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Nimmons D, Bazo-Alvarez JC, Avgerinou C, Hayes J, Osborn D, Cooper C, Petersen I, Walters K. Exploring the co-occurrence of depression, anxiety and insomnia symptoms, diagnoses and treatments in primary care: observational study using UK primary care data. BJPsych Open 2024; 10:e76. [PMID: 38634320 DOI: 10.1192/bjo.2024.20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Depression, anxiety and insomnia often co-occur. However, there is a lack of research regarding how they cluster and how this is related to medication used to treat them. AIMS To describe the frequencies and associations between depression, anxiety and insomnia, and treatment for these conditions in primary care. METHOD A retrospective cohort study using UK electronic primary care records. We included individuals aged between 18 and 99 years old with one or more records suggesting they had a diagnosis, symptom or drug treatment for anxiety, depression or insomnia between 2015 and 2017. We report the conditional probabilities of having different combinations of diagnoses, symptoms and treatments recorded. RESULTS There were 1 325 960 records indicative of depression, anxiety or insomnia, for 739 834 individuals. Depression was the most common condition (n = 106 117 records), and SSRIs were the most commonly prescribed medication (n = 347 751 records). Overall, individuals with a record of anxiety were most likely to have co-occurring symptoms and diagnoses of other mental health conditions. For example, of the individuals with a record of generalised anxiety disorder (GAD), 24% also had a diagnosis of depression. In contrast, only 0.6% of those who had a diagnosis of depression had a diagnosis or symptom of GAD. Prescribing of more than one psychotropic medication within the same year was common. For example, of those who were prescribed an SNRI (serotonin-norepinephrine reuptake inhibitor), 40% were also prescribed an SSRI (selective serotonin reuptake inhibitor). CONCLUSIONS The conditional probabilities of co-occurring anxiety, depression and insomnia symptoms, diagnoses and treatments are high.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, UK
| | - Joseph Hayes
- Division of Psychiatry, University College London, UK
| | - David Osborn
- Division of Psychiatry, University College London, UK
| | - Claudia Cooper
- Centre of Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, UK
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Nakanishi M, Yamasaki S, Nakashima T, Miyamoto Y, Cooper C, Richards M, Stanyon D, Sakai M, Yoshii H, Nishida A. Association Between Dementia, Change in Home-Care Use, and Depressive Symptoms During the COVID-19 Pandemic: A Longitudinal Study Using Data from Three Cohort Studies. J Alzheimers Dis 2024:JAD240097. [PMID: 38640160 DOI: 10.3233/jad-240097] [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] [Indexed: 04/21/2024]
Abstract
Background The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on people with dementia has been quantified. However, little is known about the impact of change in home-care use owing to the pandemic. Objective To determine the longitudinal association between dementia, change in home-care use, and depressive symptoms during the pandemic. Methods We included data of 43,782 home-dwelling older adults from the English Longitudinal Study of Ageing (ELSA), Study of health, Ageing and Retirement in Europe (SHARE), and National Health and Aging Trends Study (NHATS). This study considered the latest main wave survey prior to the pandemic as the baseline, and the COVID-19 survey as follow-up. In a series of coordinated analyses, multilevel binomial logistic regression model was used to examine the association between baseline dementia, change in home-care use at follow-up, and presence of depressive symptoms. Results Dementia, using the ELSA, SHARE, and NHATS datasets, was identified in 2.9%, 2.3%, and 6.5% of older adults, and home-care use reduced in 1.7%, 2.8%, and 1.1% of individuals with dementia, respectively. Dementia was significantly associated with the increased risk of depressive symptoms in all three cohorts. However, the interaction between dementia and period (follow-up) was non-significant in SHARE and NHATS. Across all three cohorts, home-care use during the pandemic, regardless of change in amount, was significantly associated with increased depressive symptoms, compared to the non-use of home care. Conclusions These results highlight the need for tailoring dementia care at home to promote independence and provide sustainable emotional support.
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Affiliation(s)
- Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai-shi, Miyagi, Japan
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Taeko Nakashima
- Department of Social Healthcare and Business, Faculty of Healthcare Management, Nihon Fukushi University, Mihama-cho, Aichi, Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health & Ageing at UCL, University College London, London, United Kingdom
| | - Daniel Stanyon
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Mai Sakai
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai-shi, Miyagi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai-shi, Miyagi, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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Brown P, Cooper C, Dening KH, Hoe J, Burton A. An exploration of how specialist dementia nurses perceive and maintain the skills and competencies that frame their specialism: A qualitative survey. Heliyon 2024; 10:e27856. [PMID: 38596077 PMCID: PMC11001773 DOI: 10.1016/j.heliyon.2024.e27856] [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] [Received: 08/11/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
Background UK policy for complex and long-term health conditions including dementia has recommended that specialist nursing intervention is offered across the trajectory of the condition, but there is a lack of agreement regarding the skills and competencies that specialist nurses are expected to possess. Admiral Nurses are the largest UK group of specialist dementia nurses. Objective To explore how Admiral Nurses met and were supported to meet competencies as defined in the Admiral Nurse Competency Framework, and to develop and maintain skills as dementia specialists. Design Cross-sectional, semi-structured survey. Setting Online national survey. Participants Admiral (specialist dementia) Nurses. Methods We co-designed our survey with Admiral Nurses; then invited Admiral Nurses to complete it in 2022-23 Data were analysed thematically. Results 68 (20% of all Admiral Nurses) completed the survey; most were female (85.2%), from a white ethnic group (88.2%); they reported on average 24 years of nursing experience. We identified three themes in responses: 1.Having time and skills for meaningful support, explored how participants were resourced with time and skills to understand and address family carer client needs by active listening, tailoring person-centred support, and "walking alongside" families. 2.Partnering family carers, concerned how they co-designed interventions with family carers, learning from these collaborative partnerships where expertise was shared. 3.Practice and peer-based learning, explored how participants took responsibility for using available training, peer learning and self-reflection to develop their practice. Conclusions Admiral Nurse roles enabled respondents to develop as autonomous practitioners and to access resources that supported them to build and sustain their dementia specialist practice. Learning was practice based, through partnerships with family carer clients, peer support and self-directed learning. Specialist nursing models may help address the global health workforce emergency, through enabling creative practice development and valued roles that support retention of experienced nurses.
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Affiliation(s)
- Pat Brown
- Division of Psychiatry, University College London, London, UK & Dementia UK, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK, And East London NHS Foundation Trust
| | - Karen Harrison Dening
- School of Health & Life Sciences, De Montfort University, Leicester, Leicestershire & Dementia UK, London, UK
| | - Juanita Hoe
- Geller Institute of Ageing and Memory (GIAM), University of West London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
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Chandran M, Akesson KE, Javaid MK, Harvey N, Blank RD, Brandi ML, Chevalley T, Cinelli P, Cooper C, Lems W, Lyritis GP, Makras P, Paccou J, Pierroz DD, Sosa M, Thomas T, Silverman S. Impact of osteoporosis and osteoporosis medications on fracture healing: a narrative review. Osteoporos Int 2024:10.1007/s00198-024-07059-8. [PMID: 38587674 DOI: 10.1007/s00198-024-07059-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
Antiresorptive medications do not negatively affect fracture healing in humans. Teriparatide may decrease time to fracture healing. Romosozumab has not shown a beneficial effect on human fracture healing. BACKGROUND Fracture healing is a complex process. Uncertainty exists over the influence of osteoporosis and the medications used to treat it on fracture healing. METHODS Narrative review authored by the members of the Fracture Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF), on behalf of the IOF and the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT). RESULTS Fracture healing is a multistep process. Most fractures heal through a combination of intramembranous and endochondral ossification. Radiographic imaging is important for evaluating fracture healing and for detecting delayed or non-union. The presence of callus formation, bridging trabeculae, and a decrease in the size of the fracture line over time are indicative of healing. Imaging must be combined with clinical parameters and patient-reported outcomes. Animal data support a negative effect of osteoporosis on fracture healing; however, clinical data do not appear to corroborate with this. Evidence does not support a delay in the initiation of antiresorptive therapy following acute fragility fractures. There is no reason for suspension of osteoporosis medication at the time of fracture if the person is already on treatment. Teriparatide treatment may shorten fracture healing time at certain sites such as distal radius; however, it does not prevent non-union or influence union rate. The positive effect on fracture healing that romosozumab has demonstrated in animals has not been observed in humans. CONCLUSION Overall, there appears to be no deleterious effect of osteoporosis medications on fracture healing. The benefit of treating osteoporosis and the urgent necessity to mitigate imminent refracture risk after a fracture should be given prime consideration. It is imperative that new radiological and biological markers of fracture healing be identified. It is also important to synthesize clinical and basic science methodologies to assess fracture healing, so that a convergence of the two frameworks can be achieved.
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Affiliation(s)
- M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, DUKE NUS Medical School, Singapore, Singapore.
| | - K E Akesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - M K Javaid
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - N Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R D Blank
- Garvan Institute of Medical Research, Medical College of Wisconsin, Darlinghurst, NSW, Australia
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - M L Brandi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Largo Palagi 1, Florence, Italy
| | - T Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Cinelli
- Department of Trauma Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - W Lems
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - G P Lyritis
- Hellenic Osteoporosis Foundation, Athens, Greece
| | - P Makras
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - J Paccou
- Department of Rheumatology, MABlab ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - M Sosa
- University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis and Mineral Metabolism, Canary Islands, Spain
| | - T Thomas
- Department of Rheumatology, North Hospital, CHU Saint-Etienne and INSERM U1059, University of Lyon-University Jean Monnet, Saint‑Etienne, France
| | - S Silverman
- Cedars-Sinai Medical Center and Geffen School of Medicine UCLA, Los Angeles, CA, USA
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Shoham N, Dunca D, Cooper C, Hayes JF, McQuillin A, Bass N, Lewis G, Kuchenbaecker K. Investigating the association between schizophrenia and distance visual acuity: Mendelian randomisation study - CORRIGENDUM. BJPsych Open 2024; 10:e73. [PMID: 38563245 PMCID: PMC10988597 DOI: 10.1192/bjo.2023.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
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Cooper C, Zabihi S, Akhtar A, Lee T, Isaaq A, Le Novere M, Barber J, Lord K, Rapaport P, Banks S, Duggan S, Ogden M, Walters K, Orgeta V, Rockwood K, Butler LT, Manthorpe J, Dow B, Hoe J, Hunter R, Banerjee S, Budgett J, Duffy L. Feasibility and acceptability of NIDUS-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial. Age Ageing 2024; 53:afae074. [PMID: 38643354 PMCID: PMC11032424 DOI: 10.1093/ageing/afae074] [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: 10/19/2023] [Revised: 02/23/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION In the first randomised controlled trial of a dementia training and support intervention in UK homecare agencies, we aimed to assess: acceptability of our co-designed, manualised training, delivered by non-clinical facilitators; outcome completion feasibility; and costs for a future trial. METHODS This cluster-randomised (2:1) single-blind, feasibility trial involved English homecare agencies. Intervention arm agency staff were offered group videocall sessions: 6 over 3 months, then monthly for 3 months (NIDUS-professional). Family carers (henceforth carers) and clients with dementia (dyads) were offered six to eight complementary, individual intervention sessions (NIDUS-Family). We collected potential trial measures as secondary outcomes remotely at baseline and 6 months: HCW (homecare worker) Work-related Strain Inventory (WRSI), Sense of Competence (SoC); proxy-rated Quality of Life (QOL), Disability Assessment for Dementia scale (DAD), Neuropsychiatric Inventory (NPI) and Homecare Satisfaction (HCS). RESULTS From December 2021 to September 2022, we met agency (4 intervention, 2 control) and HCWs (n = 62) recruitment targets and recruited 16 carers and 16/60 planned clients. We met a priori progression criteria for adherence (≥4/6 sessions: 29/44 [65.9%,95% confidence interval (CI): 50.1,79.5]), HCW or carer proxy-outcome completion (15/16 (93.8% [69.8,99.8]) and proceeding with adaptation for HCWs outcome completion (46/63 (73.0% [CI: 60.3,83.4]). Delivery of NIDUS-Professional costs was £6,423 (£137 per eligible client). WRSI scores decreased and SoC increased at follow-up, with no significant between-group differences. For intervention arm proxy-rated outcomes, carer-rated QOL increased, HCW-rated was unchanged; carer and HCW-rated NPI decreased; DAD decreased (greater disability) and HCS was unchanged. CONCLUSION A pragmatic trial is warranted; we will consider using aggregated, agency-level client outcomes, including neuropsychiatric symptoms.
