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Nicholls E. "I don't want to introduce it into new places in my life": The marketing and consumption of no and low alcohol drinks. Int J Drug Policy 2023; 119:104149. [PMID: 37544104 DOI: 10.1016/j.drugpo.2023.104149] [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: 05/15/2023] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Recent years have seen an expanding 'no and low alcohol' (NoLo) drinks market in the United Kingdom and other high-income countries. With the UK government pledging to increase the availability of NoLos and encourage their consumption, further research is required to underpin policy and explore the potential for NoLos to ease - or exacerbate - alcohol-related harm. METHODS This paper draws on original primary research on NoLo marketing and consumption in the UK; analysis of two NoLo marketing campaigns and semi-structured interviews with both drinkers and non-drinkers who consume NoLos. FINDINGS AND DISCUSSION Addition marketing was identified in the promotion of NoLo products, encouraging consumers to incorporate NoLo consumption into new spatial and temporal contexts on top of their typical weekly drinking patterns. However, there was resistance towards these practices from consumers, who stressed they were more likely to drink NoLos in place of alcohol and incorporate them into their existing drinking routines. CONCLUSION This paper expands a currently very limited evidence base and contributes directly to ongoing debates around 'addition' versus 'substitution' (i.e. whether NoLo products are being used on top of or in place of alcohol). Findings highlight both some of the challenges and opportunities of the expanding market, pointing towards the problematic presence of 'addition marketing' but also highlighting the ways consumers might challenge this and use NoLos flexibly to reduce consumption. As a result, NoLo promotion could function as one tool amongst many to help at least some consumers drink in moderation, alongside a broader package of measures such as education and wider social change.
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Affiliation(s)
- Emily Nicholls
- Lecturer in Sociology, University of York, United Kingdom.
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Nicholls E, Conroy D. ‘I’ve gone from one extreme to the other’: critical junctures in relationships with alcohol during the COVID-19 pandemic. Drugs: Education, Prevention and Policy 2023. [DOI: 10.1080/09687637.2023.2177524] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
| | - Dominic Conroy
- Principal Lecturer in Psychology, London Metropolitan University, London, UK
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Atkinson AM, Matthews BR, Nicholls E, Sumnall H. 'Some days I am a lunatic that thinks I can moderate': Amalgamating recovery and neo-liberal discourses within accounts of non-drinking among women active in the 'positive sobriety' community on Instagram in the UK. Int J Drug Policy 2023; 112:103937. [PMID: 36566608 DOI: 10.1016/j.drugpo.2022.103937] [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] [Received: 09/01/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In recent years, reductions in drinking in the UK and the rise of online 'positive' sobriety communities have been observed, yet peer led support groups such as Alcoholics Anonymous (AA) and neo-liberal discourses of control and responsibility dominate public understandings of (problematic) alcohol use. This paper presents research exploring how women active in the 'positive sobriety' community on Instagram position and construct their non-drinking identities and relationships with alcohol within these overlapping discourses. METHODS Semi-structured interviews (n=15) and online content produced by women active in the positive sobriety community on Instagram were analysed using thematic analysis. FINDINGS Women challenged, reproduced and amalgamated AA discourses of addiction, and the broader discourses of neo-liberalism, in ways that positioned (alcohol) consumption, agency, control and individual responsibility as defining features of feminine identity making. Drawing on these discourses, binary understandings of problematic drinking, the identity of the 'alcoholic', and the need to reach 'rock bottom' in the recovery process were rejected and challenged, but at times reproduced. Whilst a broader framing of problematic drinking that situated drinking problems on a spectrum was constructed, abstinence was engaged with and promoted as the most effective way of gaining control and responsibility over drinking in gendered ways, and in establishing an authentic sense of self. CONCLUSION This paper contributes to emerging research on online 'positive' sobriety communities, their gendered nature, and the intertwined presence of traditional recovery and neo-liberal discourses in women's accounts. Online sober communities offered alternative spaces of support and allowed for sobriety and sober femininities to be framed more positively than within traditional AA conceptualisations. However, those involved may experience tensions around (a) the need to 'tell' their personal stories of complete abstinence whilst still appealing to those who seek to 'moderate' and (b) the pressure to create and craft an 'authentic' sober self on an online platform that demands a carefully curated self-image and personal 'brand'. Further research should aim to gain more understanding of the role social media plays in "doing" sobriety and non-drinking, how this is done by people of different genders, the intersectional experiences of those participating, and how these communities can be made more equally available and accessible to those who do not consider full abstinence as necessary, whilst still appealing to those that do.
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Affiliation(s)
- Amanda Marie Atkinson
- Public Health Institute, Liverpool John Moores University, United Kingdom; Department of Sociology, University of York, UK.
| | - Beth Rachel Matthews
- Public Health Institute, Liverpool John Moores University, United Kingdom; Department of Sociology, University of York, UK
| | - Emily Nicholls
- Public Health Institute, Liverpool John Moores University, United Kingdom; Department of Sociology, University of York, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, United Kingdom; Department of Sociology, University of York, UK
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Lunnay B, Nicholls E, Pennay A, MacLean S, Wilson C, Meyer SB, Foley K, Warin M, Olver I, Ward PR. Sober Curiosity: A Qualitative Study Exploring Women's Preparedness to Reduce Alcohol by Social Class. Int J Environ Res Public Health 2022; 19:ijerph192214788. [PMID: 36429505 PMCID: PMC9690974 DOI: 10.3390/ijerph192214788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Urgent action is required to identify socially acceptable alcohol reduction options for heavy-drinking midlife Australian women. This study represents innovation in public health research to explore how current trends in popular wellness culture toward 'sober curiosity' (i.e., an interest in what reducing alcohol consumption would or could be like) and normalising non-drinking could increase women's preparedness to reduce alcohol consumption. METHODS Qualitative interviews were undertaken with 27 midlife Australian women (aged 45-64) living in Adelaide, Melbourne and Sydney in different social class groups (working, middle and affluent-class) to explore their perceptions of sober curiosity. RESULTS Women were unequally distributed across social-classes and accordingly the social-class analysis considered proportionally the volume of data at particular codes. Regardless, social-class patterns in women's preparedness to reduce alcohol consumption were generated through data analysis. Affluent women's preparedness to reduce alcohol consumption stemmed from a desire for self-regulation and to retain control; middle-class women's preparedness to reduce alcohol was part of performing civility and respectability and working-class women's preparedness to reduce alcohol was highly challenging. Options are provided for alcohol reduction targeting the social contexts of consumption (the things that lead midlife women to feel prepared to reduce drinking) according to levels of disadvantage. CONCLUSION Our findings reinstate the importance of recognising social class in public health disease prevention; validating that socially determined factors which shape daily living also shape health outcomes and this results in inequities for women in the lowest class positions to reduce alcohol and related risks.
