, O'Donnell D, Norton C, Hogan E, Browne M, Buckley CM, Kavanagh P, Martin J, Doyle S. Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020. Public Health 2020; 190:147-151. [PMID: 33386140 PMCID: PMC7577651 DOI: 10.1016/j.puhe.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/21/2020] [Accepted: 10/10/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN The study design is monitoring and evaluation of a national public health protection programme. METHODS All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.
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Affiliation(s)
- C Carroll
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - R Conway
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland.
| | - D O'Donnell
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - C Norton
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - E Hogan
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - M Browne
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - C M Buckley
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | - P Kavanagh
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; Health Intelligence Unit Strategic Planning and Transformation, Dublin, Ireland; Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Martin
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - S Doyle
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
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23
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Tracey ML, McHugh SM, Fitzgerald AP, Buckley CM, Canavan RJ, Kearney PM. Trends in blindness due to diabetic retinopathy among adults aged 18-69years over a decade in Ireland. Diabetes Res Clin Pract 2016; 121:1-8. [PMID: 27612011 DOI: 10.1016/j.diabres.2016.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 01/20/2016] [Revised: 07/27/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022]
Abstract
AIMS To describe trends in the incidence of visual impairment and blindness due to diabetic retinopathy among adults aged 18-69years in Ireland between 2004 and 2013. METHODS Data on visual impairment due to diabetic retinopathy in adults aged 18-69years or over who are registered with the National Council for the Blind of Ireland, (2004-2013) were analysed. Annual incidence rates were calculated for the adult population and the population with diagnosed diabetes. Poisson regression was used to test for changes in rates over time. The relative, attributable and population risk of blindness and visual impairment due to diabetic retinopathy were calculated for 2013. RESULTS Over the decade, the prevalence of diagnosed diabetes increased from 2.1% to 3.6%. Among people with diagnosed diabetes, the incidence of visual impairment due to diabetic retinopathy increased from 6.4 (95% CI 2.4-13.9) per 100,000 in 2004 to 11.7 (95% CI 5.9-21.0) per 100,000 in 2013. The incidence of blindness due to diabetic retinopathy varied from 31.9 per 100,000 (95% CI 21.6-45.7) in 2004 to 14.9 per 100,000 (95% CI 8.2-25.1) in 2013. CONCLUSIONS Our findings indicate the need for increased attention to preventive measures for microvascular complications among adults with diabetes in Ireland. Retinopathy screening has been standardised in Ireland, these findings provide useful baseline statistics to monitor the impact of this population-based screening programme.
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Affiliation(s)
- M L Tracey
- Dept. Epidemiology and Public Health, University College Cork, Ireland.
| | - S M McHugh
- Dept. Epidemiology and Public Health, University College Cork, Ireland
| | - A P Fitzgerald
- Dept. Epidemiology and Public Health, University College Cork, Ireland; Dept. Statistics, University College Cork, Ireland
| | - C M Buckley
- Dept. Epidemiology and Public Health, University College Cork, Ireland; Dept. Public Health, Heath Service Executive (HSE) South, Cork, Ireland
| | - R J Canavan
- Dept. Endocrinology, St. Vincent's University Hospital, Dublin, Ireland
| | - P M Kearney
- Dept. Epidemiology and Public Health, University College Cork, Ireland
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24
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Tracey ML, McHugh SM, Fitzgerald AP, Buckley CM, Canavan RJ, Kearney PM. Risk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing. J Diabetes Res 2016; 2016:5975903. [PMID: 27294152 PMCID: PMC4884580 DOI: 10.1155/2016/5975903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/26/2016] [Indexed: 12/17/2022] Open
Abstract
Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland. Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009-2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications. Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (p < 0.05). Conclusions. Early intervention to target modifiable risk factors is urgently needed to reduce diabetes-related morbidity in the older population in Ireland.