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Affiliation(s)
- Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sedigheh Zabihi
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Amirah Akhtar
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Teresa Lee
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Abdinasir Isaaq
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Marie Le Novere
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Julie Barber
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Kathryn Lord
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Penny Rapaport
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sara Banks
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sandra Duggan
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Margaret Ogden
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Kate Walters
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Vasiliki Orgeta
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Kenneth Rockwood
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Laurie T Butler
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Jill Manthorpe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Briony Dow
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Juanita Hoe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Rachael Hunter
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Sube Banerjee
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Jessica Budgett
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
| | - Larisa Duffy
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AB, UK
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Arundel CE, Clark LK, Parker A, Beard D, Coleman E, Cooper C, Devane D, Eldridge S, Galvin S, Gillies K, Hewitt CE, Sutton C, Torgerson DJ, Treweek S. Trial Forge Guidance 4: a guideline for reporting the results of randomised Studies Within A Trial (SWATs). Trials 2024; 25:183. [PMID: 38475795 PMCID: PMC10935912 DOI: 10.1186/s13063-024-08004-0] [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: 06/15/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Evidence to support decisions on trial processes is minimal. One way to generate this evidence is to use a Study Within A Trial (SWAT) to test trial processes or explore methodological uncertainties. SWAT evidence relies on replication to ensure sufficient power and broad applicability of findings. Prompt reporting is therefore essential; however, SWAT publications are often the first to be abandoned in the face of other time pressures. Reporting guidance for embedded methodology trials does exist but is not widely used. We sought therefore to build on these guidelines to develop a straightforward, concise reporting standard, which remains adherent to the CONSORT guideline. METHODS An iterative process was used to develop the guideline. This included initial meetings with key stakeholders, development of an initial guideline, pilot testing of draft guidelines, further iteration and pilot testing, and finalisation of the guideline. RESULTS We developed a reporting guideline applicable to randomised SWATs, including replications of previous evaluations. The guideline follows the Consolidated Standards for Reporting Trials (CONSORT) statement and provides example text to ensure ease and clarity of reporting across all domains. CONCLUSIONS The SWAT reporting guideline will aid authors, reviewers, and journal editors to produce and review clear, structured reports of randomised SWATs, whilst also adhering to the CONSORT guideline. TRIAL REGISTRATION EQUATOR Network - Guidelines Under Development ( https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials/#SWAT ). Registered on 25 March 2021.
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Affiliation(s)
- C E Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, Lower Ground Floor ARRC Building, University of York, York, YO10 5DD, UK.
| | - L K Clark
- York Trials Unit, Department of Health Sciences, Faculty of Science, Lower Ground Floor ARRC Building, University of York, York, YO10 5DD, UK
| | - A Parker
- York Trials Unit, Department of Health Sciences, Faculty of Science, Lower Ground Floor ARRC Building, University of York, York, YO10 5DD, UK
| | - D Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - E Coleman
- York Trials Unit, Department of Health Sciences, Faculty of Science, Lower Ground Floor ARRC Building, University of York, York, YO10 5DD, UK
| | - C Cooper
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - D Devane
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - S Eldridge
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - S Galvin
- HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland
| | - K Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - C E Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, Lower Ground Floor ARRC Building, University of York, York, YO10 5DD, UK
| | - C Sutton
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, Lower Ground Floor ARRC Building, University of York, York, YO10 5DD, UK
| | - S Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Morse RM, Lang I, Rapaport P, Poppe M, Morgan-Trimmer S, Cooper C. How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program. BMC Geriatr 2024; 24:188. [PMID: 38408902 PMCID: PMC10895907 DOI: 10.1186/s12877-024-04762-3] [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: 06/28/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials. METHODS We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis. RESULTS We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients. CONCLUSION This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.
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Affiliation(s)
- Rachel M Morse
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Iain Lang
- Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK
- UK National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (NIHR PenARC), Exeter , UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Michaela Poppe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Bell G, El Baou C, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Fearn C, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Predictors of primary care psychological therapy outcomes for depression and anxiety in people living with dementia: evidence from national healthcare records in England. Br J Psychiatry 2024:1-8. [PMID: 38328941 DOI: 10.1192/bjp.2024.12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. AIMS To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD. METHOD National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored. RESULTS People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16, P < 0.001) were associated with worse therapy outcomes in PLWD. CONCLUSIONS Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and iCope Psychological Therapies Service, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, UK
| | - Caroline Fearn
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | - Elisa Aguirre
- Redbridge Talking Therapies Service, North East London NHS Foundation Trust, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Nimmons D, Aker N, Burnand A, Jordan KP, Cooper C, Davies N, Manthorpe J, Chew-Graham CA, Kingstone T, Petersen I, Walters K. Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 157:105507. [PMID: 38097097 DOI: 10.1016/j.neubiorev.2023.105507] [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] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
People living with dementia commonly experience anxiety, which is often challenging to manage. We investigated the effectiveness of treatments for the management of anxiety in this population. We conducted a systematic review and meta-analysis of randomised controlled trials, and searched EMBASE, CINAHL, MEDLINE and PsycInfo. We estimated standardised mean differences at follow-up between treatments relative to control groups and pooled these across studies using random-effects models where feasible. Thirty-one studies were identified. Meta-analysis demonstrated non-pharmacological interventions were effective in reducing anxiety in people living with dementia, compared to care as usual or active controls. Specifically, music therapy (SMD-1.92(CI:-2.58,-1.25)), muscular approaches (SMD-0.65(CI:-1.02,-0.28)) and stimulating cognitive and physical activities (SMD-0.31(CI:-0.53,-0.09)). Pharmacological interventions with evidence of potential effectiveness included Ginkgo biloba, probiotics, olanzapine, loxapine and citalopram compared to placebo, olanzapine compared to bromazepam and buspirone and risperidone compared to haloperidol. Meta-analyses were not performed for pharmacological interventions due to studies' heterogeneity. This has practice implications when promoting the use of more non-pharmacological interventions to help reduce anxiety among people living with dementia.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK.
| | - Narin Aker
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Alice Burnand
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | | | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Tom Kingstone
- School of Medicine, Keele University, Staffordshire, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
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11
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Cooper C, Vickerstaff V, Barber J, Phillips R, Ogden M, Walters K, Lang I, Rapaport P, Orgeta V, Rockwood K, Banks S, Palomo M, Butler LT, Lord K, Livingston G, Banerjee S, Manthorpe J, Dow B, Hoe J, Hunter R, Samus Q, Budgett J. A psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) versus goal setting and routine care: a single-masked, phase 3, superiority, randomised controlled trial. Lancet Healthy Longev 2024; 5:e141-e151. [PMID: 38310894 PMCID: PMC10834374 DOI: 10.1016/s2666-7568(23)00262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Although national guidelines recommend that everyone with dementia receives personalised post-diagnostic support, few do. Unlike previous interventions that improved personalised outcomes in people with dementia, the NIDUS-Family intervention is fully manualised and deliverable by trained and supervised, non-clinical facilitators. We aimed to investigate the effectiveness of home-based goal setting plus NIDUS-Family in supporting the attainment of personalised goals set by people with dementia and their carers. METHODS We did a two-arm, single-masked, multi-site, randomised, clinical trial recruiting patient-carer dyads from community settings. We randomly assigned dyads to either home-based goal setting plus NIDUS-Family or goal setting and routine care (control). Randomisation was blocked and stratified by site (2:1; intervention to control), with allocations assigned via a remote web-based system. NIDUS-Family is tailored to goals set by dyads by selecting modules involving behavioural interventions, carer support, psychoeducation, communication and coping skills, enablement, and environmental adaptations. The intervention involved six to eight video-call or telephone sessions (or in person when COVID-19-related restrictions allowed) over 6 months, then telephone follow-ups every 2-3 months for 6 months. The primary outcome was carer-rated goal attainment scaling (GAS) score at 12 months. Analyses were done by intention to treat. This trial is registered with the ISRCTN registry, ISRCTN11425138. FINDINGS Between April 30, 2020, and May 9, 2021, we assessed 1083 potential dyads for eligibility, 781 (72·1%) of whom were excluded. Of 302 eligible dyads, we randomly assigned 98 (32·4%) to the control group and 204 (67·5%) to the intervention group. The mean age of participants with dementia was 79·9 years (SD 8·2), 169 (56%) were women, and 133 (44%) were men. 247 (82%) dyads completed the primary outcome, which favoured the intervention (mean GAS score at 12 months 58·7 [SD 13·0; n=163] vs 49·0 [14·1; n=84]; adjusted difference in means 10·23 [95% CI 5·75-14·71]; p<0·001). 31 (15·2%) participants in the intervention group and 14 (14·3%) in the control group experienced serious adverse events. INTERPRETATION To our knowledge, NIDUS-Family is the first readily scalable intervention for people with dementia and their family carers that improves attainment of personalised goals. We therefore recommend that it be implemented in health and care services. FUNDING UK Alzheimer's Society.
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Affiliation(s)
- Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London, UK.
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | | | - Margaret Ogden
- Research Network Volunteer, Alzheimer's Society, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Iain Lang
- St Luke's Campus, University of Exeter, Exeter, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sara Banks
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | - Marina Palomo
- Division of Psychiatry, University College London, London, UK
| | - Laurie T Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, UK
| | - Kathyrn Lord
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jill Manthorpe
- The Policy Institute at King's, King's College London, London, UK
| | - Briony Dow
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Juanita Hoe
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Budgett
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London, UK
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Burton A, Rapaport P, Palomo M, Lord K, Budgett J, Barber J, Hunter R, Butler L, Vickerstaff V, Rockwood K, Ogden M, Smith D, Lang I, Livingston G, Dow B, Kales H, Manthorpe J, Walters K, Hoe J, Orgeta V, Samus Q, Cooper C. Correction: Clinical and cost-effectiveness of a New psychosocial intervention to support Independence in Dementia (NIDUS-family) for family carers and people living with dementia in their own homes: a randomised controlled trial. Trials 2024; 25:18. [PMID: 38167460 PMCID: PMC10759320 DOI: 10.1186/s13063-023-07768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Marina Palomo
- Camden and Islington NHS Foundation Trust, London, UK
| | - Kathryn Lord
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - Margaret Ogden
- Alzheimer's Society Research Network Volunteers, London, UK
| | - Debs Smith
- Alzheimer's Society Research Network Volunteers, London, UK
| | - Iain Lang
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Briony Dow
- National Ageing Research Institute, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Helen Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, University of California, California, USA
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Juanita Hoe
- Division of Nursing, School of Health Sciences, City University of London, London, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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13
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O'Nions E, Lewer D, Petersen I, Brown J, Buckman JE, Charlton R, Cooper C, El Baou CÉ, Happé F, Manthorpe J, McKechnie DG, Richards M, Saunders R, Zanker C, Mandy W, Stott J. Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study. Lancet Reg Health Eur 2024; 36:100776. [PMID: 38188276 PMCID: PMC10769892 DOI: 10.1016/j.lanepe.2023.100776] [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] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
Background Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people living in the UK. Methods We studied people in the IQVIA Medical Research Database with an autism diagnosis between January 1, 1989 and January 16, 2019. For each participant diagnosed autistic, we included ten comparison participants without an autism diagnosis, matched by age, sex, and primary care practice. We calculated age- and sex-standardised mortality ratios comparing people diagnosed autistic to the reference group. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy at age 18 and years of life lost. We analysed the data separately by sex, and for people with and without a record of intellectual disability. We discuss the findings in the light of the prevalence of recorded diagnosis of autism in primary care compared to community estimates. Findings From a cohort of nearly 10 million people, we identified 17,130 participants diagnosed autistic without an intellectual disability (matched with 171,300 comparison participants), and 6450 participants diagnosed autistic with an intellectual disability (matched with 64,500 comparison participants). The apparent estimates indicated that people diagnosed with autism but not intellectual disability had 1.71 (95% CI: 1.39-2.11) times the mortality rate of people without these diagnoses. People diagnosed with autism and intellectual disability had 2.83 (95% CI: 2.33-3.43) times the mortality rate of people without these diagnoses. Likewise, the apparent reduction in life expectancy for people diagnosed with autism but not intellectual disability was 6.14 years (95% CI: 2.84-9.07) for men and 6.45 years (95% CI: 1.37-11.58 years) for women. The apparent reduction in life expectancy for people diagnosed with autism and intellectual disability was 7.28 years (95% CI: 3.78-10.27) for men and 14.59 years (95% CI: 9.45-19.02 years) for women. However, these findings are likely to be subject to exposure misclassification biases: very few autistic adults and older-adults have been diagnosed, meaning that we could only study a fraction of the total autistic population. Those who have been diagnosed may well be those with greater support needs and more co-occurring health conditions than autistic people on average. Interpretation The findings indicate that there is a group of autistic people who experience premature mortality, which is of significant concern. There is an urgent need for investigation into the reasons behind this. However, our estimates suggest that the widely reported statistic that autistic people live 16-years less on average is likely incorrect. Nine out of 10 autistic people may have been undiagnosed across the time-period studied. Hence, the results of our study do not generalise to all autistic people. Diagnosed autistic adults, and particularly older adults, are likely those with greater-than-average support needs. Therefore, we may have over-estimated the reduction in life expectancy experienced by autistic people on average. The larger reduction in life expectancy for women diagnosed with autism and intellectual disability vs. men may in part reflect disproportionate underdiagnosis of autism and/or intellectual disability in women. Funding Dunhill Medical Trust, Medical Research Council, National Institute for Health and Care Research, and the Royal College of Psychiatrists.