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Affiliation(s)
- Belinda Lunnay
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide 5000, Australia
| | - Emily Nicholls
- Department of Sociology, University of York, York YO10 5DD, UK
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Melbourne 3000, Australia
| | - Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Melbourne 3000, Australia
| | - Carlene Wilson
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Kristen Foley
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide 5000, Australia
| | - Megan Warin
- Fay Gale Centre for Research
on Gender, School of Social Sciences, University of Adelaide, Adelaide 5000, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide 5000, Australia
| | - Paul R. Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide 5000, Australia
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Nicholls E, Rands SA, Botías C, Hempel de Ibarra N. Flower sharing and pollinator health: a behavioural perspective. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210157. [PMID: 35491598 DOI: 10.1098/rstb.2021.0157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Disease is an integral part of any organisms' life, and bees have evolved immune responses and a suite of hygienic behaviours to keep them at bay in the nest. It is now evident that flowers are another transmission hub for pathogens and parasites, raising questions about adaptations that help pollinating insects stay healthy while visiting hundreds of plants over their lifetime. Drawing on recent advances in our understanding of how bees of varying size, dietary specialization and sociality differ in their foraging ranges, navigational strategies and floral resource preferences, we explore the behavioural mechanisms and strategies that may enable foraging bees to reduce disease exposure and transmission risks at flowers by partitioning overlapping resources in space and in time. By taking a novel behavioural perspective, we highlight the missing links between disease biology and the ecology of plant-pollinator relationships, critical for improving the understanding of disease transmission risks and the better design and management of habitat for pollinator conservation. This article is part of the theme issue 'Natural processes influencing pollinator health: from chemistry to landscapes'.
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Affiliation(s)
- E Nicholls
- Evolution, Behaviour and Environment, School of Life Sciences, University of Sussex, Brighton BN1 9QG, UK
| | - S A Rands
- School of Biological Sciences, University of Bristol, Bristol BS8 1TQ, UK
| | - C Botías
- Instituto Regional de Investigación y Desarrollo Agroalimentario y Forestal de Castilla La Mancha (IRIAF), CIAPA de Marchamalo, 19180 Guadalajara, Spain
| | - N Hempel de Ibarra
- Centre for Research in Animal Behaviour, Psychology, University of Exeter, Exeter EX4 4QG, UK
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Conroy D, Nicholls E. 'When I open it, I have to drink it all': Push and pull factors shaping domestic alcohol consumption during the COVID-19 pandemic UK Spring 2020 lockdown. Drug Alcohol Rev 2021; 41:1275-1283. [PMID: 34708473 PMCID: PMC8653038 DOI: 10.1111/dar.13396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Introduction The closure of licensed venues during the COVID‐19 pandemic meant that most alcohol has been consumed at home during lockdown periods in the UK, a phenomenon that remains under‐researched despite the public health implications. Methods This article draws on a study consisting of online semi‐structured interviews and focus groups with 20 UK drinkers, conducted between the first and second 2020 UK lockdowns. The study aimed to explore changing and enduring UK drinking practices within home spaces during the pandemic. Results Our findings illuminate specific ways in which assemblages and contextual factors may come together to encourage or mitigate against the consumption of any (or excessive) volumes of alcohol at home during the lockdown. For example, the physical presence of alcohol bottles may both encourage consumption (e.g. compulsion to finish an open bottle of wine) and cue reflection on one's drinking (through the potentially confronting presence of empty bottles after domestic drinking). We also highlight the significance of the home as a space separate from—and different to—public drinking spaces. Discussion and Conclusions With the increasing normalisation of domestic drinking during a global pandemic, this paper illuminates several factors that may encourage or curtail domestic alcohol consumption and invites us to consider the importance of assemblages, space and context. Such findings have wider applicability; for example, consideration of specific (and perhaps unique) push and pull factors of home spaces could inform future alcohol policy, health promotion messages and how guidance around ‘moderation’ or risky drinking is communicated.
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Affiliation(s)
- Dominic Conroy
- School of Social Sciences and Professions, London Metropolitan University, London, UK
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Nicholls E, Conroy D. Possibilities and pitfalls? Moderate drinking and alcohol abstinence at home since the COVID-19 lockdown. International Journal of Drug Policy 2021; 88:103025. [DOI: 10.1016/j.drugpo.2020.103025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023]
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Sinha CK, Rye E, Sunderland R, Rex D, Nicholls E, Okoye B. The need for Paediatric Emergency Laparotomy Audit (PELA) in the UK. Ann R Coll Surg Engl 2020; 102:209-213. [PMID: 31660765 PMCID: PMC7027412 DOI: 10.1308/rcsann.2019.0141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The National Emergency Laparotomy Audit (NELA) has raised serious concerns about the processes of care and outcomes in adult emergency laparotomies in the UK. To date, no comparable data have been published for children. The aim of this study was to investigate the need for a similar audit in children. METHODS Data were collected retrospectively following NELA guidelines. Results were analysed using QuickCalcs (GraphPad Software, La Jolla, CA, US). RESULTS The study period spanned 7.5 years. A total of 161 patients were identified for inclusion in the audit. The median patient age was 2.8 years. Half (49%) of the cohort were deemed ASA (American Society of Anesthesiologists) grade ≥2. A history of previous abdominal surgery was noted in 37% of the patients. The median time from admission to operation was 15 hours. Over a third (39%) of the operations were performed out of hours. The most common indications for surgery comprised adhesive bowel obstruction (37%), intussusception (27%) and volvulus (9%).The median length of hospital stay was 8 days with the median postoperative stay being 6 days (NELA data 10.6 days). Half (51%) of the cases required intensive care following surgery. The 30-day mortality rate was 3.1%. The overall mortality rate was 4.3% (NELA data 16%). Patient care was led by a consultant surgeon in 100% of cases (NELA data 89%). CONCLUSIONS This is the first study in children that provides baseline data about the standards of care and outcomes from a single centre paediatric emergency laparotomy audit. A larger study using data from multiple centres would be of great benefit.