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Affiliation(s)
- Marsha L. Tracey
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
| | - Sheena M. McHugh
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
| | - Anthony P. Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
- Department of Statistics, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
| | - Claire M. Buckley
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
- Department of Public Health, Health Service Executive (HSE) South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Ronan J. Canavan
- Department of Endocrinology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Patricia M. Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
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Tracey ML, McHugh SM, Buckley CM, Canavan RJ, Fitzgerald AP, Kearney PM. The prevalence of Type 2 diabetes and related complications in a nationally representative sample of adults aged 50 and over in the Republic of Ireland. Diabet Med 2016; 33:441-5. [PMID: 26112979 DOI: 10.1111/dme.12845] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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] [Accepted: 06/23/2015] [Indexed: 12/16/2022]
Abstract
AIM To investigate the prevalence of diagnosed Type 2 diabetes and its related complications in a nationally representative sample of older adults in the Republic of Ireland. METHODS Cross-sectional analysis of a population-based sample of adults aged ≥ 50 years from the first wave of The Irish Longitudinal Study on Ageing (TILDA), (2009-2011). Diagnosed Type 2 diabetes prevalence was estimated by self-report or the use of oral hypoglycaemic agents. The prevalence of microvascular and macrovascular complications was determined by self-report. RESULTS Diagnosed Type 2 diabetes prevalence was 8.4% [95% confidence interval (CI): 7.8-9.0%] and was higher among men [10.3% (95% CI: 9.4-11.2%)] than women [6.6% (95% CI: 5.9-7.5%)]; P ≤ 0.001. Among participants with diagnosed Type 2 diabetes, the overall prevalence of microvascular complications was 26.0% (95% CI: 22.4-30.0%) with no evidence of gender-specific differences (P = 0.7). The overall prevalence of macrovascular complications was 15.1% (95% CI: 12.2-18.4%) and was higher among men [17.8% (95% CI: 14.3-23.1%)] than women [11.4% (95% CI: 7.7-16.4%)]; P ≤ 0.001. CONCLUSIONS In the absence of a national diabetes register, these findings provide a robust estimate of the national prevalence of diagnosed Type 2 diabetes and level of complications among adults aged 50 years and over in Ireland.
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Affiliation(s)
- M L Tracey
- Department of Epidemiology and Public Health, University College, Cork, Republic of Ireland
| | - S M McHugh
- Department of Epidemiology and Public Health, University College, Cork, Republic of Ireland
| | - C M Buckley
- Department of Epidemiology and Public Health, University College, Cork, Republic of Ireland
- Department of Public Health, Heath Service Executive (HSE) South, Cork, Republic of Ireland
| | - R J Canavan
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Republic of Ireland
| | - A P Fitzgerald
- Department of Epidemiology and Public Health, University College, Cork, Republic of Ireland
| | - P M Kearney
- Department of Epidemiology and Public Health, University College, Cork, Republic of Ireland
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Tracey ML, Gilmartin M, O'Neill K, Fitzgerald AP, McHugh SM, Buckley CM, Canavan RJ, Kearney PM. Epidemiology of diabetes and complications among adults in the Republic of Ireland 1998-2015: a systematic review and meta-analysis. BMC Public Health 2016; 16:132. [PMID: 26861703 PMCID: PMC4748605 DOI: 10.1186/s12889-016-2818-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 02/03/2016] [Indexed: 12/14/2022] Open
Abstract
Background Accurate estimates of the burden of diabetes are essential for future planning and evaluation of services. In Ireland, there is no diabetes register and prevalence estimates vary. The aim of this review was to systematically identify and review studies reporting the prevalence of diabetes and complications among adults in Ireland between 1998 and 2015 and to examine trends in prevalence over time. Methods A systematic literature search was carried out using PubMed and Embase. Diabetes prevalence estimates were pooled by random-effects meta-analysis. Poisson regression was carried out using data from four nationally representative studies to calculate prevalence rates of doctor diagnosed diabetes between 1998 and 2015 and was also used to assess whether the rate of doctor diagnosed diabetes changed over time. Results Fifteen studies (eight diabetes prevalence and seven complication prevalence) were eligible for inclusion. In adults aged 18 years and over, the national prevalence of doctor diagnosed diabetes significantly increased from 2.2 % in 1998 to 5.2 % in 2015 (ptrend ≤ 0.001). The prevalence of diabetes complications ranged widely depending on study population and methodology used (6.5–25.2 % retinopathy; 3.2–32.0 % neuropathy; 2.5-5.2 % nephropathy). Conclusions Between 1998 and 2015, there was a significant increase in the prevalence of doctor diagnosed diabetes among adults in Ireland. Trends in microvascular and macrovascular complications prevalence could not be examined due to heterogeneity between studies and the limited availability of data. Reliable baseline data are needed to monitor improvements in care over time at a national level. A comprehensive national diabetes register is urgently needed in Ireland. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2818-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marsha L Tracey
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland.