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Affiliation(s)
- Elizabeth O'Nions
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Dan Lewer
- Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Jude Brown
- National Autistic Society, 393 City Rd, London, EC1V 1NG, UK
| | - Joshua E.J. Buckman
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, New Cross, London, SE14 6NW, UK
| | - Claudia Cooper
- Queen Mary University of London, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, London, E1 2AD, UK
| | - CÉline El Baou
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Jill Manthorpe
- NIHR Health & Social Care Workforce Research Unit, King's College London, Strand, London, WC2R 2LS, UK
| | - Douglas G.J. McKechnie
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rob Saunders
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | | | - Will Mandy
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Joshua Stott
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
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Wright LC, Lopez Chemas N, Cooper C. Lived experience codesign of self-harm interventions: a scoping review. BMJ Open 2023; 13:e079090. [PMID: 38151276 PMCID: PMC10753750 DOI: 10.1136/bmjopen-2023-079090] [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: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study aims to map existing literature describing how people with lived experience of self-harm have engaged in codesigning self-harm interventions, understand barriers and facilitators to this engagement, and how the meaningfulness of codesign has been evaluated. DESIGN Scoping review by Joanna Briggs Institute methodology. A protocol was published online (http://dx.doi.org/10.17605/OSF.IO/P52UD). DATA SOURCES PubMed, Embase, PsycINFO, Web of Science, Cochrane Library, PROSPERO, ClinicalTrials.gov and relevant websites were searched on 24 December 2022 (repeated 4 November 2023). ELIGIBILITY CRITERIA We included studies where individuals with lived experience of self-harm (first-hand or caregiver) have codesigned self-harm interventions. DATA EXTRACTION AND SYNTHESIS Results were screened at title and abstract level, then full-text level by two researchers independently. Prespecified data were extracted, charted and sorted into themes. RESULTS We included 22 codesigned interventions across mobile health, educational settings, prisons and emergency departments. Involvement varied from designing content to multistage involvement in planning, delivery and dissemination. Included papers described the contribution of 159 female, 39 male and 21 transgender or gender diverse codesigners. Few studies included contributors from a minoritised ethnic or LGBTQIA+ group. Six studies evaluated how meaningfully people with lived experience were engaged in codesign: by documenting the impact of contributions on intervention design or through postdesign reflections. Barriers included difficulties recruiting inclusively, making time for meaningful engagement in stretched services and safeguarding concerns for codesigners. Explicit processes for ensuring safety and well-being, flexible schedules, and adequate funding facilitated codesign. CONCLUSIONS To realise the potential of codesign to improve self-harm interventions, people with lived experience must be representative of those who use services. This requires processes that reassure potential contributors and referrers that codesigners will be safeguarded, remunerated, and their contributions used and valued.
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Affiliation(s)
- Lucy C Wright
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Natalia Lopez Chemas
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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15
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Whitfield E, Parnell Johnson S, Higgs P, Martin W, Morgan-Trimmer S, Burton A, Poppe M, Cooper C. Nature As a "Lifeline": The Power of Photography When Exploring the Experiences of Older Adults Living With Memory Loss and Memory Concerns. Gerontologist 2023; 63:1672-1682. [PMID: 37793397 PMCID: PMC10724040 DOI: 10.1093/geront/gnad126] [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: 01/31/2023] [Indexed: 10/06/2023] Open
Abstract
The visual is an underutilized modality through which to investigate experiences of memory loss in older people. We describe a visual ethnography with older adults experiencing subjective or objective memory loss, receiving a cognitive well-being group intervention designed to prevent cognitive decline and dementia (APPLE-Tree program). We aimed to explore lived experiences of people with memory concerns, how participants engaged with this photography and codesign project, and how collaboration with an artist/photographer enhanced this process. Nineteen participants shared photographs reflecting what they valued in their daily lives, their experiences of memory concerns, and the intervention. Fourteen participated in qualitative photo-elicitation interviews, and 13 collaborated with a professional artist/photographer to cocreate an exhibition, in individual meetings and workshops, during which a researcher took ethnographic field notes. Eight participants were reinterviewed after the exhibition launch.We contextualize images produced by participants in relation to discourses around the visual and aging and highlight their relationship with themes developed through thematic analysis that interconnects photographic, observational, and interview data. We present themes around the use of photographs to: (1) celebrate connections to nature as a lifeline; (2) anchor lives within the context of relationships with family; and (3) reflect on self and identity, enduring through aging, memory concerns, pandemic, and aging stereotypes. We explore visual research as a powerful tool for eliciting meaningful accounts from older adults experiencing cognitive change and to connect the arts and social sciences within aging studies.
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Affiliation(s)
- Elenyd Whitfield
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Paul Higgs
- UCL Division of Psychiatry, University College London, London, UK
| | - Wendy Martin
- Department of Health Sciences, Brunel University London, LondonUK
| | | | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | - Michaela Poppe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Kanis JA, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Vandenput L, Harvey NC, Lorentzon M, Leslie WD. Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX. Osteoporos Int 2023; 34:2027-2045. [PMID: 37566158 PMCID: PMC7615305 DOI: 10.1007/s00198-023-06870-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. RESULTS A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
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Affiliation(s)
- J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - P J M Elders
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Nordström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - E Sornay-Rendu
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
| | - L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Alberts S, Nadarajah A, Cooper C, Brijnath B, Loganathan S, Varghese M, Antoniades J, Baruah U, Dow B, Kent M, Rao R, Budgett J, Ahmed A. Attitudes to long-term care in India: a secondary mixed-methods analysis. Lancet 2023; 402 Suppl 1:S19. [PMID: 37997058 DOI: 10.1016/s0140-6736(23)02101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND India is the world's most populous country, and overseas Indians the world's largest diaspora. Many of the more than 1·4 million UK-based Indians will be providing care at a distance for parents living in India. Globalisation has contributed to a shift in India from traditional joint family systems to more nuclear structures. We investigated how commonly Indian parents consider and use long-term care facilities and attitudes to their use. METHODS We did a secondary mixed-methods statistical analysis of the LASI (Longitudinal Ageing Study in India), a national, cross-sectional household survey administered in 2017-18 to 73 396 randomly selected adults aged 45 years and older in all Indian states and Union Territories (42 261 [58%] women, 31 135 [42%] men). We report the proportion and sociodemographic predictors of respondents' parent(s) living in a care home. We also did a secondary thematic analysis of the qualitative interviews from the Moving Pictures India Study, exploring attitudes to long-term care in 2022. These interviews included 19 carers (nine [47%] women; age range 31-79 years) for people with dementia and 25 professionals (19 [76%] women; age range 24-56 years) purposively selected for diversity from networks of the team based at a Bangalore hospital, India. FINDINGS 24 LASI participants reported that their parent was living in a long-term care facility (father [n=8], mother [n=15], both parents [n=1]). Although rare overall, use and consideration of use of long-term care were more frequently reported in urban areas (n=14, 58%), by people in middle-income quintiles (n=17, 71%) with higher levels of education (n=7, 29%), who rated their health as good or very good (n=15, 63%). The themes identified in qualitative interviews were the use of long-term care facilities as a last resort, social expectations, and limited availability of long-term care facilities. INTERPRETATION Although interviews were only conducted in Bangalore and respondents could misrepresent living arrangements due to ongoing societal stigma, the data show that very few people reside in old age homes across India, with strong preference towards intergenerational and community care. With the UK home to a growing diaspora of nuclear Indian families, our findings illustrate the contexts in which they provide care at a distance, navigating cross-cultural attitudes and social norms around long-term care. FUNDING Alzheimer's Association US.
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Affiliation(s)
- Sweedal Alberts
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Abinaya Nadarajah
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Santosh Loganathan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | | | - Upasana Baruah
- National Ageing Research Institute (NARI), VIC, Australia
| | - Briony Dow
- National Ageing Research Institute (NARI), VIC, Australia
| | | | - Rachita Rao
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jessica Budgett
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Amaani Ahmed
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Javaid MK, Calo M, Wullich S, Mohsin Z, Osorio EC, Orjuela AM, Unigarro CA, Mendez-Sanchez L, Naranjo JT, Vieira LT, Tutiya KK, Inacio AM, de Leon AOG, García JCV, Habib C, Subies F, Guyot JP, Diehl M, Carabelli G, Soulie A, Cooper C. Development, implementation and evaluation of a multinational FLS mentorship programme in Latin America. Osteoporos Int 2023; 34:1881-1891. [PMID: 37418151 PMCID: PMC10579116 DOI: 10.1007/s00198-023-06742-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/03/2023] [Indexed: 07/08/2023]
Abstract
Realising the benefits of systematic secondary fracture prevention requires supporting local sites to get started and becoming effective. We here describe the development, implementation and impact of a regional fracture liaison service (FLS) mentorship programme in Latin America that led to 64 FLS getting started and coverage of 17,205 patients. INTRODUCTION Despite treatments and service models to deliver effective secondary fracture prevention, most patients are left untreated after a fragility fracture. To improve the capability to get FLS started and more effective, we describe the development, implementation and evaluation of an international programme to develop national communities of FLS mentors as part of the Capture the Fracture Partnership in Latin America. METHODS The IOF regional team and the University of Oxford developed the curriculum and associated resources for training mentors in setting up FLS, service improvement and mentorship. Mentors were selected during a preparatory meeting, trained using live online sessions followed by regular mentor-led post-training meetings. The programme was evaluated using a pre-training needs assessment and post-training evaluation based on Moore's outcomes. RESULTS The mentorship programme was initiated in Mexico, Brazil, Colombia and Argentina. The mentors were multidisciplinary, including orthopaedic surgery, rehabilitation, rheumatology, endocrinology, geriatrics, gynaecology and internal medicine. There was 100% participation in training sessions and reported satisfaction with the training. Since the initiation of the training programme, 22 FLS have been set up in Mexico, 30 in Brazil, 3 in Colombia and 9 in Argentina, in comparison with two in Chile and none in any other LATAM countries that were not involved in the mentorship programme. This equates to approximately 17,025 additional patients identified from 2019 to 2021 after initiation of mentorship. The mentors have engaged with 58 FLS for service development. Post-training activities include two published national best practice guidelines and other country-specific resources for FLS in the local language. CONCLUSION Despite the COVID pandemic, the mentorship pillar of the Capture the Fracture Partnership has developed a community of FLS mentors with measurable improvement in national FLS provision. The programme is a potentially scalable platform to develop communities of mentors in other countries.