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Affiliation(s)
- CK Sinha
- St George’s University Hospitals NHS Foundation Trust, UK
| | - E Rye
- St George’s University Hospitals NHS Foundation Trust, UK
| | - R Sunderland
- St George’s University Hospitals NHS Foundation Trust, UK
| | - D Rex
- St George’s University Hospitals NHS Foundation Trust, UK
| | - E Nicholls
- St George’s University Hospitals NHS Foundation Trust, UK
| | - B Okoye
- St George’s University Hospitals NHS Foundation Trust, UK
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Nicholls E. 'I feel like I have to become part of that identity': Negotiating femininities and friendships through alcohol consumption in Newcastle, UK. Int J Drug Policy 2019; 81:102524. [PMID: 31345645 DOI: 10.1016/j.drugpo.2019.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/26/2019] [Revised: 06/25/2019] [Accepted: 07/06/2019] [Indexed: 11/18/2022]
Abstract
Whilst women's excessive alcohol consumption has traditionally been regarded as a potential threat to health, safety and even femininity, recent research highlights the important role that alcohol plays in many young women's lives. Drawing on data from semi-structured interviews with women aged 18-25 in Newcastle, UK, this paper will consider the role that alcohol can play in the negotiation of female friendships in the Night Time Economy, highlighting the ways in which young women may regard alcohol as a tool to enhance socialising, trust and intimacy (both when pre-drinking and in bars, pubs and clubs). The role of alcohol in 'doing' gender and femininity will also be explored, as young women collectively display feminine identities through particular drinking choices and practices that may include heavy drinking and drunkenness. Finally, I will consider the implications for young women who do not engage in these collective practices of alcohol consumption and suggest avenues for future work on the under-researched topic of the experiences of non-drinkers.
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Affiliation(s)
- Emily Nicholls
- Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom.
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Nicholls E, Krishna S, Wright O, Stabler D, Krefft A, Somanathan H, Hempel de Ibarra N. A matter of taste: the adverse effect of pollen compounds on the pre-ingestive gustatory experience of sugar solutions for honeybees. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 2019; 205:333-346. [PMID: 31165282 PMCID: PMC6579781 DOI: 10.1007/s00359-019-01347-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
In addition to sugars, nectar contains multiple nutrient compounds in varying concentrations, yet little is known of their effect on the reward properties of nectar and the resulting implications for insect behaviour. We examined the pre-ingestive responses of honeybees to sucrose solutions containing a mix of pollen compounds, the amino acids proline or phenylalanine, or known distasteful substances, quinine and salt. We predicted that in taste and learning assays, bees would respond positively to the presence of nutrient compounds in a sucrose solution. However, bees’ proboscis extension responses decreased when their antennae were stimulated with pollen- or amino acid-supplemented sucrose solutions. Compared to pure sucrose, bees exhibited worse acquisition when conditioned to an odour with pollen-supplemented sucrose as the unconditioned stimulus. Such learning impairment was also observed with quinine-containing sucrose solutions. Our results suggest that bees can use their antennae to detect pollen compounds in floral nectars. Depending on the type and concentrations of compounds present, this may result in nectar being perceived as distasteful by bees, making it less effective in reinforcing the learning of floral cues. Such reward devaluation might be adaptive in cases where plants benefit from regulating the frequency of bee visitation.
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Affiliation(s)
- E Nicholls
- Centre for Research in Animal Behaviour, University of Exeter, Exeter, UK
- School of Life Sciences, University of Sussex, Brighton, UK
| | - S Krishna
- Centre for Research in Animal Behaviour, University of Exeter, Exeter, UK
- Centre for Research in Ecology and Evolution, Indian Institute of Science Education and Research Thiruvananthapuram (IISER-TVM), Thiruvananthapuram, India
| | - O Wright
- Centre for Research in Animal Behaviour, University of Exeter, Exeter, UK
| | - D Stabler
- Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - A Krefft
- Centre for Research in Animal Behaviour, University of Exeter, Exeter, UK
| | - H Somanathan
- Centre for Research in Ecology and Evolution, Indian Institute of Science Education and Research Thiruvananthapuram (IISER-TVM), Thiruvananthapuram, India
| | - N Hempel de Ibarra
- Centre for Research in Animal Behaviour, University of Exeter, Exeter, UK.
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Marshall M, Peat G, Nicholls E, Myers HL, Mamas MA, van der Windt DA. Metabolic risk factors and the incidence and progression of radiographic hand osteoarthritis: a population-based cohort study. Scand J Rheumatol 2018; 48:52-63. [PMID: 29952684 PMCID: PMC6319183 DOI: 10.1080/03009742.2018.1459831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether selected metabolic factors are associated with greater amounts of radiographic hand osteoarthritis (OA) incidence and progression. METHODS The study identified 706 adults, aged 50-69 years, with hand pain and hand radiographs at baseline, from two population-based cohorts. Metabolic factors (body mass index, hypertension, dyslipidaemia, and diabetes) were ascertained at baseline by direct measurement and medical records. Analyses were undertaken following multiple imputation of missing data, and in complete cases (sensitivity analyses). Multivariable regression models estimated associations between metabolic factors and two measures of radiographic change at 7 years for all participants, individuals free of baseline radiographic OA, and in baseline hand OA subsets. Estimates were adjusted for baseline values and other covariates. RESULTS The most consistent and strong associations observed were between the presence of diabetes and the amount of radiographic progression in individuals with nodal OA [adjusted mean differences in Kellgren-Lawrence summed score of 4.50 (-0.26, 9.25)], generalized OA [3.27 (-2.89, 9.42)], and erosive OA [3.05 (-13.56, 19.67)]. The remaining associations were generally weak or inconsistent, although numbers were limited for analyses of incident radiographic OA and erosive OA in particular. CONCLUSION Overall metabolic risk factors were not independently or collectively associated with greater amounts of radiographic hand OA incidence or progression over 7 years, but diabetes was associated with radiographic progression in nodal, and possibly generalized and erosive OA. Diabetes has previously been associated with prevalent but not incident hand OA. Further investigation in hand OA subsets using objective measures accounting for disease duration and control is warranted.