| | - Michael Gilmartin
- Department of Medicine, Royal College of Surgeons, Dublin, Republic of Ireland
| | - Kate O'Neill
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| | - Anthony P Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| | - Sheena M McHugh
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
| | - Claire M Buckley
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland.,Department of Public Health, Heath Service Executive (HSE) South, Cork, Republic of Ireland
| | - Ronan J Canavan
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Republic of Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Republic of Ireland
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Tracey ML, McHugh SM, Fitzgerald AP, Buckley CM, Canavan RJ, Kearney PM. Trends in the incidence of visual impairment due to diabetic retinopathy in Ireland, 2004–2013. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Flannery C, McHugh S, Murphy K, Buckley CM, Thackeray K, O’Connor A, Moran J, Quinlan D, Bradley C. PP13 The role of the diabetes nurse specialist (DNS) in the management of patients with diabetes: a systematic review. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.111] [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: 11/04/2022]
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29
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Healy O, Buckley CM, Droog E, Foley C, McHugh S, Browne J. PP11 Analysis of emergency and urgent care system policy in ireland, policy coherence and implementation. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.109] [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: 11/04/2022]
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30
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Tracey ML, McHugh SM, Fitzgerald AP, Buckley CM, Canavan RJ, Kearney PM. OP26 Trends in the incidence of visual impairment due to diabetic retinopathy among adults in the republic of ireland, 2004–2013. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.26] [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: 11/04/2022]
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31
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Millar SR, 'Connor JM, Buckley CM, Kearney PM, Perry IJ. PP03 The prevalence and determinants of undiagnosed and diagnosed type 2 diabetes in middle-aged irish adults. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.101] [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: 11/04/2022]
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32
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O'Reilly MA, Millar SR, Buckley CM, Harrington JM, Perry IJ, Cahill MR. Smoking as an independent risk factor for macrocytosis in middle-aged adults: a population-based observational study. Am J Hematol 2015; 90:E196-7. [PMID: 26096846 DOI: 10.1002/ajh.24085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Maeve a. O'Reilly
- Department of Haematology; Cork University Hospital; Cork Ireland
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
| | - Seán R. Millar
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
| | - Claire M. Buckley
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
| | - Janas M. Harrington
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
| | - Ivan J. Perry
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
| | - Mary R. Cahill
- Department of Haematology; Cork University Hospital; Cork Ireland
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
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33
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McNamara GM, Kabir Z, O’Neill SM, Buckley CM. PP67 The effect of depression on amputation, in people with diabetes. a systematic review and meta-analysis. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.164] [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: 11/04/2022]
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34
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Ryan A, Uppal M, Cunning I, Buckley CM. A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service. Diabet Foot Ankle 2015; 6:25508. [PMID: 26048860 PMCID: PMC4457780 DOI: 10.3402/dfa.v6.25508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/29/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. METHODS An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the 'Guidelines on prevention & management of foot problems in Type 2 Diabetes' by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. RESULTS An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. DISCUSSION During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines.
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Affiliation(s)
- Alexandra Ryan
- Community Podiatry Services, North and South Lee, Grattan Street Health Centre, Health Service Executive, Cork, Ireland
| | - Meenakshi Uppal
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Imelda Cunning
- Community Podiatry Services, North and South Lee, Grattan Street Health Centre, Health Service Executive, Cork, Ireland
| | - Claire M Buckley
- Department of General Practice, University College Cork, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland;
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Buckley CM, Ali F, Roberts GA, Kearney PM, Perry IJ, Bradley CP. Timing of access to secondary healthcare services and lower extremity amputations in patients with diabetes: a case-control study. BMJ Open Diabetes Res Care 2015; 3:e000069. [PMID: 26336607 PMCID: PMC4553909 DOI: 10.1136/bmjdrc-2014-000069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/08/2014] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the association between timing of patient access to secondary healthcare services for diabetes management and lower extremity amputation (LEA) among patients with diabetes. RESEARCH DESIGN AND METHODS A case-control study was conducted in the secondary healthcare system in Ireland. Cases were 116 patients with diabetes who underwent a first major non-traumatic LEA between 2006 and 2012. Controls were 348 patients with diabetes, over 45 years, admitted to the same hospital as an emergency or electively, frequency-matched for gender, type of diabetes, and year. Data were collected for 7 years prior to the event year. ORs for LEA in patients with diabetes comparing early versus late referral from primary to secondary healthcare were calculated. RESULTS Statistically significant risk factors associated with LEA in patients with diabetes included being single, chronic kidney disease, hypertension, and hyperglycemia. Documented retinopathy was a significant protective factor. In unconditional logistic regression analysis adjusted for potential confounders, there was no evidence of a reduced risk of LEA among patients referred earlier to secondary healthcare for diabetes management. CONCLUSIONS Specialist referral may need to occur earlier than the 7-year cut-off used to demonstrate an effect on reducing LEA risk. Documented retinopathy was associated with reduced risk of LEA, most likely as a proxy for better self-care. Variation in the management of diabetes in primary care may also be impacting on outcomes. Efforts to develop more integrated care between primary and secondary services may be beneficial, rather than focusing on timing of referral to secondary healthcare.
