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Al Wattar BH, Rogozińska E, Vale C, Fisher D, Petersen I, Nicum S, Bannington D, Talaulikar V, Freemantle N. Effectiveness and safety of menopause treatments: pitfalls of available evidence and future research need. Climacteric 2024; 27:154-158. [PMID: 38275167 DOI: 10.1080/13697137.2023.2297880] [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: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
By 2050 more than 1.6 billion women worldwide will be of post-reproductive age, with >75% reporting severe menopausal symptoms. The last few years saw a gradual uplift in public awareness reaffirming the health needs of women with menopause. Still, effective translation of available evidence on menopause treatments is hindered by several methodological limitations and poor research conduct. We argue that a paradigm shift is required in menopause research to address the remaining knowledge gap and guide safe evidence-based care provision. A critical misconception across studies on menopause is the assumption that women represent a homogeneous group who respond similarly to a particular therapy irrespective of their exposure and individual risk factors. We highlight potential solutions to optimize the quality of future research in menopause including adopting robust trial methodology, standardize outcome reporting to capture quality-of-life measures, and improve lay patient and public involvement in future research.
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Affiliation(s)
- B H Al Wattar
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - E Rogozińska
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - C Vale
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - D Fisher
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - I Petersen
- Primary Care & Population Health, Institute of Epidemiology & Health, University College London Hospitals, London, UK
| | - S Nicum
- Research Department of Oncology, Cancer Institute, University College London Hospitals, London, UK
| | | | - V Talaulikar
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - N Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
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Schneider H, Masilela T, Mndebele J, Vallabhjee K, Petersen I, Gilson L, Engelbrecht B. Special series on the District Health System. S Afr Med J 2023; 113:14. [PMID: 38525616 DOI: 10.7196/samj.2023.v113i11.1653] [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: 10/26/2023] [Indexed: 03/26/2024] Open
Affiliation(s)
| | - T Masilela
- Outcomes Facilitator, Department of Planning, Monitoring and Evaluation, South Africa.
| | - J Mndebele
- Chief Director, District Health Services, KwaZulu-Natal Department of Health, South Africa.
| | - K Vallabhjee
- Advisor, Clinton Health Access Initiative, South Africa.
| | - I Petersen
- Director and Research Professor, Centre for Rural Health, School of Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Gilson
- Professor, Division of Health Policy and Systems, School of Public Health, University of Cape Town, South Africa.
| | - B Engelbrecht
- Adjunct Associate Professor, School of Public Health, University of Cape Town, and Extraordinary Associate Professor, Faculty of Health Sciences, North West University, Potchefstroom, South Africa.
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Capasso I, Garzon S, Kumar S, Weaver AL, Mc Gree M, De Vitis LA, Uccella S, Petersen I, Glaser G, Langstraat C, Scambia G, Fanfani F, Mariani A. Prognostic factors in patients with endometrial cancer with isolated lymphatic recurrence. Int J Gynecol Cancer 2023; 33:1169-1178. [PMID: 37321674 DOI: 10.1136/ijgc-2023-004435] [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] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To analyze the clinicopathological features and outcomes in patients with endometrial cancer with isolated lymphatic recurrence after lymphadenectomy, stratified by different isolated lymphatic recurrence sites and treatment approaches. METHODS We retrospectively reviewed all surgically treated patients with endometrial cancer, identifying those with recurrence. We defined primary isolated lymphatic recurrence as the first and unique evidence of recurrence in lymph node-bearing areas, without concomitant vaginal, hematogenous, or peritoneal recurrence. Isolated lymphatic recurrences were classified as pelvic, para-aortic, distant, or multiple sites. Our primary outcome was cause-specific survival after diagnosis of the recurrence. RESULTS Among 4216 patients with surgically staged endometrial cancer, we identified 66 (1.6%) women with isolated lymphatic recurrence. The overall median cause-specific survival for patients with isolated lymphatic recurrence was 24 months. Although cause-specific survival was not significantly different between the four isolated lymphatic recurrence groups (p=0.21), 7 of 15 (47%) patients with isolated lymphatic recurrence in the para-aortic area were long-term survivors. At multivariate Cox regression, the absence of lymphovascular space invasion and grade 1 histology in the primary tumor were significantly associated with improved cause-specific survival. In addition, patients with isolated lymphatic recurrence who underwent surgery for recurrence (with/without other associated therapies) had improved cause-specific survival compared with patients who did not undergo surgery, also after adjusting for age. CONCLUSIONS Low-grade histology and absence of lymphovascular space invasion in the primary tumor were predictors of improved prognosis in patients with endometrial cancer with isolated lymphatic recurrence. In addition, in this retrospective cohort, patients with isolated lymphatic recurrence who were selected for eradicative surgical treatment had improved cause-specific survival.