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Affiliation(s)
- M Marshall
- a Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences , Keele University , Staffordshire , UK
| | - G Peat
- a Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences , Keele University , Staffordshire , UK
| | - E Nicholls
- b Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit , Keele University , Staffordshire , UK
| | - H L Myers
- b Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit , Keele University , Staffordshire , UK
| | - M A Mamas
- c Keele Cardiovascular Research Group, Guy Hilton Research Centre , Keele University , Stoke-on-Trent , UK
| | - D A van der Windt
- a Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences , Keele University , Staffordshire , UK
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Arango-Lasprilla JC, Rivera D, Nicholls E, Aguayo Arelis A, García de la Cadena C, Peñalver Guia AI, Vergara-Moragues E, Rodriguez-Lorenzana A, Marín-Morales A, Soto-Añari M, Lara L, Rodríguez-Agudelo Y, Alcazar Tebar C, Galarza-Del-Angel J, Rodriguez-Irizarry W, Ibañéz-Alfonso JA, García-Guerrero CE, Delgado-Mejía ID, Pohlenz Amador S, Sánchez-SanSegundo M. Modified Wisconsin Card Sorting Test (M-WCST): Normative data for Spanish-speaking pediatric population. NeuroRehabilitation 2018; 41:617-626. [PMID: 28946592 DOI: 10.3233/nre-172242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/15/2022]
Abstract
OBJECTIVE To generate normative data for the Modified Wisconsin Card Sorting Test (M-WCST) in Spanish-speaking pediatric populations. METHOD The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the M-WCST as part of a larger neuropsychological battery. Number of categories, perseverative errors, and total error scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS The final multiple linear regression models indicated main effects for age on all scores, such that the number of categories correct increased and total number of perseverative errors and total number of errors decrease linearly as a function of age. Age2 had a significant effect in Chile, Cuba, Ecuador, and Spain for numbers of categories; a significant effect for number of perseverative errors in Chile, Cuba, Mexico, and Spain; and a significant effect for number of total errors in Chile, Cuba, Peru, and Spain. Models showed an effect for MLPE in Cuba (total errors), Ecuador (categories and total errors), Mexico (all scores), Paraguay (perseverative errors and total error), and Spain (categories and total errors). Sex affected number of total errors for Ecuador. CONCLUSIONS This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the M-WCST with pediatric populations.
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Affiliation(s)
- J C Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - D Rivera
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - E Nicholls
- Nemours/AI DuPont Hospital for Children, Wilmington, USA
| | - A Aguayo Arelis
- Departamento de investigación, Psicología, Universidad Enrique Díaz de León, Guadalajara, Mexico
| | - C García de la Cadena
- Departamento de Psicología, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | | | - A Marín-Morales
- CIMCYC-The Mind, Brain and Behaviour Research Centre, Universidad de Granada, Granada, Spain
| | | | - L Lara
- Universidad Autónoma de Chile, Talca, Chile
| | - Y Rodríguez-Agudelo
- Instituto Nacional de Neurología y Neurocirugía, MVS, Ciudad de México, Mexico
| | | | - J Galarza-Del-Angel
- Laboratorio de Psicofisiología, Facultad de Ciencias Humanas, Universidad Autónoma de Baja California, Mexicali, México
| | | | | | | | | | - S Pohlenz Amador
- Escuela de Ciencias Psicológicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
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Nicholls E, Robinson V, Farndon L, Vernon W. 'A good fit?' Bringing the sociology of footwear to the clinical encounter in podiatry services: a narrative review. J Foot Ankle Res 2018; 11:9. [PMID: 29560031 PMCID: PMC5859502 DOI: 10.1186/s13047-018-0253-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development. Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and – crucially – any barriers to adopting ‘healthier’ footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. Conclusion A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary ‘moment’ of the clinical encounter.
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Affiliation(s)
| | | | - Lisa Farndon
- 3Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Wesley Vernon
- 3Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Healey EL, Jinks C, Foster NE, Chew-Graham CA, Pincus T, Hartshorne L, Cooke K, Nicholls E, Proctor J, Lewis M, Dent S, Wathall S, Hay EM, McBeth J. The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol. Musculoskeletal Care 2017; 16:118-132. [PMID: 29218808 DOI: 10.1002/msc.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/22/2022]
Abstract
INTRODUCTION This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings.
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Affiliation(s)
- E L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - T Pincus
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - L Hartshorne
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Cooke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Proctor
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - M Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Dent
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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Sinha CK, Decker E, Rex D, Mukhtar Z, Murphy F, Nicholls E, Okoye B, Giuliani S. Thirty-days readmissions in pediatric surgery: The first U.K. experience. J Pediatr Surg 2016; 51:1877-1880. [PMID: 27430864 DOI: 10.1016/j.jpedsurg.2016.06.015] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 06/25/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK. METHODS Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes. Neonates were excluded from this study. Comorbidities, involving one or more systems, were also identified for each case of readmission. ReAds were classified into emergency and elective cohort depending on the nature of the primary operation. Outcomes were compared between these two groups. Data were quoted as median (range) unless indicated otherwise. Data were analyzed using SPSS software Desktop 22.0, using Mann-Whitney U and Chi-Squared tests, with a consideration that a P≤0.05 was significant. RESULTS A total of 2378 procedures were performed during the study period. Elective cases, including day cases, accounted for 77% (n=1837) of all cases. The remaining 23% (n=541) were emergency cases. Total unplanned readmission rate within 30days (ReAd) was 2%. Further surgical procedures were required in 38%. Having excluded neonates, the most common primary procedure leading to readmission within 30days was appendicectomy (26%). Overall, the most common cause for readmission within 30days was postoperative infection (30%). The ReAd in emergency cohort was 3.5% in comparison to 1.5% in elective, which was significantly different (P value=0.007). CONCLUSION Readmission within thirty days of primary procedure in pediatric surgery has little published data. An efficient discharge planning may play a vital role in preventing unwanted readmission. Elective operations had a significantly lower readmission rate than emergency operations. Having excluded neonates, appendicectomy was found to be the most common operation associated with readmission in the pediatric surgical practice. Although widely used as quality care indicator in adults, more studies are required to validate readmission rate as a quality of care indicator in pediatric surgery practice.