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Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Fauzi Ali
- Department of Endocrinology, University Hospital Waterford, Waterford, Ireland
| | - Graham A Roberts
- Department of Endocrinology, University Hospital Waterford, Waterford, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Tracey ML, Mc Hugh SM, Buckley CM, Fitzgerald AP, Kearney PM. OP78 The prevalence of type 2 diabetes and related complications in a nationally representative sample of adults aged 50 and over in Ireland. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.80] [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: 11/04/2022]
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37
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Buckley CM, Casey C, Bradley CP. Patientsmate: potentially a useful tool for documenting clinical performance. J Eval Clin Pract 2013; 19:1083. [PMID: 23387959 DOI: 10.1111/jep.12018] [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] [Accepted: 11/08/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Cork, Ireland
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38
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O Connor JM, Millar SR, Buckley CM, Kearney PM, Perry IJ. The prevalence and determinants of undiagnosed and diagnosed type 2 diabetes in middle-aged irish adults. PLoS One 2013; 8:e80504. [PMID: 24282548 PMCID: PMC3840064 DOI: 10.1371/journal.pone.0080504] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 10/03/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes within the Republic of Ireland is poorly defined, although a recent report suggested 135,000 cases in adults aged 45+, with approximately one-third of these undiagnosed. This study aims to assess the prevalence of undiagnosed and diagnosed diabetes in middle-aged adults, and compare features related to either condition, in order to investigate why certain individuals remain undetected. METHODS This was a cross-sectional study involving a sample of 2,047 men and women, aged between 50-69 years, randomly selected from a large primary care centre. Univariate logistic regression was used to explore socio-economic, metabolic and other health related variable associations with undiagnosed or diagnosed diabetes. A final multivariate analysis was used to determine odds ratios and 95% confidence intervals for having undiagnosed compared to diagnosed diabetes, adjusted for gender, age and significant covariates determined from univariate models. PRINCIPLE FINDINGS The total prevalence of diabetes was 8.5% (95% CI: 7.4%-8.8%); 72 subjects (3.5%) had undiagnosed diabetes (95% CI: 2.8%-4.4%) and 102 subjects (5.0%) had diagnosed diabetes (95% CI: 4.1%-6.0%). Obesity, dyslipidaemia, and family history of diabetes were positively associated with both undiagnosed and diagnosed type 2 diabetes. Compared with diagnosed subjects, study participants with undiagnosed diabetes were significantly more likely to have low levels of physical activity and were less likely to be on treatment for diabetes-related conditions or to have private medical insurance. CONCLUSIONS The prevalence of diabetes within the Cork and Kerry Diabetes and Heart Disease Study is comparable to recent estimates from the Slán National Health and Lifestyle Survey, a study which was nationally representative of the general population. A considerable proportion of diabetes cases were undiagnosed (41%), emphasising the need for more effective detection strategies and equitable access to primary healthcare.
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Affiliation(s)
- Jennifer M. O Connor
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Seán R. Millar
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Claire M. Buckley
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Patricia M. Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Ivan J. Perry
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
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39
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Buckley CM, Ali F, Roberts G, Kearney PM, Perry IJ, Bradley CP. Timing of access to secondary healthcare services for diabetes management and lower extremity amputation in people with diabetes: a protocol of a case-control study. BMJ Open 2013; 3:e003871. [PMID: 24171939 PMCID: PMC3816241 DOI: 10.1136/bmjopen-2013-003871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Lower extremity amputation (LEA) is a complication of diabetes and a marker of the quality of diabetes care. Clinical and sociodemographic determinants of LEA in people with diabetes are well known. However, the role of service-related factors has been less well explored. Early referral to secondary healthcare is assumed to prevent the occurrence of LEA. The objective of this study is to investigate a possible association between the timing of patient access to secondary healthcare services for diabetes management, as a key marker of service-related factors, and LEA in patients with diabetes. METHODS/DESIGN This is a case-control study. The source population is people with diabetes. Cases will be people with diabetes who have undergone a first major LEA, identified from the hospital discharge data at each of three regional centres for diabetes care. Controls will be patients with diabetes without LEA admitted to the same centre either electively or as an emergency. Frequency-matching will be applied for gender, type of diabetes, year and centre of LEA. Three controls per case will be selected from the same population as the cases. With a power of 90% to detect OR of 0.4 for an association between 'good quality care' and LEA in people with diabetes, 107 cases and 321 controls are required. Services involved in diabetes management are endocrinology, ophthalmology, renal, cardiology, vascular surgery and podiatry; timing of first contact with any of these services is the main exploratory variable. Using unconditional logistic regression, an association between this exposure and the outcome of major LEA in people with diabetes will be explored, while adjusting for confounders. ETHICS AND DISSEMINATION Ethical approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals, Ireland. Results will be presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Cork, Ireland