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Affiliation(s)
| | - M Calo
- International Osteoporosis Foundation Latin America Office, Buenos Aires, Argentina
| | - S Wullich
- International Osteoporosis Foundation Latin America Office, Buenos Aires, Argentina
| | | | | | | | | | - L Mendez-Sanchez
- Facultad de Medicina, Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - J Torres Naranjo
- Centro de Investigación Ósea Y de La Composición Corporal (CIO), Guadalajara, Mexico
| | | | | | - A Manoel Inacio
- Hospital da Cruz Vermelha Brasileira Do Paraná, Med Sênior, Curitiba, PR, Brazil
| | | | | | - C Habib
- Hospital Austral and Sanatorio Las Lomas, Buenos Aires, Argentina
| | - F Subies
- Hospital Austral and Sanatorio Las Lomas, Buenos Aires, Argentina
| | - J P Guyot
- Hospital Austral and Sanatorio Las Lomas, Buenos Aires, Argentina
| | - M Diehl
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Carabelli
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Soulie
- International Osteoporosis Foundation Europe Office, Nyon, Switzerland
| | - C Cooper
- NDORMS, Oxford, UK
- MRC LEU, University of Southampton, Southampton, UK
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19
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Frost R, Avgerinou C, Kalwarowsky S, Mahmood F, Goodman C, Clegg A, Hopkins J, Gould R, Gardner B, Marston L, Hunter R, Kharicha K, Cooper C, Skelton DA, Drennan V, Logan P, Walters K. Enabling health and maintaining independence for older people at home (HomeHealth trial): a multicentre randomised controlled trial. Lancet 2023; 402 Suppl 1:S42. [PMID: 37997084 DOI: 10.1016/s0140-6736(23)02071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND NHS frailty services commonly target more severely frail older people, despite evidence suggesting frailty can be prevented or reversed when addressed at an earlier stage. HomeHealth is a new home-based, manualised voluntary sector service supporting older people with mild frailty to maintain their independence through behaviour change. Over six appointments, a trained HomeHealth worker discusses what matters to the older person and supports them to set and achieve goals around mobility, nutrition, socialising and/or psychological wellbeing. The service showed promising effects in a feasibility trial. We aimed to test the clinical and cost-effectiveness of HomeHealth for maintaining independence in older people with mild frailty compared with treatment as usual. METHODS In this single-blind multicentre randomised controlled trial, we recruited community-dwelling older people aged 65 years or older with mild frailty from 27 general practices, community groups and sheltered housing in London, Yorkshire, and Hertfordshire. Participants were randomly assigned (1:1) to receive either HomeHealth monthly for 6 months or treatment as usual (usual GP and outpatient care, no specific frailty services). Our primary outcome was independence in activities of daily living, measured by blinded outcome assessors using the modified Barthel Index, and analysed using linear mixed models, including 6-month and 12-month data and controlling for baseline Barthel score and site. The study was approved by the Social Care Research Ethics Committee, and all participants provided written or orally recorded informed consent. This study is registered with the ISRCTN registry, ISRCTN54268283. FINDINGS This trial took place between Jan 18, 2021, and July 4, 2023. We recruited 388 participants (mean age 81·4 years; 64% female [n=250], 94% White British/European [n=364], 2·5% Asian [n=10], 1·5% Black [n=6], 2·0% other [n=8]). We achieved high retention for 6-month follow-up (89%, 345/388), 12-month follow-up (86%, 334/388), and medical notes data (89%, 347/388). 182 (93%) of 195 participants in the intervention group completed the intervention, attending a mean of 5·6 appointments. HomeHealth had no effect on Barthel Index scores at 12 months (mean difference 0·250, 95% CI -0·932 to 1·432). At 6 months, there was a small reduction in psychological distress (-1·237, -2·127 to -0·348) and frailty (-0·124, -0·232 to -0·017), and at 12 months, we found small positive effects on wellbeing (1·449, 0·124 to 2·775) in those receiving HomeHealth. Other outcomes in analysis to date showed no significant difference. Health economic outcomes (including quality of life, capability, health services use and care needs or burden) are pending. INTERPRETATION This high-quality trial showed that HomeHealth did not maintain independence in older people with mild frailty, and had limited effects upon secondary outcomes. Future studies need to explore different ways to promote health in this population. FUNDING National Institute for Health and Care Research Health Technology Assessment (NIHR HTA).
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sarah Kalwarowsky
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Farah Mahmood
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford, UK
| | | | - Rebecca Gould
- Division of Psychiatry, University College London, London, UK
| | | | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Kalpa Kharicha
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dawn A Skelton
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, St George's University, London, UK
| | - Pip Logan
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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20
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Javaid MK, Pinedo-Villanueva R, Shah A, Mohsin Z, Hiligsmann M, Motek-Soulié A, Fuggle NR, Halbout P, Cooper C. The Capture the Fracture® Partnership: an overview of a global initiative to increase the secondary fracture prevention care for patient benefit. Osteoporos Int 2023; 34:1827-1835. [PMID: 37418152 PMCID: PMC10579122 DOI: 10.1007/s00198-023-06759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/03/2023] [Indexed: 07/08/2023]
Abstract
The Capture the Fracture® Partnership (CTF-P) is a unique collaboration between the International Osteoporosis Foundation, academic units and industry partners to enhance the implementation of effective, efficient fracture liaison services (FLSs) with a good patient experience. CTF-P has generated valuable resources for the specific countries as well as the broader FLS community to improve the initiation, effectiveness and sustainability of FLS in a wide range of healthcare settings.
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Affiliation(s)
- M K Javaid
- The Botnar Research Centre, NDORMS, University of Oxford, Old Rd, Headington, Oxford, OX3 7LD, United Kingdom.
| | | | - A Shah
- NDORMS, University of Oxford, Oxford, United Kingdom
| | - Z Mohsin
- NDORMS, University of Oxford, Oxford, United Kingdom
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health research Institute, Maastricht University, Maastricht, the Netherlands
| | - A Motek-Soulié
- International Osteoporosis Foundation, Nyon, Switzerland
| | - N R Fuggle
- MRC LEU, University of Southampton, Southampton, United Kingdom
| | - P Halbout
- International Osteoporosis Foundation, Nyon, Switzerland
| | - C Cooper
- NDORMS, University of Oxford, Oxford, United Kingdom
- MRC LEU, University of Southampton, Southampton, United Kingdom
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21
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Rookes T, Frost R, Barrado-Martin Y, Marston L, Cooper C, Gardner B, Armstrong M, Walters K. Type of goals set and progress towards these goals, as part of a behaviour change intervention, in people with mild cognitive impairment: a secondary analysis. Lancet 2023; 402 Suppl 1:S80. [PMID: 37997126 DOI: 10.1016/s0140-6736(23)02112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) affects 5-20% of older people in the UK, but often goes undiagnosed and is associated with increased risk of dementia. Targeting risk factors such as physical inactivity and social isolation through behaviour-change interventions could reduce this risk. However, it is unclear how MCI impacts engagement with these interventions. We aimed to explore how MCI affects goal-setting priorities and progress towards these goals in a behaviour-change intervention (HomeHealth). METHODS This was a secondary analysis of a completed randomised controlled trial, HomeHealth, which started in January 2021 and recruited 386 participants aged 65 years and older with mild frailty according to the Clinical Frailty Scale from general practices and the community in England. Participants were randomly assigned (1:1) to receive either the HomeHealth intervention (n=195) or treatment as usual (n=191) for 6 months. An evidence-based behaviour change intervention supported older people to work on goals to maintain independence, addressing factors affecting capability, opportunity, and motivation. Goal setting and progress information was available for 167 (86%) of 195 participants who received the intervention. The type of goal set and goal progress (scale 0-2) were compared between participants with healthy cognition, those with potential MCI, and those with probable dementia (rated with Montreal Cognitive Assessment [MoCA]). Qualitative semi-structured interviews were conducted between Aug 16, 2022, and May 18, 2023, with 29 people with MCI who received the intervention, to explore the perceived impact of MCI on goal setting, progress, and maintenance. Data were analysed using codebook thematic analysis. FINDINGS The mean age of participants was 80·8 years, 105 (63%) of 167 were women and 158 (95%) were white. 54 (32%) of 167 participants had healthy cognition, 94 (56%) had potential MCI, and 19 (11%) probable dementia. Distribution of goal type was similar across the three groups, with most participants setting mobility goals. Progress towards goals (scale 0-2) was similar in people with healthy cognition and potential MCI (1·24 and 1·18, respectively) but lower in those with probable dementia (0·76). However, all met the moderate progress cutoff (0·66-1·32). People with MCI recognised their cognition was getting worse but did not feel the HomeHealth intervention could help. Rather than setting new goals, people with MCI built on existing behaviours. Many did not initially understand the intervention and felt they would have benefitted from contact in between sessions or from more sessions to help goal progress. Once the sessions ended, less than a quarter of participants maintained the goal progress. INTERPRETATION Interventions to help older adults age well can be successfully delivered in people with MCI, to help them set and make progress towards goals. However, to maintain changes, more intense support is needed. FUNDING National Institute for Health and Care Research (NIHR) School for Primary Care Research, NIHR Health Technology Assessment.
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Affiliation(s)
- Tasmin Rookes
- Department of Primary Care and Population Health, University College London, London, UK.
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Megan Armstrong
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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22
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Renouf P, Budgett J, Wyman D, Banks S, Poppe M, Cooper C. Non-clinically trained facilitators' experiences of remote psychosocial interventions for older adults with memory loss and their family carers. BJPsych Open 2023; 9:e174. [PMID: 37791537 PMCID: PMC10594201 DOI: 10.1192/bjo.2023.558] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Dementia is the seventh leading cause of global mortality, with cases increasing. Psychosocial interventions might help prevent dementia and improve quality of life. Although it is cost-effective for non-clinically trained staff to deliver these, concerns are raised and little is known about the resulting impact on staff, especially for remote interventions. AIMS To explore how non-clinically trained facilitators experienced delivering remote, one-to-one and group-based psychosocial interventions with older adults with memory loss and their family carers, under training and supervision. METHOD We conducted a secondary thematic analysis of interviews with non-clinically trained facilitators, employed by universities, the National Health Service and third-sector organisations, who facilitated either of two manualised interventions: the APPLE-Tree group dementia prevention for people with mild memory loss or the NIDUS-Family one-to-one dyadic intervention for people living with dementia and their family carers. RESULTS The overarching theme of building confidence in developing therapeutic relationships was explained with subthemes that described the roles of positioning expertise (subtheme 1), developing clinical skills (subtheme 2), peer support (subtheme 3) in enabling this process and remote delivery as a potential barrier to it (subtheme 4). CONCLUSIONS Non-clinically trained facilitators can have positive experiences delivering remote psychosocial interventions with older adults. Differences in life experience could compound initial fears of being 'in at the deep end' and 'exposed' as lacking expertise. Fears were allayed by experiencing positive therapeutic relationships and outcomes, and by growing confidence. For this to happen, appropriate training and supervision is needed, alongside accounting for the challenges of remote delivery.