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Affiliation(s)
- C K Sinha
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
| | - E Decker
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - D Rex
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - Z Mukhtar
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - F Murphy
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - E Nicholls
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - B Okoye
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
| | - S Giuliani
- Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK
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Farndon L, Robinson V, Nicholls E, Vernon W. If the shoe fits: development of an on-line tool to aid practitioner/patient discussions about 'healthy footwear'. J Foot Ankle Res 2016; 9:17. [PMID: 27274358 PMCID: PMC4895812 DOI: 10.1186/s13047-016-0149-2] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A previous study highlighted the importance of footwear to individuals' sense of their identity, demonstrating that shoes must 'fit' someone socially, as well as functionally. However, unhealthy shoes can have a detrimental effect on both foot health and mobility. This project utilises qualitative social science methods to enable podiatrists to understand the broader contribution of footwear to patients' sense of themselves and from this an online toolkit was developed to aid footwear education. METHOD Semi-structured interviews were conducted with six podiatrists/shoe-fitters and 13 people with foot pathologies, some of whom also completed shoe diaries. These were supplemented with some follow-up interviews and photographs of participants' own shoes were taken to allow in-depth discussions. RESULTS Four areas related to 'fit' were identified; practicalities, personal, purpose and pressures, all of which need to be considered when discussing changes in footwear. These were incorporated into an online toolkit which was further validated by service users and practitioners in a focus group. CONCLUSION This toolkit can support podiatrists in partnership with patients to identify and address possible barriers to changing footwear towards a more suitable shoe. Enabling patients to make healthier shoe choices will help contribute to improvements in their foot health and mobility.
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Affiliation(s)
- Lisa Farndon
- Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Emily Nicholls
- Department of Sociology, University of Portsmouth, Portsmouth, UK
| | - Wesley Vernon
- Department of Sociology, University of Portsmouth, Portsmouth, UK
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17
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Foster N, Nicholls E, Holden M, Healey E, Kigozi J, Jowett S, Tooth S, Hay E. OP0105 Improving the Effectiveness of Exercise Therapy for Older Adults with Knee Osteoarthritis: A Pragmatic Randomised Controlled Trial (The Beep Trial). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foster N, Nicholls E, Holden M, Healey E, Tooth S, Hay E. Improving the effectiveness of exercise therapy for older adults with knee pain: a pragmatic randomised controlled trial (the beep trial). Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Keeley T, Al-Janabi H, Nicholls E, Foster NE, Jowett S, Coast J. A longitudinal assessment of the responsiveness of the ICECAP-A in a randomised controlled trial of a knee pain intervention. Qual Life Res 2015; 24:2319-31. [PMID: 25894061 PMCID: PMC4564441 DOI: 10.1007/s11136-015-0980-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2015] [Indexed: 01/02/2023]
Abstract
PURPOSE The ICECAP-A is a simple measure of capability well-being for use with the adult population. The descriptive system is made up of five key attributes: Stability, Attachment, Autonomy, Achievement and Enjoyment. Studies have begun to assess the psychometric properties of the measure, including the construct and content validity and feasibility for use. This is the first study to use longitudinal data to assess the responsiveness of the measure. METHODS This responsiveness study was completed alongside a randomised controlled trial comparing three physiotherapy-led exercise interventions for older adults with knee pain attributable to osteoarthritis. Anchor-based methodologies were used to explore the relationship between change over time in ICECAP-A score (the target measure) and change over time in another measure (the anchor). Analyses were completed using the non-value-weighted and value-weighted ICECAP-A scores. The EQ-5D-3L was used as a comparator measure to contextualise change in the ICECAP-A. Effect sizes, standardised response means and t tests were used to quantify responsiveness. RESULTS Small changes in the ICECAP-A scores were seen in response to underlying changes in patients' health-related quality of life, anxiety and depression. Non-weighted scores were slightly more responsive than value-weighted scores. ICECAP-A change was of comparable size to change in the EQ-5D-3L reference measure. CONCLUSION This first analysis of the responsiveness using longitudinal data provides some positive evidence for the responsiveness of the ICECAP-A measure. There is a need for further research in those with low health and capability, and experiencing larger underlying changes in quality of life.
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Affiliation(s)
- T Keeley
- MRC Midland Hub for Trials Methodology Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Health Economics Unit, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - H Al-Janabi
- Health Economics Unit, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - S Jowett
- Health Economics Unit, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - J Coast
- MRC Midland Hub for Trials Methodology Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Health Economics Unit, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Nicholls E, Thomas E, van der Windt DA, Croft PR, Peat G. Pain trajectory groups in persons with, or at high risk of, knee osteoarthritis: findings from the Knee Clinical Assessment Study and the Osteoarthritis Initiative. Osteoarthritis Cartilage 2014; 22:2041-50. [PMID: 25305072 PMCID: PMC4256061 DOI: 10.1016/j.joca.2014.09.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The authors aimed to characterize distinct trajectories of knee pain in adults who had, or were at high risk of, knee osteoarthritis using data from two population-based cohorts. METHOD Latent class growth analysis was applied to measures of knee pain severity on activity obtained at 18-month intervals for up to 6 years between 2002 and 2009 from symptomatic participants aged over 50 years in the Knee Clinical Assessment Study (CAS-K) in the United Kingdom. The optimum latent class growth model from CAS-K was then tested for reproducibility in a matched sample of participants from the Osteoarthritis Initiative (OAI) in the United States. RESULTS A 5-class linear model produced interpretable trajectories in CAS-K with reasonable goodness of fit and which were labelled "Mild, non-progressive" (N = 201, 35%), "Progressive" (N = 162, 28%), "Moderate" (N = 124, 22%) "Improving" (N = 68, 12%), and "Severe, non-improving" (N = 15, 3%). We were able to reproduce "Mild, non-progressive", "Moderate", and "Severe, non-improving" classes in the matched sample of participants from the OAI, however, absence of a "Progressive" class and instability of the "Improving" classes in the OAI was observed. CONCLUSIONS Our findings strengthen the grounds for moving beyond a simple stereotype of osteoarthritis as "slowly progressive". Mild, non-progressive or improving symptom trajectories, although difficult to reproduce, can nevertheless represent a genuinely favourable prognosis for a sizeable minority.