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Fauzi Ali
- Department of Medicine and Metabolism, Waterford Institute of Technology, Waterford, Ireland
| | - Graham Roberts
- Department of Medicine and Metabolism, Waterford Institute of Technology, Waterford, Ireland
| | - Patricia M Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Balanda KP, Buckley CM, Barron SJ, Fahy LE, Madden JM, Harrington JM, Perry IJ, Kearney PM. Prevalence of diabetes in the Republic of Ireland: results from the National Health Survey (SLAN) 2007. PLoS One 2013; 8:e78406. [PMID: 24147134 PMCID: PMC3797781 DOI: 10.1371/journal.pone.0078406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/10/2013] [Indexed: 12/16/2022] Open
Abstract
Background Current estimates of diabetes prevalence in the Republic of Ireland (RoI) are based on UK epidemiological studies. This study uses Irish data to describe the prevalence of doctor-diagnosed diabetes amongst all adults aged 18+ years and undiagnosed diabetes amongst those aged 45+ years. Methods The survey of lifestyle attitudes and nutrition (SLAN) 2007 is based on a nationally representative sample of Irish adults aged 18+ years (n = 10,364). Self-reported doctor-diagnosed diabetes was recorded for respondents in the full sample. Diabetes medication use, measured height and weight, and non-fasting blood samples were variously recorded in sub-samples of younger (n = 967) and older (n = 1,207) respondents. Results The prevalence of doctor-diagnosed diabetes amongst adults aged 18+ years was 3.5% (95% CI 3.1% - 3.9%). After adjustment for other explanatory variables; the risk of self-reported doctor-diagnosed diabetes was significantly related to age (p < 0.0001), employment status (p = 0.0003) and obesity (p = 0.0003). Amongst adults aged 45+ years, the prevalence of doctor-diagnosed diabetes was 8.9% (95% CI 7.3% -10.5%) and undiagnosed diabetes was 2.8% (95% CI 1.4% - 4.1%). This represented 31.2% of diabetes cases in this age group. Conclusion Notwithstanding methodological differences, these prevalence estimates are consistent with those in the UK and France. However, the percentage of undiagnosed cases amongst adults aged 45+ years appears to be higher in the RoI. Increased efforts to improve early detection and population level interventions to address adverse diet and lifestyle factors are urgently needed.
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Affiliation(s)
| | - Claire M. Buckley
- Department of General Practice, University College Cork, Cork, Ireland
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | | | | | - Jamie M. Madden
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Janas M. Harrington
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Ivan J. Perry
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Patricia M. Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
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Buckley CM, Madden J, Balanda K, Barron S, Fahy L, Harrington J, Perry IJ, M Kearney P. Pre-diabetes in adults 45 years and over in Ireland: the Survey of Lifestyle, Attitudes and Nutrition in Ireland 2007. Diabet Med 2013; 30:1198-203. [PMID: 23659572 DOI: 10.1111/dme.12226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 12/03/2012] [Revised: 03/19/2013] [Accepted: 05/07/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pre-diabetes is an important indicator of future diabetes burden and many countries are reporting prevalence estimates of pre-diabetes. To date in Ireland, estimates of the prevalence of pre-diabetes were unavailable. Our objectives were to estimate the prevalence of pre-diabetes in a nationally representative sample of Irish adults and to explore determinants of pre-diabetes. METHODS The Survey of Lifestyle Attitudes and Nutrition 2007 was a cross-sectional survey on health and lifestyle in a nationally representative sample of Irish adults. Analysis was performed on a subsample of 1132 participants ≥ 45 years who provided blood samples. Determination of pre-diabetes was based on American Diabetes Association HbA1c cut points of 39-46 mmol/mol (5.7-6.4%). To explore determinants, we modelled pre-diabetes prevalence as a function of a set of health system and socio-demographic variables using logistic regression. RESULTS The overall weighted prevalence estimate of pre-diabetes in participants ≥ 45 years was 19.8% (95% CI 16.4-23.9). There was no significant difference between age or gender-specific prevalence rates. Obesity was significantly associated with pre-diabetes on univariate and multivariate analysis. Population attributable fraction estimates for excess BMI, physical inactivity and poor diet as causes of pre-diabetes were 31.3% (95% CI -3.9 to 54.5), 10.0% (95% CI -2.7 to 21.3) and 6.1% (95% CI -4.9 to 15.9), respectively. CONCLUSIONS The high levels of pre-diabetes detected in this study are worrying. Population level interventions to address diet and lifestyle factors are needed urgently to prevent progression to diabetes in high-risk individuals.