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Affiliation(s)
- Philippa Renouf
- Division of Psychiatry, University College London, UK; and Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, UK; and Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Danielle Wyman
- School of Psychology and Sport Science, Anglia Ruskin University, UK
| | - Sara Banks
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Michaela Poppe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; and Memory Services, East London NHS Foundation Trust, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; and Memory Services, East London NHS Foundation Trust, UK
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23
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Hubler A, Cooper C, Heinzman K, Jacob J, Hapner E, McDonald AM. Voice Handicap Following Curative Therapy for Locally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e237. [PMID: 37784939 DOI: 10.1016/j.ijrobp.2023.06.1160] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Voice changes are a common late effect experienced by head and neck cancer (HNC) survivors, but most prior studies have focused primarily on patients with larynx tumors. The purpose of this study was to characterize voice handicap in a broader population of long term HNC survivors. We also sought to determine the sensitivity of a single question screener for voice handicap in this population. MATERIALS/METHODS This study enrolled patients with locally advanced HNC (T3+ or N+) who received ≥60 Gy at a single academic institution and survived at least 2 years from the completion of radiation therapy (RT). Voice handicap was assessed using the more comprehensive and validated 10-question Voice Handicap Index (VHI-10). Clinically significant voice handicap was defined as a total VHI-10 score of >11. Patient reported hoarseness was assessed by the single question "Have you had problems with hoarseness?" from the EORTC QLQ-HN35 form. Descriptive statistics and univariate binomial logistic regression were used to identify factors associated with significant voice handicap. Missing data were not imputed and denominators were adjusted for each analysis. All analyses were performed using RStudio (PBC, Boston, MA). RESULTS A total of 199 patients were enrolled in this study and included in the analysis; 182 (91%) completed the VHI-10 and 189 (95%) completed the EORTC QLQ-HN35. The median time from completion of RT to QoL assessment was 5.6 years (range: 1.7 - 28.9 years) and the median age was 65 years (range: 25 - 88 years). The primary tumor was most commonly within the oropharynx (51%) followed by larynx (13%) and oral cavity (11%). Surgery was performed in 64% and 63% systemic therapy. Clinically significant voice handicap was present in 34% of patients and the median VHI-10 score was 8 (range: 0 - 40). Primary tumors of the larynx (OR 7.18; 95% CI 2.52-23.8) and oral cavity (OR 3.29; 95% CI 1.21-9.35; p = 0.02) were associated with a higher odds of significant voice handicap than oropharynx tumors. Other factors associated with voice handicap were African American race (OR = 2.78 versus white race, 95% CI 1.13-7.14), female sex (OR 2.34; 95% CI 1.21-4.55), and T3+ tumor stage (OR = 3.53, 95% CI 1.48-9.19). The sensitivity and specificity of the single item hoarseness question from the EORTC QLQ-HN35 for predicting significant voice handicap ranged from 64.6% and 69.7% when a "A little bit" was considered a positive response to 24.6% and 98.2% when "Very much" was considered a positive response. CONCLUSION Significant voice handicap was present in more than one-third of long term HNC survivors in this cohort and primary tumors of the larynx and oral cavity were associated with a higher odds of voice impairment. A single question about hoarseness was not sensitive for detecting significant voice impairment, potentially because voice quality is impacted by a range of factors besides hoarseness. Results of this study highlight the need to improve our understanding of how voice handicap impacts the QoL of HNC survivors.
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Affiliation(s)
- A Hubler
- University of Alabama at Birmingham, Birmingham, AL
| | - C Cooper
- University of Alabama at Birmingham, Birmingham, AL
| | - K Heinzman
- University of Alabama at Birmingham, Birmingham, AL
| | - J Jacob
- University of Alabama at Birmingham, Birmingham, AL
| | - E Hapner
- University of Alabama at Birmingham, Birmingham, AL
| | - A M McDonald
- University of Alabama at Birmingham, Birmingham, AL
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24
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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Dang TH, Thodis A, Ulapane N, Antoniades J, Gurgone M, Nguyen T, Gilbert A, Wickramasinghe N, Varghese M, Loganathan S, Enticott J, Mortimer D, Dow B, Cooper C, Xiao LD, Brijnath B. 'It's Too nice': Adapting iSupport Lite for Ethnically Diverse Family Carers of a Person with Dementia. Clin Gerontol 2023:1-14. [PMID: 37697628 DOI: 10.1080/07317115.2023.2254296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Resources to support dementia carers from ethnically diverse families are limited. We explored carers' and service providers' views on adapting the World Health Organization's iSupport Lite messages to meet their needs. METHODS Six online workshops were conducted with ethnically diverse family carers and service providers (n = 21) from nine linguistic groups across Australia. Recruitment was via convenience and snowball sampling from existing networks. Data were analyzed using thematic analysis. RESULTS Participants reported that iSupport Lite over-emphasized support from family and friends and made help-seeking sound "too easy". They wanted messages to dispel notions of carers as "superheroes", demonstrate that caring and help-seeking is stressful and time-consuming, and that poor decision-making and relationship breakdown does occur. Feedback was incorporated to co-produce a revised suite of resources. CONCLUSIONS Beyond language translation, cultural adaptation using co-design provided participants the opportunity to develop more culturally relevant care resources that meet their needs. These resources will be evaluated for clinical and cost-effectiveness in future research. CLINICAL IMPLICATIONS By design, multilingual resources for carers must incorporate cultural needs to communicate support messages. If this intervention is effective, it could help to reduce dementia care disparities in ethnically diverse populations in Australia and globally.
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Affiliation(s)
- Thu Ha Dang
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
| | - Antonia Thodis
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Nalika Ulapane
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Centre for Health Economics and Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Mary Gurgone
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Centre of Capability and Culture, Perth, Australia
- Association of Culturally Appropriate Services (AfCAS), Perth, Australia
- Perth Foundation for Women, Perth, Australia
| | - Tuan Nguyen
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
- Faculty of Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Health Strategy and Policy Institute, Hanoi, Viet Nam
| | - Andrew Gilbert
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- Department of Social Inquiry, La Trobe University, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Digital Health Cooperative Research Centre, Swinburne University of Technology, Melbourne, Australia
| | | | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Joanne Enticott
- Centre for Health Economics and Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Duncan Mortimer
- Centre for Health Economics and Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Briony Dow
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
- School of Social Sciences, University of Western Australia, Perth, Australia
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Abstract
PURPOSE OF REVIEW Dementia policy priorities recommend that people who are living with dementia and their family should have access to support and interventions delivered by dementia specialists, including specialist nurses. However, specialist dementia nursing models and role-related competencies are not clearly defined. We systematically review the current evidence regarding specialist dementia nursing models and their impacts. RECENT FINDINGS Thirty-one studies from across three databases, and grey literature were included in the review. One framework defining specific specialist dementia nursing competencies was found. We did not find convincing evidence of the effectiveness of specialist nursing dementia services, relative to standard models of care from the current, limited evidence base, although families living with dementia valued it. No Randomised Controlled Trial (RCT) has compared the impact of specialist nursing on client and carer outcomes relative to less specialist care, although one nonrandomised study reported that specialist dementia nursing reduces emergency and inpatient service use compared with a usual care group. SUMMARY Current models of specialist dementia nursing are numerous and heterogeneous. Further exploration of the specialist nursing skills and the impact of specialist nursing interventions is needed to usefully inform workforce development strategies and clinical practice.
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Affiliation(s)
- Pat Brown
- Division of Psychiatry, University college London, and Dementia UK
| | | | - Jordan Ayden
- Division of Psychiatry, University College London
| | - Karen Harrison Dening
- Faculty of Health and Life Sciences, De Montfort University, Leicester, and Dementia UK
| | - Juanita Hoe
- Geller Institute of Ageing and Memory (GIAM), University of West London
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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27
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John A, Saunders R, Desai R, Bell G, Fearn C, Buckman JEJ, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, Richards M, Stott J. Associations between psychological therapy outcomes for depression and incidence of dementia. Psychol Med 2023; 53:4869-4879. [PMID: 36106698 PMCID: PMC10476047 DOI: 10.1017/s0033291722002537] [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: 02/14/2022] [Revised: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia. METHODS National psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later. RESULTS Improvements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (HR = 0.88, 95% CI 0.83-0.94), after adjustment for key covariates. Strongest effects were observed for vascular dementia (HR = 0.86, 95% CI 0.77-0.97) compared with Alzheimer's disease (HR = 0.91, 95% CI 0.83-1.00). CONCLUSIONS Reliable improvement in depression across psychological therapy was associated with reduced incidence of future dementia. Results are consistent with at least two possibilities. Firstly, psychological interventions to improve symptoms of depression may have the potential to contribute to dementia risk reduction efforts. Secondly, psychological therapies may be less effective in people with underlying dementia pathology or they may be more likely to drop out of therapy (reverse causality). Tackling the under-representation of older people in psychological therapies and optimizing therapy outcomes is an important goal for future research.
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Affiliation(s)
- Amber John
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Rob Saunders
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
| | - Roopal Desai
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Georgia Bell
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Caroline Fearn
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Joshua E. J. Buckman
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Barbara Brown
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Shirley Nurock
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Stewart Michael
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Paul Ware
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | | | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Josh Stott
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
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Giebel C, Reilly S, Gabbay M, Dickinson J, Tetlow H, Hogan H, Griffiths A, Cooper C. Dementia care navigation: A systematic review on different service types and their prevalence. Int J Geriatr Psychiatry 2023; 38:e5977. [PMID: 37526320 DOI: 10.1002/gps.5977] [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: 01/17/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. METHODS The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non-clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. RESULTS We included 14 papers reporting on six studies. All services were US-based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well-being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. CONCLUSIONS DCN services have the potential to effectively provide non-clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Siobhan Reilly
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Julie Dickinson
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Hilary Tetlow
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | | | - Alys Griffiths
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - Claudia Cooper
- Centre of Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London, UK
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Cooper C, Dawson-Hughes B, Halbout P, Harvey NC, Kanis JA, Reginster JY, Rizzoli R. In Memoriam : Lorie Fitzpatrick MD - 1954-2023. Osteoporos Int 2023; 34:1281-1282. [PMID: 37162536 DOI: 10.1007/s00198-023-06767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - B Dawson-Hughes
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - P Halbout
- International Osteoporosis Foundation, Nyon, Switzerland
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - J-Y Reginster
- World Health Organization (WHO) Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Rizzoli
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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O'Nions E, Petersen I, Buckman JE, Charlton R, Cooper C, Corbett A, Happé F, Manthorpe J, Richards M, Saunders R, Zanker C, Mandy W, Stott J. Autism in England: assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data. Lancet Reg Health Eur 2023; 29:100626. [PMID: 37090088 PMCID: PMC10114511 DOI: 10.1016/j.lanepe.2023.100626] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Background Autism has long been viewed as a paediatric condition, meaning that many autistic adults missed out on a diagnosis as children when autism was little known. We estimated numbers of diagnosed and undiagnosed autistic people in England, and examined how diagnostic rates differed by socio-demographic factors. Methods This population-based cohort study of prospectively collected primary care data from IQVIA Medical Research Data (IMRD) compared the prevalence of diagnosed autism to community prevalence to estimate underdiagnosis. 602,433 individuals registered at an English primary care practice in 2018 and 5,586,100 individuals registered between 2000 and 2018 were included. Findings Rates of diagnosed autism in children/young people were much higher than in adults/older adults. As of 2018, 2.94% of 10- to 14-year-olds had a diagnosis (1 in 34), vs. 0.02% aged 70+ (1 in 6000). Exploratory projections based on these data suggest that, as of 2018, 463,500 people (0.82% of the English population) may have been diagnosed autistic, and between 435,700 and 1,197,300 may be autistic and undiagnosed (59-72% of autistic people, 0.77%-2.12% of the English population). Age-related inequalities were also evident in new diagnoses (incidence): c.1 in 250 5- to 9-year-olds had a newly-recorded autism diagnosis in 2018, vs. c.1 in 4000 20- to 49-year-olds, and c.1 in 18,000 people aged 50+. Interpretation Substantial age-related differences in the proportions of people diagnosed suggest an urgent need to improve access to adult autism diagnostic services. Funding Dunhill Medical Trust, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, the Wellcome Trust, and the Royal College of Psychiatrists.