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Affiliation(s)
- Ilaria Capasso
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Sanjeev Kumar
- Department of Gynecologic Oncology, Baptist Memorial Hospital for Women, Memphis, Tennessee, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela Mc Gree
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie Langstraat
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giovanni Scambia
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Francesco Fanfani
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Andrea Mariani
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Laughlin BS, Golafshar M, Prince M, Liu W, Kutyreff CJ, Ahmed SK, Vern Gross TZ, Haddock M, Petersen I, DeWees TA, Ashman JB. Dosimetric comparison between proton beam therapy, intensity modulated radiation therapy, and 3D conformal therapy for soft tissue extremity sarcoma. Acta Oncol 2023:1-7. [PMID: 37154167 DOI: 10.1080/0284186x.2023.2209267] [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: 05/10/2023]
Abstract
PURPOSE/OBJECTIVES Proton beam therapy (PBT) may provide a dosimetric advantage in sparing soft tissue and bone for selected patients with extremity soft sarcoma (eSTS). We compared PBT with photons plans generated using intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT). MATERIALS/METHODS Seventeen patients previously treated with pencil beam scanning PBT were included in this study. Of these patients, 14 treated with pre-operative 50 Gy in 25 fractions were analyzed. IMRT and 3D-CRT plans were created to compare against the original PBT plans. Dose-volume histogram (DVH) indices were evaluated amongst PBT, IMRT, and 3D plans. Kruskal-Wallis rank sum tests were used to get the statistical significance. A p value smaller than .05 was considered to be statistically significant. RESULTS For the clinical target volume (CTV), D2%, D95%, D98%, Dmin, Dmax, and V50Gy, were assessed. Dmin, D1%, Dmax, Dmean, V1Gy, V5Gy, and V50Gy were evaluated for the adjacent soft tissue. D1%, Dmax, Dmean, and V35-50% were evaluated for bone. All plans met CTV target coverage. The PBT plans delivered less dose to soft tissue and bone. The mean dose to the soft tissue was 2 Gy, 11 Gy, and 13 Gy for PBT, IMRT, and 3D, respectively (p < .001). The mean dose to adjacent bone was 15 Gy, 26 Gy, and 28 Gy for PBT, IMRT, and 3D, respectively (p = .022). CONCLUSION PBT plans for selected patients with eSTS demonstrated improved sparing of circumferential soft tissue and adjacent bone compared to IMRT and 3D-CRT. Further evaluation will determine if this improved dosimetry correlates with reduced toxicity and improved quality of life.
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Affiliation(s)
| | - Michael Golafshar
- Department of Quanitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Matthew Prince
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Michael Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Todd A DeWees
- Department of Quanitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
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5
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Kumar A, Langstraat C, Petersen I, Glaser G, Bakkum-Gamez J, Mariani A, Kulsrud V, Zundel J, Garda A, Cliby W, Haddock M, Dowdy S. Creation of a surgical service line to treat patients with recurrent gynecologic cancer with curative intent: Complex oncologic multidisciplinary pelvic surgery (COMPS) (559). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01780-2] [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: 11/24/2022]
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6
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Nkhoma KB, Cook A, Giusti A, Farrant L, Petrus R, Petersen I, Gwyther L, Venkatapuram S, Harding R. A systematic review of impact of person-centred interventions for serious physical illness in terms of outcomes and costs. BMJ Open 2022; 12:e054386. [PMID: 35831052 PMCID: PMC9280891 DOI: 10.1136/bmjopen-2021-054386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/20/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Person-centred care (PCC) is being internationally recognised as a critical attribute of high-quality healthcare. The International Alliance of Patients Organisations defines PCC as care that is focused and organised around people, rather than disease. Focusing on delivery, we aimed to review and evaluate the evidence from interventions that aimed to deliver PCC for people with serious physical illness and identify models of PCC interventions. METHODS Systematic review of literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched AMED, CINAHL, Cochrane Library, Embase, Medline, PsycINFO, using the following key concepts: patient/person-centred care, family centred care, family based care, individualised care, holistic care, serious illness, chronic illness, long-term conditions from inception to April 2022. Due to heterogeneity of interventions and populations studied, narrative synthesis was conducted. Study quality was appraised using the Joanna Briggs checklist. RESULTS We screened n=6156 papers. Seventy-two papers (reporting n=55 different studies) were retained in the review. Most of these studies (n=47) were randomised controlled trials. Our search yielded two main types of interventions: (1) studies with self-management components and (2) technology-based interventions. We synthesised findings across these two models:Self-management component: the interventions consisted of training of patients and/or caregivers or staff. Some studies reported that interventions had effect in reduction hospital admissions, improving quality of life and reducing costs of care.Technology-based interventions: consisted of mobile phone, mobile app, tablet/computer and video. Although some interventions showed improvements for self-efficacy, hospitalisations and length of stay, quality of life did not improve across most studies. DISCUSSION PCC interventions using self-management have some effects in reducing costs of care and improving quality of life. Technology-based interventions improves self-efficacy but has no effect on quality of life. However, very few studies used self-management and technology approaches. Further work is needed to identify how self-management and technology approaches can be used to manage serious illness. PROSPERO REGISTRATION NUMBER CRD42018108302.