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Affiliation(s)
- C M Buckley
- Department of General Practice, University College Cork (UCC), Cork, Ireland; Department of Epidemiology and Public Health, University College Cork (UCC), Cork, Ireland
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Buckley CM, Perry IJ, Bradley CP, Kearney PM. Does contact with a podiatrist prevent the occurrence of a lower extremity amputation in people with diabetes? A systematic review and meta-analysis. BMJ Open 2013; 3:bmjopen-2012-002331. [PMID: 23657467 PMCID: PMC3651976 DOI: 10.1136/bmjopen-2012-002331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine the effect of contact with a podiatrist on the occurrence of Lower Extremity Amputation (LEA) in people with diabetes. DESIGN AND DATA SOURCES We conducted a systematic review of available literature on the effect of contact with a podiatrist on the risk of LEA in people with diabetes. Eligible studies, published in English, were identified through searches of PubMed, CINAHL, EMBASE and Cochrane databases. The key terms, 'podiatry', 'amputation' and 'diabetes', were searched as Medical Subject Heading terms. Reference lists of selected papers were hand-searched for additional articles. No date restrictions were imposed. STUDY SELECTION Published randomised and analytical observational studies of the effect of contact with a podiatrist on the risk of LEA in people with diabetes were included. Cross-sectional studies, review articles, chart reviews and case series were excluded. Two reviewers independently assessed titles, abstracts and full articles to identify eligible studies and extracted data related to the study design, characteristics of participants, interventions, outcomes, control for confounding factors and risk estimates. ANALYSIS Meta-analysis was performed separately for randomised and non-randomised studies. Relative risks (RRs) with 95% CIs were estimated with fixed and random effects models as appropriate. RESULTS Six studies met the inclusion criteria and five provided data included in meta-analysis. The identified studies were heterogenous in design and included people with diabetes at both low and high risk of amputation. Contact with a podiatrist did not significantly affect the RR of LEA in a meta-analysis of available data from randomised controlled trials (RCTs); (1.41, 95% CI 0.20 to 9.78, 2 RCTs) or from cohort studies; (0.73, 95% CI 0.39 to 1.33, 3 Cohort studies with four substudies in one cohort). CONCLUSIONS There are very limited data available on the effect of contact with a podiatrist on the risk of LEA in people with diabetes.
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Affiliation(s)
- C M Buckley
- Department of General Practice, University College Cork, Cork, Ireland
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Buckley CM, Kearney PM, Ali F, Bhuachalla CN, Casey C, Roberts G, Perry IJ, Bradley CP. Concordance studies between hospital discharge data and medical records for the recording of lower extremity amputation and diabetes in the Republic of Ireland. BMC Res Notes 2013; 6:148. [PMID: 23587134 PMCID: PMC3640954 DOI: 10.1186/1756-0500-6-148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/08/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hospital discharge data have been used to study trends in Lower Extremity Amputation (LEA) rates in people with and without diabetes. The aim of this study was to assess the reliability of routine hospital discharge data in the Republic of Ireland (RoI) for this purpose by determining the level of agreement between hospital discharge data and medical records for both the occurrence of LEA and diagnosis of diabetes. METHODS Two concordance studies between hospital discharge data (HIPE) and medical records were performed. To determine the level of agreement for LEA occurrence, HIPE records were compared to theatre logbooks in 9 hospitals utilising HIPE over a two-year period in a defined study area. To determine the level of agreement for diabetes diagnosis, HIPE records were compared to laboratory records in each of the 4 largest hospitals utilising HIPE over a one week period in the same study area. The proportions of positive and negative agreement and Cohen's kappa statistic of agreement were calculated. RESULTS During a two-year study period in 9 hospitals, 216 LEAs were recorded in both data sources. Sixteen LEAs were recorded in medical records alone and 25 LEAs were recorded in hospital discharge records alone. The proportion of positive agreement was 0.91 (95% CI 0.88-0.94), the proportion of negative agreement was 0.99 (95% CI 0.98-0.99) and the kappa statistic was 0.91 (95% CI 0.88-0.94). During a one-week study period in 4 hospitals, 49 patients with diabetes and 716 patients without diabetes were recorded in both data sources. Eighteen patients had diabetes in medical records alone and 2 patients had diabetes in hospital discharge records alone. The proportion of positive agreement was 0.83 (95% CI 0.76-0.9), the proportion of negative agreement was 0.99 (95% CI 0.98-0.99) and the kappa statistic was 0.82 (95% CI 0.75-0.89). CONCLUSIONS This study detected high levels of agreement between hospital discharge data and medical records for LEA and diabetes in a defined study area. Based on these findings, we suggest that HIPE is sufficiently reliable to monitor trends in LEAs in people with and without diabetes in the RoI.