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El Baou C, Desai R, Cooper C, Marchant NL, Pilling S, Richards M, Saunders R, Buckman JEJ, Aguirre E, John A, Stott J. Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England. Eur Heart J 2023; 44:1650-1662. [PMID: 37072130 PMCID: PMC10163979 DOI: 10.1093/eurheartj/ehad188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 04/20/2023] Open
Abstract
AIMS People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. METHODS AND RESULTS A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES-ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses. CONCLUSION Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.
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Affiliation(s)
- Céline El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| | - Roopal Desai
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | | | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope—Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
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Rees J, Burton A, Walters K, Cooper C. Exploring the provision and support of care for long-term conditions in dementia: A qualitative study combining interviews and document analysis. Dementia (London) 2023; 22:820-837. [PMID: 36883009 PMCID: PMC9996169 DOI: 10.1177/14713012231161854] [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] [Indexed: 03/09/2023]
Abstract
BACKGROUND The challenge of managing multiple long-term conditions is a prevalent issue for people with dementia and those who support their care. The presence of dementia complicates healthcare delivery and the development of personalised care plans, as health systems and clinical guidelines are often designed around single condition services. OBJECTIVE This study aimed to explore how care for long-term conditions is provided and supported for people with dementia in the community. METHODS In a qualitative, case study design, consecutive telephone or video-call interviews were conducted with people with dementia, their family carers and healthcare providers over a four-month period. Participant accounts were triangulated with documentary analysis of primary care medical records and event-based diaries kept by participants with dementia. Thematic analysis was used to develop across-group themes. FINDINGS Six main themes were identified from eight case studies: 1) Balancing support and independence, 2) Implementing and adapting advice for dementia contexts, 3) Prioritising physical, cognitive and mental health needs, 4) Competing and entwined needs and priorities, 5) Curating supportive professional networks, 6) Family carer support and coping. DISCUSSION These findings reflect the dynamic nature of dementia care which requires the adaptation of support in response to changing need. We witnessed the daily realities for families of implementing care recommendations in the community, which were often adapted for the contexts of family carers' priorities for care of the person living with dementia and what they were able to provide. Realistic self-management plans which are deliverable in practice must consider the intersection of physical, cognitive and mental health needs and priorities, and family carers needs and resources.
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Affiliation(s)
- Jessica Rees
- Division of Psychiatry, 4919University College London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health4919, University College London, London, UK
| | - Kate Walters
- Primary Care and Population Health, 4919University College London, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental health, Wolfson Institute of Population Health, 4617Queen Mary University of London, London, UK
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Moore KJ, Crawley S, Fisher E, Cooper C, Vickerstaff V, Sampson EL. Exploring how family carers of a person with dementia manage pre-death grief: A mixed methods study. Int J Geriatr Psychiatry 2023; 38:e5867. [PMID: 36862574 DOI: 10.1002/gps.5867] [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: 04/29/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Many family carers of a person with dementia experience pre-death grief. We aimed to identify strategies that help carers manage pre-death grief. We hypothesised that emotion and problem focussed styles would be associated with lower, and dysfunctional coping with higher grief intensity. METHODS Mixed methods observational study using structured and semi-structured interviews with 150 family carers of people with dementia living at home or in a care home. Most participants were female (77%), caring for a parent (48%) or partner/spouse (47%) with mild (25%), moderate (43%) or severe (32%) dementia. They completed the Marwit-Meuser Caregiver Grief Inventory Short Form and the Brief Coping Orientation to Problems Experienced (Brief-COPE) questionnaire. We asked carers to identify strategies used for managing grief. We recorded field notes for 150 interviews and audio-recorded additional interviews with a sub-sample of 16 participants. RESULTS Correlations indicated that emotion-oriented coping was associated with lower grief (R = -0.341), and dysfunctional coping with higher grief (R = 0.435), with a small association with problem-focused strategies (R = -0.109), partly supporting our hypothesis. Our qualitative themes broadly match the three Brief-COPE styles. Unhelpful strategies of denial and avoidance align with dysfunctional coping strategies. Psychological strategies (including acceptance and humour) and seeking support were consistent with emotion-focused strategies, but we did not identify a theme relating to problem-focused strategies. CONCLUSION Most carers identified multiple strategies for processing grief. Carers could readily identify supports and services that they found helpful for managing pre-death grief, yet current services appear under-resourced to meet growing demand. (ClinicalTrials.gov ID: NCT03332979).
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Affiliation(s)
- Kirsten J Moore
- National Ageing Research Institute, Parkville, Victoria, Australia
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
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Shoham N, Lewis G, Hayes JF, Silverstein SM, Cooper C. Association between visual impairment and psychosis: A longitudinal study and nested case-control study of adults. Schizophr Res 2023; 254:81-89. [PMID: 36805651 DOI: 10.1016/j.schres.2023.02.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Theories propose that visual impairment might increase the risk of psychosis, and vice versa. We aimed to investigate the relationship between visual impairment and psychosis in the UK Biobank cohort. STUDY DESIGN In a nested case control study of ~116,000 adults, we tested whether a Schizophrenia Spectrum Disorder (SSD) diagnosis as exposure was associated with visual impairment. We also tested longitudinally whether poorer visual acuity, and thinner retinal structures on Optical Coherence Tomography (OCT) scans in 2009 were associated with psychotic experiences in 2016. We adjusted for age, sex, depression and anxiety symptoms; and socioeconomic variables and vascular risk factors where appropriate. We compared complete case with multiple imputation models, designed to reduce bias potentially introduced by missing data. RESULTS People with visual impairment had greater odds of SSD than controls in multiply imputed data (Adjusted Odds Ratio [AOR] 1.42, 95 % Confidence Interval [CI] 1.05-1.93, p = 0.021). We also found evidence that poorer visual acuity was associated with psychotic experiences during follow-up (AOR per 0.1 point worse visual acuity score 1.06, 95 % CI 1.01-1.11, p = 0.020; and 1.04, 95 % CI 1.00-1.08, p = 0.037 in right and left eye respectively). In complete case data (15 % of this cohort) we found no clear association, although confidence intervals included the multiple imputation effect estimates. OCT measures were not associated with psychotic experiences. CONCLUSIONS Our findings highlight the importance of eye care for people with psychotic illnesses. We could not conclude whether visual impairment is a likely causal risk factor for psychosis.
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Affiliation(s)
- Natalie Shoham
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.
| | - Gemma Lewis
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Joseph F Hayes
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK
| | - Steven M Silverstein
- University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Boulevard, Rochester, NY 14642, USA; Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Claudia Cooper
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AD, UK; East London NHS Foundation Trust, UK
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Shoham N, Dunca D, Cooper C, Hayes JF, McQuillin A, Bass N, Lewis G, Kuchenbaecker K. Investigating the association between schizophrenia and distance visual acuity: Mendelian randomisation study. BJPsych Open 2023; 9:e33. [PMID: 36746515 PMCID: PMC9970182 DOI: 10.1192/bjo.2023.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Increased rates of visual impairment are observed in people with schizophrenia. AIMS We assessed whether genetically predicted poor distance acuity is causally associated with schizophrenia, and whether genetically predicted schizophrenia is causally associated with poorer visual acuity. METHOD We used bidirectional, two-sample Mendelian randomisation to assess the effect of poor distance acuity on schizophrenia risk, poorer visual acuity on schizophrenia risk and schizophrenia on visual acuity, in European and East Asian ancestry samples ranging from approximately 14 000 to 500 000 participants. Genetic instrumental variables were obtained from the largest available summary statistics: for schizophrenia, from the Psychiatric Genomics Consortium; for visual acuity, from the UK Biobank; and for poor distance acuity, from a meta-analysis of case-control samples. We used the inverse variance-weighted method and sensitivity analyses to test validity of results. RESULTS We found little evidence that poor distance acuity was causally associated with schizophrenia (odds ratio 1.00, 95% CI 0.91-1.10). Genetically predicted schizophrenia was associated with poorer visual acuity (mean difference in logMAR score: 0.024, 95% CI 0.014-0.033) in European ancestry samples, with a similar but less precise effect that in smaller East Asian ancestry samples (mean difference: 0.186, 95% CI -0.008 to 0.379). CONCLUSIONS Genetic evidence supports schizophrenia being a causal risk factor for poorer visual acuity, but not the converse. This highlights the importance of visual care for people with psychosis and refutes previous hypotheses that visual impairment is a potential target for prevention of schizophrenia.
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Affiliation(s)
- Natalie Shoham
- Division of Psychiatry, University College London, UK; and Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Correspondence: Natalie Shoham.
| | - Diana Dunca
- UCL Genetics Institute, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; and Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Nick Bass
- Division of Psychiatry, University College London, UK; and Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, UK
| | - Karoline Kuchenbaecker
- Division of Psychiatry, University College London, UK; and UCL Genetics Institute, University College London, UK
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Carter C, James T, Higgs P, Cooper C, Rapaport P. Understanding the subjective experiences of memory concern and MCI diagnosis: A scoping review. Dementia (London) 2023; 22:439-474. [PMID: 36574609 PMCID: PMC9841475 DOI: 10.1177/14713012221147710] [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] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Many older people experience memory concerns; a minority receive a diagnosis of Mild Cognitive Impairment (MCI) or Subjective Cognitive decline (SCD). There are concerns that medicalisation of MCI and memory concern may fail to acknowledge subjective experiences. AIM We explore the meaning individuals give to their memory concerns, with or without a diagnosis of MCI and SCD. METHOD We scoped literature exploring subjective experiences of memory concern, with or without a diagnosis of MCI or SCD. We searched CINAHL, PsycINFO and MEDLINE in March 2020, and updated in Sept 2021.We used (Arksey & O'Malley, 2005) framework to guide our scoping review method and thematic analysis to analyse our findings. RESULTS We screened 12,033 search results reviewing the full texts of 92 papers. We included 24 papers, including a total of 453 participants, the majority of whom were female, from White ethnic majority populations (or from studies where ethnicity was not identified) with high levels of education. In 15 out of 24 studies, 272 participants were diagnosed with MCI. We identified two themes; Making a diagnosis personal and Remembering not to forget. We found that subjective experiences include normative comparison with others of the same age and responses including fear, relief, and acceptance, but culminating in uncertainty. CONCLUSION Drawing upon sociology, we highlight the subjective experiences of living with memory concerns, SCD and an MCI diagnosis. We identify a gap between the intended purpose of diagnostic labels to bring understanding and certainty and the lived experiences of those ascribed them.