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Affiliation(s)
- E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
| | - E Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
| | - D A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
| | - P R Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
| | - G Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
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22
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Kwok WY, Kloppenburg M, Marshall M, Nicholls E, Rosendaal FR, Peat G. The prevalence of erosive osteoarthritis in carpometacarpal joints and its clinical burden in symptomatic community-dwelling adults. Osteoarthritis Cartilage 2014; 22:756-63. [PMID: 24680934 PMCID: PMC4071416 DOI: 10.1016/j.joca.2014.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 02/19/2014] [Accepted: 03/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the prevalence of erosive disease in first carpometacarpal joints (CMCJs) and investigate its clinical impact compared with radiographic thumb base (TB) osteoarthritis (OA). PATIENT AND METHODS Standardized assessments with hand radiographs were performed in participants of two population-based cohort studies in North Staffordshire with hand symptoms lasting ≥1 day in the past month. Erosive disease was defined as the presence of eroded or remodeled phase in ≥1 interphalangeal joint (IPJ) or first CMCJ following the Verbruggen-Veys classification. Hand pain and function were assessed with Australian/Canadian Hand Osteoarthritis Index (AUSCAN). Prevalence was estimated by dividing the number of persons with erosive lesions by population size. Linear and logistic regression analyses were used to contrast clinical determinants between persons with erosions and with radiographic TB OA. Results were presented as mean differences and odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for age, sex and radiographic severity. RESULTS 1,076 participants were studied (60% women, mean age 64.7 years (SD 8.3); 24 persons had erosive disease in the TB. The prevalence of erosive disease in first CMCJs was 2.2% (95% CI 1.4, 3.3). Only 0.5% (95% CI 0.2, 1.2) had erosive disease affecting IPJs and first CMCJs combined. More persons with erosive disease of first CMCJs reported pain in their TB than persons with radiographic TB OA, AUSCAN pain and function scores were similar. CONCLUSION Erosive disease of first CMCJs was present in 2.2% of subjects with hand pain and was often not accompanied by erosions in IPJs. Erosive disease was associated with TB pain, but not with the level of pain, when compared with radiographic TB OA.
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Affiliation(s)
- W Y Kwok
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Marshall
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G Peat
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
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Gray GJ, Aouf N, Richardson MA, Butters B, Walmsley R, Nicholls E. Feature-based recognition approaches for infrared anti-ship missile seekers. The Imaging Science Journal 2013. [DOI: 10.1179/1743131x12y.0000000012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Marshall M, Peat G, Nicholls E, van der Windt D, Myers H, Dziedzic K. Subsets of symptomatic hand osteoarthritis in community-dwelling older adults in the United Kingdom: prevalence, inter-relationships, risk factor profiles and clinical characteristics at baseline and 3-years. Osteoarthritis Cartilage 2013; 21:1674-84. [PMID: 23954700 PMCID: PMC3819994 DOI: 10.1016/j.joca.2013.08.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/04/2013] [Accepted: 08/03/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the population prevalence, inter-relationships, risk factor profiles and clinical characteristics of subsets of symptomatic hand osteoarthritis (OA) with a view to understanding their relative frequency and distinctiveness. METHOD 1076 community-dwelling adults with hand symptoms (60% women, mean age 64.7 years) were recruited and classified into pre-defined subsets using physical examination and standardised hand radiographs, scored with the Kellgren & Lawrence (K&L) and Verbruggen-Veys grading systems. Detailed information on selected risk factors was obtained from direct measurement (Body Mass Index (BMI)), self-complete questionnaires (excessive use of hands, previous hand injury) and medical record review (hypertension, dyslipidaemia, type 2 diabetes). Hand pain and disability were self-reported at baseline and 3-year follow-up using Australian/Canadian Osteoarthritis Hand Index (AUSCAN). RESULTS Crude population prevalence estimates for symptomatic hand OA subsets in the adult population aged 50 years and over were: thumb base OA (22.4%), nodal interphalangeal joint (IPJ) OA (15.5%), generalised hand OA (10.4%), non-nodal IPJ OA (4.9%), erosive OA (1.0%). Apart from thumb base OA, there was considerable overlap between the subsets. Erosive OA appeared the most distinctive with the highest female: male ratio, and the most disability at baseline and 3-years. A higher frequency of obesity, hypertension, dyslipidaemia, and metabolic syndrome was observed in this subset. CONCLUSION Overlap in the occurrence of hand OA subsets poses conceptual and practical challenges to the pursuit of distinct phenotypes. Erosive OA may nevertheless provide particular insight into the role of metabolic and cardiovascular risk factors in the pathogenesis of OA.
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Affiliation(s)
- M. Marshall
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - G. Peat
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - E. Nicholls
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - D. van der Windt
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - H. Myers
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - K. Dziedzic
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
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Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Arango-Lasprilla JC, Nicholls E, Villaseñor Cabrera T, Drew A, Jimenez-Maldonado M, Martinez-Cortes ML. Health-related quality of life in caregivers of individuals with traumatic brain injury from Guadalajara, Mexico. J Rehabil Med 2011; 43:983-6. [DOI: 10.2340/16501977-0883] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Marshall M, van der Windt D, Nicholls E, Myers H, Hay E, Dziedzic K. Radiographic hand osteoarthritis: patterns and associations with hand pain and function in a community-dwelling sample. Osteoarthritis Cartilage 2009; 17:1440-7. [PMID: 19500560 DOI: 10.1016/j.joca.2009.05.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [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] [Received: 11/10/2008] [Revised: 04/16/2009] [Accepted: 05/11/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patterns of radiographic osteoarthritis (ROA) of the hand are often examined by row, with the four joints of the thumb studied inconsistently. The objectives of this study were to determine relationships of ROA at different hand joints, use the findings to define radiographic sub-groups and investigate their associations with pain and function. METHODS Sixteen joints in each hand were scored for the presence of ROA in a community-dwelling cohort of adults, 50-years-and-over, with self-reported hand pain or problems. Principal components analysis (PCA) with varimax rotation was used to study patterns of ROA in the hand joints and identify distinct sub-groups. Differences in pain and function between these sub-groups were assessed using Australian/Canadian Osteoarthritis Index (AUSCAN), Grip Ability Test (GAT) and grip and pinch strength. RESULTS PCA was undertaken on data from 592 participants and identified four components: distal interphalangeal joints (DIPs), proximal interphalangeal joints (PIPs), metacarpophalangeal joints (MCPs), thumb joints. However, the left thumb interphalangeal (IP) joint cross-loaded with the PIP and thumb groups. On this basis, participants were categorised into four radiographic sub-groups: no osteoarthritis (OA), finger only OA, thumb only OA and combined thumb and finger OA. Statistically significant differences were found between the sub-groups for AUSCAN function, and in women alone for grip and pinch strength. Participants with combined thumb and finger OA had the worst scores. CONCLUSION Individual thumb joints can be clustered together as a joint group in ROA. Four radiographic sub-groups of hand OA can be distinguished. Pain and functional difficulties were highest in participants with both thumb and finger OA.