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Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Room 2.57, Western Gateway Building, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Fawzi Ali
- Department of Medicine and Metabolism, Waterford Institute of Technology, Waterford, Ireland
| | | | - Caoimhe Casey
- Department of General Practice, University College Cork, Room 2.57, Western Gateway Building, Cork, Ireland
| | - Graham Roberts
- Department of Medicine and Metabolism, Waterford Institute of Technology, Waterford, Ireland
| | - Ivan J Perry
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, University College Cork, Room 2.57, Western Gateway Building, Cork, Ireland
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Buckley CM, Kearney PM, Perry IJ, Bradley CP. PS11 Does Contact with a Podiatrist Prevent The Occurrence of a Lower Extremity Amputation in people with Diabetes? A Systematic Review and Meta-Analysis. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.110] [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: 11/04/2022]
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Buckley CM, Kearney PM, McHugh S, Harrington J, Bradley CP, Perry IJ. PS12 Diabetes and Pre-Diabetes Prevalence Rates in the Survey of Lifestyles, Attitude and Nutrition (Slan) in the Republic of Ireland. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Buckley CM, O'Farrell A, Canavan RJ, Lynch AD, De La Harpe DV, Bradley CP, Perry IJ. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland. PLoS One 2012; 7:e41492. [PMID: 22859991 PMCID: PMC3409236 DOI: 10.1371/journal.pone.0041492] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/21/2012] [Indexed: 12/30/2022] Open
Abstract
Aims To describe trends in the incidence of non-traumatic amputations among people with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a lower extremity amputation compared to an individual without diabetes in the Republic of Ireland. Methods All adults who underwent a nontraumatic amputation during 2005 to 2009 were identified using HIPE (Hospital In-patient Enquiry) data. Participants were classified as having diabetes or not having diabetes. Incidence rates were calculated using the number of discharges for diabetes and non-diabetes related lower extremity amputations as the numerator and estimates of the resident population with and without diabetes as the denominator. Age-adjusted incidence rates were used for trend analysis. Results Total diabetes-related amputation rates increased non-significantly during the study period; 144.2 in 2005 to 175.7 in 2009 per 100,000 people with diabetes (p = 0.11). Total non-diabetes related amputation rates dropped non-significantly from 12.0 in 2005 to 9.2 in 2009 per 100,000 people without diabetes (p = 0.16). An individual with diabetes was 22.3 (95% CI 19.1–26.1) times more likely to undergo a nontraumatic amputation than an individual without diabetes in 2005 and this did not change significantly by 2009. Discussion This study provides the first national estimate of lower extremity amputation rates in the Republic of Ireland. Diabetes-related amputation rates have remained steady despite an increase in people with diabetes. These estimates provide a base-line and will allow follow-up over time.
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Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Cork, Ireland.
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Martínez-Mier EA, Soto-Rojas AE, Buckley CM, Margineda J, Zero DT. Evaluation of the direct and diffusion methods for the determination of fluoride content in table salt. Community Dent Health 2009; 26:204-210. [PMID: 20088217 PMCID: PMC2870713] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The aim of this study was to assess methods currently used for analyzing fluoridated salt in order to identify the most useful method for this type of analysis. BASIC RESEARCH DESIGN Seventy-five fluoridated salt samples were obtained. Samples were analyzed for fluoride content, with and without pretreatment, using direct and diffusion methods. Element analysis was also conducted in selected samples. Fluoride was added to ultra pure NaCl and non-fluoridated commercial salt samples and Ca and Mg were added to fluoride samples in order to assess fluoride recoveries using modifications to the methods. RESULTS Larger amounts of fluoride were found and recovered using diffusion than direct methods (96%-100% for diffusion vs. 67%-90% for direct). Statistically significant differences were obtained between direct and diffusion methods using different ion strength adjusters. Pretreatment methods reduced the amount of recovered fluoride. Determination of fluoride content was influenced both by the presence of NaCl and other ions in the salt. CONCLUSION Direct and diffusion techniques for analysis of fluoridated salt are suitable methods for fluoride analysis. The choice of method should depend on the purpose of the analysis.
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Affiliation(s)
- E A Martínez-Mier
- Department of Preventive and Community, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis 46202, USA.