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Affiliation(s)
- Christine Carter
- Christine Carter, Division of Psychiatry,
University College London, Maple House, 149 Tottenham Court Road, Bloomsbury,
London W1T7NF, UK.
| | - Tiffeny James
- Division of Psychiatry, 4919University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, 4919University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, 4919University College London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, 4919University College London, London, UK
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Affiliation(s)
- Sally McManus
- National Centre for Social Research, 35 Northampton Square, London EC1V0AX, UK
- City, University of London, London EC1V 0HB
| | - David Gunnell
- Population Health Sciences, University of Bristol; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, University of London, London EC1V 0HB, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, UK, London, UK
| | | | - Louise M Howard
- IoPPN, Section of Women's Mental Health, Kings College London, London, UK
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rachel Jenkins
- Health Services and Population Research Department, IoPPN, Kings College London, London, UK
| | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Louis Appleby
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Stott J, Saunders R, Desai R, Bell G, Fearn C, Buckman JEJ, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, Richards M, John A. Associations between psychological intervention for anxiety disorders and risk of dementia: a prospective cohort study using national health-care records data in England. Lancet Healthy Longev 2023; 4:e12-e22. [PMID: 36509102 PMCID: PMC10570142 DOI: 10.1016/s2666-7568(22)00242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Meta-analyses support an association between anxiety in older adulthood and dementia. The aim of this study was to use routinely collected health data to test whether treatment of anxiety disorders through psychological intervention is associated with a lower incidence of dementia. METHODS In this prospective cohort study, data from nationally provided psychological therapy services in England termed Improving Access to Psychological Therapies from 2012 to 2019 were linked to medical records, including dementia diagnoses as defined by the tenth edition of the International Classification of Diseases, up to 8 follow-up years later. Inclusion criteria were as follows: (1) patients who were aged 65 years and older; (2) patients with a probable anxiety disorder; and (3) those with no previous or current diagnosis of dementia. Cox proportional hazards models were constructed to test whether reliable improvement in anxiety following psychological intervention was associated with future dementia incidence. The primary outcome was all-cause dementia and cases were identified using ICD-10 dementia codes from Hospital Episode Statistics, Mental Health Services Dataset, and mortality data. For main analyses, hazards ratios (HRs) are presented. FINDINGS Data from 128 077 people aged 65 years and older attending a nationally provided psychological intervention service in England were linked to medical records. 88 019 (69·0%) of 127 064 participants with available gender data were women and 39 585 (31·0%) were men. 111 225 (95·9%) of 115 989 with available ethnicity data were of White ethnicity. The mean age of the sample was 71·55 years (SD 5·69). Fully adjusted models included data from 111 958 people after 16 119 were excluded due to missing data on key variables or covariates. 4510 (4·0%) of 111 958 participants had a dementia diagnosis. The remaining 107 448 (96·0%) were censored either at date of death or when the final follow-up period available for analyses was reached. People who showed reliable improvement in anxiety had lower rates of later dementia diagnosis (3·9%) than those who did not show reliable improvement (5·1%). Reliable improvement in anxiety following psychological intervention was associated with reduced incidence of all-cause dementia (HR 0·83 [95% CI 0·78-0·88]), Alzheimer's disease (HR 0·85 [0·77-0·94]), and vascular dementia (HR 0·80 [0·71-0·90]). Effects did not differ depending on anxiety disorder diagnosis. INTERPRETATION Results showed that reliable improvement in anxiety from psychological therapy was associated with reduced incidence of future dementia. There are multiple plausible explanations for this finding and further research is needed to distinguish between these possibilities. Missing data in the sample limit reliability of findings. FUNDING Alzheimer's Society, Medical Research Council, Wellcome Trust, and UCLH National Institute for Health and Care Research Biomedical Research Centre.
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Affiliation(s)
| | - Rob Saunders
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | | | | | - Joshua E J Buckman
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK; iCope-Camden and Islington Psychological Therapies Services, St Pancras Hospital, London, UK
| | | | | | | | | | | | | | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK
| | - Stephen Pilling
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
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Thodis A, Dang TH, Antoniades J, Gilbert AS, Nguyen T, Hlis D, Gurgone M, Dow B, Cooper C, Xiao LD, Wickramasinghe N, Ulapane N, Varghese M, Loganathan S, Enticott J, Mortimer D, Brijnath B. Improving the lives of ethnically diverse family carers and people living with dementia using digital media resources - Protocol for the Draw-Care randomised controlled trial. Digit Health 2023; 9:20552076231205733. [PMID: 37846403 PMCID: PMC10576921 DOI: 10.1177/20552076231205733] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/19/2023] [Indexed: 10/18/2023] Open
Abstract
Objectives Ethnically diverse family carers of people living with dementia (hereafter carers and people with dementia) experience more psychological distress than other carers. To reduce this inequality, culturally adapted, multilingual, evidence-based practical assistance is needed. This paper details the Draw-Care study protocol including a randomised control trial (RCT) to test the effectiveness of a digital intervention comprising a multilingual website, virtual assistant, animated films, and information, on the lives of carers and people with dementia in Australia. Methods The Draw-Care intervention will be evaluated in a 12-week active waitlist parallel design RCT with 194 carers from Arabic, Cantonese, Greek, Hindi, Italian, Mandarin, Spanish, Tamil, and Vietnamese-speaking language groups. Our intervention was based on the World Health Organization's (WHO) iSupport Lite online carer support messages and was co-designed with carers, people with dementia, service providers, and clinicians. Culturally adapted multilingual digital resources were created in nine languages and English. Results In Phase I (2022), six co-design workshops with stakeholders and interviews with people with dementia informed the development of the intervention which will be trialled and evaluated in Phases II and III (2023 and 2024). Conclusions Digital media content is a novel approach to providing cost-effective access to health care information. This study protocol details the three study phases including the RCT of a co-designed, culturally adapted, multilingual, digital intervention for carers and people with dementia to advance the evidence in dementia and digital healthcare research and help meet the needs of carers and people with dementia in Australia and globally.
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Affiliation(s)
- Antonia Thodis
- National Ageing Research Institute, Parkville, Australia
| | - Thu-Ha Dang
- National Ageing Research Institute, Parkville, Australia
- Swinburne University of Technology, Hawthorn, Australia
| | - Josefine Antoniades
- National Ageing Research Institute, Parkville, Australia
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Clayton, Australia
| | - Andrew S. Gilbert
- National Ageing Research Institute, Parkville, Australia
- Department of General Practice, University of Melbourne, Australia
| | - Tuan Nguyen
- National Ageing Research Institute, Parkville, Australia
- Swinburne University of Technology, Hawthorn, Australia
- University of South Australia, Adelaide, Australia
- Health Strategy and Policy Institute, Hanoi, Viet Nam
| | - Danijela Hlis
- National Ageing Research Institute, Parkville, Australia
- OPAN/NOPRG & Dementia Australia Advocate, Melbourne, Australia
| | - Mary Gurgone
- National Ageing Research Institute, Parkville, Australia
- Centre of Capability and Culture, Melbourne, Australia
- Association of Culturally Appropriate Services (AfCAS), Melbourne, Australia
- Perth Foundation for Women, Melbourne, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Australia
| | | | | | | | | | | | | | - Joanne Enticott
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Clayton, Australia
| | - Duncan Mortimer
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Clayton, Australia
| | - Bianca Brijnath
- National Ageing Research Institute, Parkville, Australia
- University of Western Australia, Perth, Australia
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Zabihi S, Duffy L, Kelleher D, Lord K, Dar A, Koutsoubelis F, Banks S, Rapaport P, Mason C, Vickerstaff V, Barber JA, Manthorpe J, Walters K, Lang I, Rockwood K, Duggan S, Kales H, Cooper C. Feasibility and acceptability of NIDUS-Professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial protocol. BMJ Open 2022; 12:e066166. [PMID: 36572489 PMCID: PMC9806004 DOI: 10.1136/bmjopen-2022-066166] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Most people living with dementia want to remain living in their own homes, and are supported to do so by family carers and homecare workers. There are concerns that homecare is often unable to meet the needs of this client group, with limited evidence regarding effective interventions to improve it for people living with dementia. We have developed a training and support programme for homecare workers (NIDUS-Professional) to be delivered alongside support sessions for people living with dementia and their family carers (NIDUS-Family). We aim to assess (1) its acceptability among homecare workers and employing agencies, and (2) the feasibility of homecare workers, people living with dementia and their family carers completing the outcomes of intervention in a future randomised controlled trial. METHODS AND ANALYSIS This is a cluster-randomised (2:1) single-blind, multisite feasibility trial. We aim to recruit 60-90 homecare workers, 30-60 clients living with dementia and their family carers through 6-9 English homecare agencies. In the intervention arm, homecare staff will be offered six group sessions on video call over three months, followed by monthly group sessions over the subsequent three-month period. Outcome measures will be collected at baseline and at six months. ETHICS AND DISSEMINATION The study received ethical approval on 7 January 2020 from the Camden & King's Cross Research Ethics Committee. Study reference: 19/LO/1667. Findings will be disseminated through a peer-reviewed journal, conference presentation and blog to research and clinical audiences; we will attend forums to present findings to participating homecare agencies and their clients. TRIAL REGISTRATION NUMBER ISRCTN15757555.
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Affiliation(s)
- Sedigheh Zabihi
- Division of Psychiatry, University College London, London, UK
| | - Larisa Duffy
- Division of Psychiatry, University College London, London, UK
| | - Daniel Kelleher
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Kathryn Lord
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Ayesha Dar
- Division of Psychiatry, University College London, London, UK
| | | | - Sara Banks
- Division of Psychiatry, University College London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Clare Mason
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Julie A Barber
- Department of Statistical Science, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Iain Lang
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, Exeter, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Helen Kales
- Department of Psychiatry and Behavioural Sciences, UC Davis Health, University of California, Davis, California, USA
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
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Bogdanova N, Cooper C, Ahmad G, McManus S, Shoham N. Associations between sociodemographic characteristics and receipt of professional diagnosis in Common Mental Disorder: Results from the Adult Psychiatric Morbidity Survey 2014. J Affect Disord 2022; 319:112-118. [PMID: 36155230 DOI: 10.1016/j.jad.2022.09.085] [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: 01/10/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many people with Common Mental Disorders (CMDs), especially men, people from older age groups, and ethnic minority backgrounds, receive no treatment. Self-acknowledgement of mental illness symptoms, and a professional diagnosis are usually required to access treatment. To understand barriers, we therefore tested whether these groups were relatively less likely to self-diagnose a CMD, or to receive a professional diagnosis. METHODS We analysed data from the 2014 English Adult Psychiatric Morbidity Survey (APMS). We used regression models to examine whether gender, age, and minority ethnic status were associated with professional and self-diagnosis, after controlling for CMD symptoms. RESULTS 27.3 % of the population reported a professional and self-diagnosis of CMD, 15.9 % a self- diagnosis only, and the remainder no diagnosis. Odds of professional diagnosis were lower for men compared with women (adjusted odds ratio [AOR] 0.54, 95 % confidence intervals [CI] 0.47-0.62). People from White Other (0.49, 0.36-0.67), Black (0.31, 0.18-0.51), and Asian (0.22, 0.15-0.33) groups were less likely than the White British group to receive a professional diagnosis. The least likely age group to have a professional CMD diagnosis (relative to adults aged 16-34) were people aged over 75 (0.52, 0.39-0.69). Patterns were similar for self-diagnosis. LIMITATIONS Ethnicity categories were heterogeneous. Data are cross-sectional, and selection and response bias are possible. CONCLUSIONS For every three people who self-diagnose CMD, two have a professional diagnosis. Men, ethnic minority, and older age groups are less likely to receive a diagnosis or self-diagnose after adjustment for presence of symptoms.
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Affiliation(s)
- Nadezhda Bogdanova
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Claudia Cooper
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland; Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom of Great Britain and Northern Ireland; East London NHS Foundation Trust, London E1 8DE, United Kingdom of Great Britain and Northern Ireland
| | - Gargie Ahmad
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8EF, United Kingdom of Great Britain and Northern Ireland
| | - Sally McManus
- City, University of London, Northampton Square, London EC1V 0HB, United Kingdom of Great Britain and Northern Ireland; National Centre for Social Research, 35 Northampton Square, London EC1V 0AX, United Kingdom of Great Britain and Northern Ireland
| | - Natalie Shoham
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, United Kingdom of Great Britain and Northern Ireland.
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Wyman DL, Butler L, Bright P, Morgan‐Trimmer S, Budgett J, Cooper C. A systematic review of process evaluations for psychosocial interventions designed to improve the wellbeing and quality of life of community-dwelling people with dementia and their carers. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5828. [PMID: 36317287 PMCID: PMC9827886 DOI: 10.1002/gps.5828] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/16/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Psychosocial interventions improve the wellbeing and quality of life of People Living with Dementia (PLWD) and their family carers; but due to their complexity it can be challenging to identify mechanisms of action. We reviewed process evaluations that have sought to elucidate how these interventions work, to inform their implementation. METHOD We systematically reviewed process evaluations of studies evaluating psychosocial interventions for PLWD in their own home and/or their family carers. We rated study quality using the Mixed Methods Appraisal Tool. We described, with reference to Medical Research Council (2015) process evaluation guidance, how implementation, mechanisms of impact and contextual factors were investigated; and describe commonalities in the mechanisms of action identified across studies. RESULTS Twenty four included studies evaluated the processes of 22 interventions. These studies collectively applied five frameworks; almost all frameworks' advised evaluations were theory-based and used mixed-methods analyses, but only 5/24 evaluation designs were informed by the intervention theory and 8/24 used mixed methods. 8/24 evaluations considered contextual factors in their design, though 20/24 cited contextual factors in findings. Interventions were more successful where PLWD were motivated and aware of potential benefits, and when carers could support engagement and were themselves supported by the intervention. How the intervention aligned with participants' current needs and stage of dementia were key influencing factors. CONCLUSION Knowing how interventions can influence change for community-dwelling people with dementia and their family carer's will improve translation of trial findings into practice. Robust, theory-driven process evaluations can enable this.