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Affiliation(s)
- M Marshall
- Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.
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Abstract
Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n=169), with chemotherapy (C, n=272), radiotherapy (R, n=158), or both chemotherapy and radiotherapy (C/RT n=81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (<10 nmol l−1) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P=0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both P<0.005) and LH abnormalities after radiotherapy (11% P<0.01) and chemotherapy (10%, P<0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3–9.25) iu l−1 compared to 3 (IQR 1–5) iu l−1 for S; P<0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (−2 (IQR −8.0 to −1.5) vs 1.0. (IQR −4.0–4.0) P<0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P=0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% P<0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors.
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Affiliation(s)
- R A Huddart
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
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Abstract
BACKGROUND Large bowel volvulus is extremely uncommon in children. The probable pathogenesis, predisposing factors and management of large bowel volvulus in children are debatable. METHODS Seven consecutive cases of large bowel volvulus occurring over a 6-year period are reported. RESULTS Two patients with caecal volvulus, one with transverse and subsequent sigmoid volvulus, one with transverse colon volvulus and three children with sigmoid volvulus are reported. Four girls and one boy with cerebral palsy, one female with Moya Moya disease and spastic paraplegia and an otherwise healthy boy presented at a mean age of 8.3 years (range: 3-15 years). The common presentation was abdominal distension (n = 6), tenderness (n = 6), constipation (n = 7) and bloody mucoid discharge per rectum (n = 6). Plain abdominal X-ray and barium enema were diagnostic. Resection with primary ileocolic, colocolic or colorectal anastomosis was performed in all cases. The mean follow-up was 3.4 years (range: 1-6 years) and there was no mortality. CONCLUSIONS Large bowel volvulus in children may be due to congenital anomalous or absent ligamentous fixation of the large bowel, and abnormal mesocolon or a common ileocolo-mesentery. Large bowel obstruction due to volvulus must be considered in the differential diagnosis in a child presenting with constipation associated with bloody mucoid discharge per rectum. Resection of the involved segment and primary anastomosis is the definitive treatment for large bowel volvulus in children.
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Affiliation(s)
- M Samuel
- Department of Paediatric Surgery, St George's Hospital, London, UK
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Markovic B, Nicholls E. The expression of cytokine messenger-rnas in clear cell acanthoma. Int J Oncol 1993; 2:519-22. [PMID: 21573585 DOI: 10.3892/ijo.2.4.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Clear cell acanthoma (syn: Degos' acanthoma) is a tumorous condition of the skin of unknown aetiology. It is seen as fleshy vascular papules which are solitary and are usually located on die lower extremities. We have studied 4 cases using cDNA-mRNA in situ hybridization for growth and immunological factors thought to be important molecular regulators in the skin. We obtained strongest binding with an interleukin-2 (IL-2) probe which bound to the tumour cells in the epidermis and to lymphoid cells in the dermal infiltrate. We also observed binding of probes for IL-1beta, IL-4, IL-6, IFN-alpha and TGF-alpha. Binding with the IL-2R probe was confined to scant cells in the tumour and a few cells in the lymphoid infiltrate. The significance of these observations and possible mechanisms for the pathogenesis of clear cell acanthoma are discussed.
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Wielgosz AT, Wielgosz M, Biro E, Nicholls E, MacWilliam L, Haney T. Risk factors for myocardial infarction: the importance of relaxation. Br J Med Psychol 1988; 61 ( Pt 3):209-17. [PMID: 3179243 DOI: 10.1111/j.2044-8341.1988.tb02782.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Several risk factors for acute myocardial infarction (AMI) were examined, including history of smoking and hypercholesterolemia, income, education, coronary-prone behaviour by Structured Interview (SI) and the type and quality of stress-reducing relaxing activities, in a case-control study. Our sample included 100 AMI patients (80 males and 20 females, with mean ages 57.3 and 64.1 years, respectively), as well as 100 age- and sex-matched controls. Univariate differences between cases and controls were significant for history of smoking, income level, SI-defined hostility, SI-defined suppression of hostility, amount and type of relaxing activities and history of hypercholesterolemia. Multivariable analyses demonstrated that AMI patients reported significantly lower levels of relaxation and income, but higher levels of suppressed hostility and a higher incidence of hypercholesterolemia. Our findings confirm the significance of hostility and particularly suppressed hostility as AMI risk factors; furthermore, inadequate relaxation was identified as an independent risk factor associated with AMI.