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Buckley JD, Pendergrass TW, Buckley CM, Pritchard DJ, Nesbit ME, Provisor AJ, Robison LL. Epidemiology of osteosarcoma and Ewing's sarcoma in childhood: a study of 305 cases by the Children's Cancer Group. Cancer 1998; 83:1440-8. [PMID: 9762947 DOI: 10.1002/(sici)1097-0142(19981001)83:7<1440::aid-cncr23>3.0.co;2-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Children's Cancer Group conducted a case-control study to determine the role of a broad range of environmental and familial factors in the etiology of Ewing's sarcoma and osteosarcoma in children. These factors included radiation exposure and, for children with osteosarcoma, parental exposure to beryllium. METHODS The parents of 152 children with osteosarcoma and 153 children with Ewing's sarcoma were interviewed by telephone. Controls were obtained by random digit dialing and were matched to cases by age and race. RESULTS Female osteosarcoma patients had earlier onset of breast development (age 11.4 vs. 11.8 years, P=0.03) and menarche (age 12.1 vs. 12.5 years, P=0.002) but no significant differences in growth, whereas male osteosarcoma patients were similar in age at the onset of secondary sexual characteristics but reported significantly less weight gain during their growth spurt (6.6 vs. 11.7 kg, P=0.003). For children with Ewing's sarcoma, the growth spurt began earlier (age 12.1 vs. 12.7 years, P=0.12) and resulted in less weight and height gain (5.2 vs. 9.7 kg, P=0.002, and 10.2 vs. 12.7 cm, P=0.02, respectively) for males, but no differences were observed among females. For factors not related to growth and development (including a wide range of occupational, medical, and household exposures), there was little evidence of an etiologic role with respect to either tumor type. CONCLUSIONS Differences between cases and controls with respect to growth and development showed no consistent pattern. This study did not identify any important risk factors for either type of childhood bone tumor.
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Affiliation(s)
- J D Buckley
- Department of Preventive Medicine, University of Southern California, Los Angeles, USA
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Abstract
A glutathione S-transferase (GST) was purified to homogeneity from the white-rot fungus, Phanerochaete chrysosporium, by affinity chromatography on glutathione-agarose followed by Mono-Q ion-exchange FPLC. This protein immunoblotted with antisera to rat Theta class GST 5-5 and also showed N-terminal sequence similarity to the Theta class, including the presence of a conserved serine residue that has been specifically implicated in catalysis in this class [Wilce, Board, Feil and Parker (1995) EMBO J. 14, 2133-2143] and other residues conserved in plant sequences. Catalytic activity was found to be highly labile in the purified protein, although preliminary evidence for activity (approx. 120 m-units/mg) with 1,2-epoxy-3-(p-nitrophenoxy)propane was obtained in some preparations. The enzyme seems to be a dimer with a subunit molecular mass of 25 kDa by SDS/PAGE. The native molecular masses estimated by non-denaturing electrophoresis and by Superose-12 gel filtration were 58 and 45 kDa respectively. A second protein purified in this study also gave low level of activity with 1,2-epoxy-3-(p-nitrophenoxy)propane and had a subunit molecular mass of 28 kDa (native size 62-63 kDa), but did not immunoblot with any GST class and seemed to be N-terminally blocked.
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Affiliation(s)
- C A Dowd
- Department of Biochemistry, University College Cork, Lee Maltings, Prospect Row, Cork, Ireland
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Abstract
The causes of most childhood cancer remain elusive; some children clearly have a genetic predisposition, but in the majority the relative contributions of environmental and host factors are not established. One approach to this question is through twin concordance studies, but only the most common malignancy, acute leukemia, has been studied to date, owing to the rarity of other forms of childhood cancer. The aim of the study was to determine the concordance rates for childhood cancer in twins, in order to clarify the importance of constitutional predisposition for a range of tumor types. Twins with cancer were ascertained through three cooperative clinical trials groups, a cancer-twin registry, and a large pediatric hospital. Subjects were sent a postal questionnaire requesting information on cancer concordance and zygosity. Data were obtained on 556 twins with cancer. Three twin pairs, out of 197 twin pairs (76 monozygous, MZ, twin pairs), were concordant for leukemia, giving an MZ case-wise concordance rate (5%) that is substantially lower than previously reported. The case-wise concordance for non-retinoblastoma solid tumors was 2.2%: Two twin pairs were concordant for CNS tumors, one was concordant for neuroblastoma, and two twin pairs were concordant for cancer but not for the type of cancer. The results of the present study, together with previous data from population studies of siblings and offspring, suggest that there is not in general a strong constitutional genetic component for childhood cancers other than retinoblastoma.
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Affiliation(s)
- J D Buckley
- Department of Preventive Medicine, University of Southern California, USA
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