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Affiliation(s)
- Kennedy Bashan Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK
| | - Amelia Cook
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Alessandra Giusti
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lindsay Farrant
- School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Ruwayda Petrus
- School of Applied Human Sciences, University of KwaZulu-Natal College of Humanities, Durban, South Africa
| | - I Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Liz Gwyther
- School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Avgerinou C, Petersen I, Clegg A, West RM, Osborn D, Walters K. 1071 INCIDENCE OF RECORDED OSTEOPOROSIS, OSTEOPENIA AND FRAGILITY FRACTURE IN OLDER PEOPLE: ANALYSIS OF UK PRIMARY CARE DATA. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.014] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Osteoporosis is common in later life, leading to fragility fractures associated with increased mortality, disability, and costs. There is a surprising lack of data regarding the incidence of osteoporosis. We aimed to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in older people, explore time trends in diagnosis, and differences by age, sex, and social deprivation.
Method
We used de-identified patient data provided as part of routine primary care (IQVIA Medical Research Database (IMRD). All patients aged 50-99y registered with THIN (The Health Improvement Network) participating practices between 1/1/2000–31/12/2018 were included. Crude incidence rates (IR) were estimated per 10,000 person-years (PY). We used Poisson regression to calculate adjusted Incidence Rate Ratios (IRR) accounting for sex, age, calendar year and deprivation.
Results
The IR of osteoporosis was significantly higher in women, 84.32 (95%CI 83.81–84.83) vs. 16.66 (95%CI 16.43–16.90) in men per 10,000PY. In women, recorded IR of osteoporosis reached a peak in 2009. In the adjusted model, older men in most deprived areas had a higher IRR of osteoporosis [1.67 (95% 1.59–1.74)] compared to those in least deprived areas. Women were more likely to be diagnosed with osteopenia compared to men, at any age. Incidence of osteopenia diagnosis increased over time. In the adjusted model, men in most deprived areas had a higher IRR of osteopenia [1.44 (95%CI 1.35–1.53)] compared to least deprived areas. The IR of fragility fracture was higher in women, 84.97 (95%CI 84.45–85.48) vs. 31.15 (95%CI 30.83–31.48) in men per 10,000PY. In the adjusted model, men in most deprived areas had an increased IRR of fragility fracture [1.53 (95%CI 1.48–1.59)] compared to least deprived areas.
Conclusion
Community bone health interventions might be targeted at populations at higher risk of fragility fractures, including older men living in socially deprived areas.
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Affiliation(s)
- C Avgerinou
- Department of Primary Care and Population Health, University College London , UK
| | - I Petersen
- Department of Primary Care and Population Health, University College London , UK
| | - A Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds , UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds , UK
| | - D Osborn
- Division of Psychiatry, University College London , UK
| | - K Walters
- Department of Primary Care and Population Health, University College London , UK
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8
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Laughlin BS, Golafshar MA, Ahmed S, Prince M, Anderson JD, Vern-Gross T, Seetharam M, Goulding K, Petersen I, DeWees T, Ashman JB. Early Experience Using Proton Beam Therapy for Extremity Soft Tissue Sarcoma: A Multicenter Study. Int J Part Ther 2022; 9:1-11. [PMID: 35774491 PMCID: PMC9238125 DOI: 10.14338/ijpt-21-00037.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Purpose
Proton beam therapy (PBT) may provide an advantage when planning well-selected patients with extremity soft tissue sarcoma (eSTS), specifically for large, anatomically challenging cases. We analyzed our early experience with PBT on toxicity and outcomes.
Materials and Methods
A retrospective study was performed for eSTS treated between June 2016 and October 2020 with pencil beam scanning PBT at 2 institutions. Diagnostic, treatment, and toxicity characteristics were gathered from baseline to last follow-up or death. Wound complications were defined as secondary operations for wound repair (debridement, drainage, skin graft, and muscle flap) or nonoperative management requiring hospitalization. Statistical analysis was performed with R software.