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Mao Y, Morrison H, Urrutia M, Davies J, Hockin J, Nicholls E, Bourdeau R, Wigle D. The Eastern Ontario Risk Factor Survey. Can J Public Health 1987; 78:335-9. [PMID: 3690453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Wielgosz AT, Nicholls E, Biro E, MacWilliam L, Mao Y. Random digit dialing. Can J Public Health 1987; 78:201-2. [PMID: 3607700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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MacWilliam L, Mao Y, Nicholls E, Wigle DT. Fatal accidental childhood injuries in Canada. Can J Public Health 1987; 78:129-35. [PMID: 3581000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Prokocimer PG, Nicholls E, Gaba DM, Maze M. Epinephrine arrhythmogenicity is enhanced by acute, but not chronic, aminophylline administration during halothane anesthesia in dogs. Anesthesiology 1986; 65:13-8. [PMID: 3729049 DOI: 10.1097/00000542-198607000-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors determined the effect of acute and chronic aminophylline treatment on the arrhythmogenicity of epinephrine during halothane anesthesia. The dose of epinephrine required to achieve an arrhythmia threshold (ADE) was determined in nine unpremedicated dogs anesthetized with halothane (1.5% v/v) in oxygen (A0). Aminophylline was then infused to achieve and sustain a therapeutic theophylline level (mean +/- SD) of 17 +/- 2 micrograms X ml-1 (A1), at which time the ADE was reassessed. The aminophylline infusion regimen was then adjusted to provide a supratherapeutic level of theophylline of 34 micrograms X ml-1 (A2) and the ADE was reassessed. In an additional seven dogs the ADE was assessed before and after 6 weeks of oral aminophylline treatment that yielded a plasma theophylline level of 18 +/- 3 micrograms X ml-1. The ADE was significantly (P less than 0.01) reduced from a basal value (mean +/- SD) of 2.63 +/- 0.97 micrograms X kg X -1 X min-1 to 1.39 +/- 0.47 in the A1 state. There was no further decrement in the ADE at the A2 state (1.17 +/- 0.36). The plasma epinephrine level at the arrhythmia threshold decreased commensurately from 50.7 +/- 40.2 ng X ml-1 (A0) to 20.0 +/- 7.9 and 19.2 +/- 7.6 in the A1 and A2 states, respectively (P less than 0.01). In contrast to these acute treatment experiments, neither the ADE (2.65 +/- 0.95 vs. 2.97 +/- 1.49 micrograms X kg-1 X min-1) nor the plasma epinephrine levels at the arrhythmia threshold (47.2 +/- 13.7 vs. 51.1 +/- 22.0 ng X ml-1) were different after chronic aminophylline treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nicholls E. Endodontic treatment during root formation. Int Dent J 1981; 31:49-59. [PMID: 6937443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Various forms of endodontic treatment may be used in an attempt to maintain pulpal vitality during the period of root formation. In teeth with advanced caries but with no clinical evidence of pulpitis, indirect pulp capping with the retention of a small amount of softened dentine in the base of the cavity is preferable to further excavation and direct capping of a resulting exposure. Direct capping of pulpal exposures in traumatized incisors is confined to teeth in which the tissue loss is limited and the exposure is small and recent. Where there is more serious contamination of the pulp, whether by trauma or by caries, pulpotomy is indicated. In each of these three forms of treatment, calcium hydroxide is the dressing of choice. In incompletely formed teeth with necrotic pulps, the anatomy of the root canal poses problems which may not be entirely evident radiographically because of differential root development in the buccolingual and mesiodistal planes, whilst surgical treatment may result in excessive root shortening, besides being unacceptable to many patients. Treatment of these teeth is directed towards stimulating calcific closure of the apical foramen, preparatory to the insertion of a conventional root filling. Important factors in this form of treatment are the removal of necrotic tissue from the root canal, the preservation of vital tissue in the apical part of the root, and the use of a suitable agent as a root canal dressing. Calcium hydroxide is the agent of choice for this purpose.
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Jenkins T, Nicholls E, Gordon E, Mendelsohn D, Seftel HC, Andrew MJ. Familial hypercholesterolaemia--a common genetic disorder in the Afrikaans population. S Afr Med J 1980; 57:943-7. [PMID: 7404060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Serum cholesterol levels have been studied in three groups of young White South Africans. The mean levels were highest among the Jewish (195,7 mg/dl or 5,10 mmol/l), lowest among the Afrikaans (174,9 mg/dl of 4,55 mmol/l), and intermediate in the English-speaking Gentile population (180,0 mg/dl or 4,67 mmol/l). Levels were significantly higher in females than in males in the Jewish and English-speaking Gentile populations, but not significantly higher in Afrikaans females compared with males. Studies carried out on the families of individuals found to have serum cholesterol levels above 300 mg/dl (7,8 mmol/l) emphasized that, in addition to the serum cholesterol studies, detailed family studies are essential if an accurate diagnosis of familial hypercholesterolaemia (FH) is to be made. From such studies in the Afrikaans population and also from the known number of homozygotes for FH in one area of South Africa, all of whom came from Afrikaans families, it has been estimated that the frequency of the FH gene is unusually high in this population. It is postulated that the latter finding could help to explain the high incidence of and mortality rate from ischaemic heart disease in young White South Africans.
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Abstract
The effect of oral beta-sympathomimetic tocolytic therapy on neonatal serum glucose concentrations in the first several hours after delivery was examined in 12 babies. Hypoglycemia was noted in eight babies, and was sustained over at least a 30-minute period in five. The group with sustained hypoglycemia had a higher cord serum insulin concentration, a lower serum glucose nadir, and a more rapid initial rate of serum glucose disappearance than those babies with normoglycemia or transient hypoglycemia. Sustained hypoglycemia was observed in five of six babies delivered within two days of the termination of tocolytic therapy, but was not present in any of six babies delivered five or more days after the end of tocolytic therapy. Speculations as to the interaction between beta-sympathomimetic tocolytic drugs administered to the mother and fetal and neonatal glucose metabolism are made.
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Nicholls E. Some surgical aspects of endodontic and endodontic-periodontic treatment of posterior teeth. Refuat Hapeh Vehashinayim 1970; 19:20-7. [PMID: 5283601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Byzantiadou A, Nicholls E. [Root canal morphology following mechanical preparation]. Stomatol Chron (Athenai) 1969; 13:174-84. [PMID: 5268791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Nicholls E. Molar endodontics. J Anglocont Dent Soc 1969:5-9. [PMID: 5274589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Schuster A, Duffau G, Nicholls E, Pino M. Lung aspirate puncture as a diagnostic aid in pulmonary tuberculosis in childhood. A preliminary study. Pediatrics 1968; 42:647-50. [PMID: 4971450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Nicholls E. Research and clinical practice in endodontics. Dent Pract Dent Rec 1965; 16:81-90. [PMID: 5215272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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