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Lvovskiy A, Paz-Soldan C, Eidietis N, Dal Molin A, Nocente M, Cooper C, Rigamonti D, Tardocchi M, Taussig D. Upgrades to the gamma ray imager on DIII-D enabling access to high flux hard x-ray measurements during the runaway electron plateau phase (invited). Rev Sci Instrum 2022; 93:113524. [PMID: 36461541 DOI: 10.1063/5.0101690] [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] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/07/2022] [Indexed: 06/17/2023]
Abstract
The Gamma Ray Imager (GRI) is a pinhole camera providing 2D imaging of MeV hard x-ray (HXR) bremsstrahlung emission from runaway electrons (REs) over the poloidal cross section of the DIII-D tokamak. We report a series of upgrades to the GRI expanding the access to RE scenarios from the diagnosis of a trace amount of REs to high flux HXR measurements during the RE plateau phase. We present the implementation of novel gamma ray detectors based on LYSO and YAP crystals coupled to multi-pixel photon counters, enabling a count rate in excess of 1 MHz. Finally, we highlight new insights into the RE physics discovered during the current quench and RE plateau phase experiments as the result of these upgrades.
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Affiliation(s)
- A Lvovskiy
- General Atomics, P.O. Box 85608, San Diego, California 92186, USA
| | - C Paz-Soldan
- General Atomics, P.O. Box 85608, San Diego, California 92186, USA
| | - N Eidietis
- General Atomics, P.O. Box 85608, San Diego, California 92186, USA
| | - A Dal Molin
- Dipartimento di Fisica, Università degli Studi di Milano-Bicocca, 20126 Milan, Italy
| | - M Nocente
- Dipartimento di Fisica, Università degli Studi di Milano-Bicocca, 20126 Milan, Italy
| | - C Cooper
- Oak Ridge Associated Universities, Oak Ridge, Tennessee 37830, USA
| | - D Rigamonti
- Istituto per la Scienza e Tecnologia dei Plasmi, CNR, 20126 Milan, Italy
| | - M Tardocchi
- Istituto per la Scienza e Tecnologia dei Plasmi, CNR, 20126 Milan, Italy
| | - D Taussig
- General Atomics, P.O. Box 85608, San Diego, California 92186, USA
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Walker-Bone K, D’Angelo S, Linaker CH, Stevens MJ, Ntani G, Cooper C, Syddall HE. Morbidities among older workers and work exit: the HEAF cohort. Occup Med (Lond) 2022; 72:470-477. [PMID: 35904117 PMCID: PMC9578672 DOI: 10.1093/occmed/kqac068] [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: 11/13/2022] Open
Abstract
BACKGROUND Governments need people to work to older ages, but the prevalence of chronic disease and comorbidity increases with age and impacts work ability. AIMS To investigate the effects of objective health diagnoses on exit from paid work amongst older workers. METHODS Health and Employment After Fifty (HEAF) is a population cohort of adults aged 50-64 years recruited from English GP practices which contribute to the Clinical Practice Research Datalink (CPRD). Participants have completed questionnaires about health and work at baseline and annually for 2 years: their responses were linked with their objective health diagnoses from the CPRD and data analysed using Cox regression. RESULTS Of 4888 HEAF participants ever in paid work, 580 (25%) men and 642 (25%) women exited employment, 277 of them mainly or partly for a health reason (health-related job loss (HRJL)). Amongst HEAF participants who remained in work (n = 3666) or who exited work but not for health reasons (n = 945), there was a similar prevalence of background health conditions. In men and women, HRJL was associated with inflammatory arthritis, sleep disorders, common mental health conditions and musculoskeletal pain. There were however gender differences: widespread pain and lower limb osteoarthritis were associated with HRJL in women but hypertension and cardiovascular disease in men. CONCLUSIONS Improved diagnosis and management of common conditions might be expected to increase working lives. Workplace well-being interventions targeting obesity and increasing mobility might contribute to extended working lives. Employers of predominantly female, as compared with male workforces may need different strategies to retain older workers.
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Affiliation(s)
- K Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Australia
| | - S D’Angelo
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - C H Linaker
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - M J Stevens
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - G Ntani
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - C Cooper
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - H E Syddall
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton SO16 6YD, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
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Bataiosu R, Scolari FL, Brahmbhatt D, Hoss S, Chow C, Cooper C, Tsoi M, Rowin E, Maron MS, Billia F, Ralph-Edwards A, Rakowski H, Adler A. Left atrial remodelling after septal myectomy is associated with a reduced 5-year risk of atrial fibrillation in hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1726] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial diameter (LAD) is an established predictor of atrial fibrillation (AF) and adverse outcomes in hypertrophic cardiomyopathy (HCM). However, the impact of LAD remodelling after surgical myectomy on the development of late onset AF is still poorly understood.
Purpose
To investigate the association between LAD remodelling and new occurrence of AF in the first five years after surgical myectomy in a large patient population with HCM.
Methods
1177 HCM patients without a history of AF, subjected to surgical myectomy at two referral centres between 2001 and 2020 were retrospectively reviewed. Paired echocardiographic studies before and shortly after surgical myectomy were available in 894 (76%) patients and 889 (75%) patients had complete LAD measurements, defined as the anteroposterior diameter at end-systole from parasternal long axis view. LAD was considered normal when ≤40mm. Late onset AF was determined as AF documented between one month and 5 years follow up after myectomy. Patients were grouped as having normal LAD pre- and post-myectomy (group 1), enlarged pre-myectomy LAD but normal post-myectomy LAD (group 2), and those with enlarged LAD post-myectomy (group 3). Cox proportional hazards models were applied to evaluate the impact of LAD on late onset AF.
Results
Late onset AF was detected in 63 (7%) patients, 56% male, with an incidence of 1%/year. Patients with AF were older (56±13 vs. 52±14 years, p=0.03), had a larger post-surgery LAD (44±7 vs. 41±6 mm, p<0.001) and a lower left ventricular ejection fraction (58±6 vs. 61±6%, p=0.002) compared to patients without AF. Postoperative left ventricular maximal wall thickness (14±4 mm vs. 15±4mm, p=0.53), left ventricular outflow tract obstruction (6% vs. 8%, p=0.49) or moderate/severe mitral regurgitation (13% vs. 9%, p=0.29) were similar between patients with and without late onset AF. Among the 227 patients in group 1, late onset AF occurred in only 5 (3%), in comparison to 8 (5%) of 182 patients in group 2, and in 36 (10%) of the 480 patients in group 3 (p=0.006). Using group 1 as reference, the hazard ratio for developing AF was 2.1 (95% CI 0.7–6.5, p=0.15) for patients in group 2 and 3.5 (95% CI 1.4–9.4, p=0.005) for patients in group 3.
Conclusion
In our study we were able to show that the overall post-myectomy 5-year risk for developing AF was 1%/year. Normal LAD and reverse LAD remodelling correlated with a lower risk for developing late onset AF, whereas a higher risk was associated with enlarged post-myectomy LAD. These results highlight the possible clinical benefit of LAD remodelling after myectomy in reducing late onset AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bataiosu
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - F L Scolari
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - D Brahmbhatt
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - S Hoss
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - C Chow
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - C Cooper
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - M Tsoi
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - E Rowin
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - M S Maron
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - F Billia
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - A Ralph-Edwards
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - H Rakowski
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - A Adler
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
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Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Brown B, Nurock S, Michael S, Ware P, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England. EClinicalMedicine 2022; 52:101692. [PMID: 36313148 PMCID: PMC9596302 DOI: 10.1016/j.eclinm.2022.101692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia. Methods National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration). Findings Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia. Interpretation Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes. Funding This work was supported by the Alzheimer's Society.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E. J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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Canoy D, Harvey NC, Prieto-Alhambra D, Cooper C, Meyer HE, Åsvold BO, Nazarzadeh M, Rahimi K. Correction: Elevated blood pressure, antihypertensive medications and bone health in the population: revisiting old hypotheses and exploring future research directions. Osteoporos Int 2022; 33:2241. [PMID: 35997785 PMCID: PMC9546964 DOI: 10.1007/s00198-022-06537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- D Canoy
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK.
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - N C Harvey
- MRC Life Course Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Cooper
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- MRC Life Course Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H E Meyer
- Department of Community Medicine and Global Health, Faculty of Medicine, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - B O Åsvold
- Department of Endocrinology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - M Nazarzadeh
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK
| | - K Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Vandenput L, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int 2022; 33:2103-2136. [PMID: 35639106 DOI: 10.1007/s00198-022-06435-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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Affiliation(s)
- L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Center Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Bone Biology, Healthy Ageing Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Oxford Biomedical Research Unit, , University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, University Hospital and University of Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - P J M Elders
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, Arctic University of Norway, Tromsø, Norway
| | - P Nordström
- Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- Institute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Barwon Health, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP (Research Group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
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Cooper C, Zack S, Shah S. Implementation of a COVID-19 Vaccination Program in the Emergency Department. Hosp Pharm 2022; 57:599-602. [PMID: 36081542 PMCID: PMC9445539 DOI: 10.1177/00185787221095773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
| | | | - Shailly Shah
- Emory University Hospital Midtown, Atlanta, GA, USA
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50
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Ahmad G, McManus S, Cooper C, Hatch SL, Das-Munshi J. Prevalence of common mental disorders and treatment receipt for people from ethnic minority backgrounds in England: repeated cross-sectional surveys of the general population in 2007 and 2014. Br J Psychiatry 2022; 221:520-527. [PMID: 35049474 DOI: 10.1192/bjp.2021.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Concerns persist that some ethnic minority groups experience longstanding mental health inequalities in England. It is unclear if these have changed over time. AIMS To assess the prevalence of common mental disorders (CMDs) and treatment receipt by ethnicity, and changes over time, using data from the nationally representative probability sample in the Adult Psychiatric Morbidity Surveys. METHOD We used survey data from 2007 (n = 7187) and 2014 (n = 7413). A Clinical Interview Schedule - Revised score of ≥12 indicated presence of a CMD. Treatment receipt included current antidepressant use; any counselling or therapy; seeing a general practitioner about mental health; or seeing a community psychiatrist, psychologist or psychiatric nurse, in the past 12 months. Multivariable logistic regression assessed CMD prevalence and treatment receipt by ethnicity. RESULTS CMD prevalence was highest in the Black group; ethnic variation was explained by demographic and socioeconomic factors. After adjustment for these factors and CMDs, odds ratios for treatment receipt were lower for the Asian (0.62, 95% CI 0.39-1.00) and White Other (0.58, 95% CI 0.38-0.87) groups in 2014, compared with the White British group; for the Black group, this inequality appeared to be widening over time (2007 treatment receipt odds ratio 0.68, 95% CI 0.38-1.23; 2014 treatment receipt odds ratio 0.23, 95% CI 0.13-0.40; survey year interaction P < 0.0001). CONCLUSIONS Treatment receipt was lower for all ethnic minority groups compared with the White British group, and lowest among Black people, for whom inequalities appear to be widening over time. Addressing socioeconomic inequality could reduce ethnic inequalities in mental health problems, but this does not explain pronounced treatment inequalities.
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Affiliation(s)
- Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, and National Centre for Social Research, UK
| | - Claudia Cooper
- Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Stephani L Hatch
- ESRC Centre for Society and Mental Health, King's College London, UK
| | - Jayati Das-Munshi
- ESRC Centre for Society and Mental Health, King's College London, UK
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