Results
Twenty consecutive patients with a median age 51.5 years (range, 19–78 years) were included. Median follow-up was 13.7 months (range, 1.7–48.1 months). Tumor presentation was primary (n = 17) or recurrent after prior combined modality therapy (n = 3). Tumor location was either lower extremity (n = 16) or upper extremity (n = 4). Radiation was delivered preoperatively in most patients (n = 18). Median pretreatment tumor size was 7.9 cm (range, 1.3 –30.0 cm). The 1-year locoregional control was 100%. Four patients (20%) had developed metastatic disease by end of follow-up. Maximum toxicity for acute dermatitis was grade 2 in 8 patients (40%) and grade 3 in 3 patients (15%). After preoperative radiation and surgical resection, acute wound complications occurred in 6 patients (35%). Tumor size was larger in patients with acute wound complications compared with those without (medians 16 cm, range [12–30.0 cm] vs 6.3 cm, [1.3–14.4 cm], P = .003).
Conclusion
PBT for well selected eSTS cases demonstrated excellent local control and similar acute wound complication rate comparable to historic controls. Long-term follow-up and further dosimetric analyses will provide further insight into potential advantages of PBT in this patient population.
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Affiliation(s)
| | | | - Safia Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Matthew Prince
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Mahesh Seetharam
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Krista Goulding
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Todd DeWees
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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Salerno KE, Alektiar KM, Baldini EH, Bedi M, Bishop AJ, Bradfield L, Chung P, DeLaney TF, Folpe A, Kane JM, Li XA, Petersen I, Powell J, Stolten M, Thorpe S, Trent JC, Voermans M, Guadagnolo BA. Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2021; 11:339-351. [PMID: 34326023 DOI: 10.1016/j.prro.2021.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 03/23/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults. METHODS The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended. CONCLUSIONS Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life.
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Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland.
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew J Bishop
- Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Folpe
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
| | - John M Kane
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - John Powell
- Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Michael Stolten
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Steven Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California
| | - Jonathan C Trent
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Health System, Miami, Florida
| | - Maria Voermans
- Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
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DeWees T, Abraha F, Corbin K, Brown P, Hallemeier C, Davis B, Petersen I, Martenson J, Ahmed S, Olivier K, Vern-Gross T, Rule W, Wong W, Vora S, Patel S, Ashman J, Schild S, Trifiletti D, Vargas C, Ma D. PO-1498 Clinical Sensitivity of PROMIS-10 Physical and Mental Quality of Life Domains to Radiation Therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Garzon S, Mariani A, Grassi T, Weaver A, McGree M, Petersen I, Weroha SJ, Glaser G, Langstraat C, Kollikonda S, Amarnath S, Alhilli M. Not all high-intermediate risk endometrial cancers are created equal: recurrence-free survival and cause-specific survival after observation or vaginal brachytherapy in all possible subgroups of early-stage high-intermediate risk endometrial cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01056-8] [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: 11/30/2022]
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12
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Narasimhulu DM, Block MS, Weaver AL, McGree M, Kumar A, Langstraat C, Petersen I, Mariani A, Glaser G. Sequencing chemotherapy before radiotherapy for women with stage IIIC endometrial cancer. Int J Gynecol Cancer 2021; 31:702-708. [PMID: 33771845 DOI: 10.1136/ijgc-2020-002158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE It is unclear how to best sequence adjuvant chemotherapy and radiotherapy for advanced endometrial cancer. We studied the outcomes for women treated with chemotherapy before radiotherapy in a chemotherapy-first (chemotherapy for 6 cycles followed radiotherapy) or 'sandwich' approach (chemotherapy for 3 cycles followed by radiotherapy and subsequently chemotherapy for 3 cycles). METHODS Women with stage IIIC endometrial cancer and no gross residual disease treated with chemotherapy before radiotherapy between April 2003 and April 2016 were included. The Kaplan-Meier method was used to estimate recurrence and survival. We performed a meta-analysis of endometrial cancer trials comparing chemotherapy and radiotherapy versus radiotherapy alone. RESULTS A total of 102 patients were included. The mean (SD) age was 63.8 (10.6) years; 84 patients received the chemotherapy-first approach and 18 patients received the 'sandwich' approach. Pelvic and para-aortic nodes were removed in 99% and 88.2%, respectively. Among all the patients, we observed 1 pelvic (1%), 1 para-aortic (1%), and 5 vaginal (4.9%) recurrences. At 3 years, for the 'sandwich' and chemotherapy-first approaches, the vaginal recurrence was 11.8% and 4.2%, pelvic recurrence was 0% and 1.5%, para-aortic recurrence was 0% and 1.2%, distant recurrence was 42.9% and 24.4%, and overall survival was 70.3% and 81.7%, respectively. With 'chemotherapy before radiotherapy' 94.9% completed 4+ chemotherapy cycles (vs 71-90% reported in the literature for 'radiotherapy before chemotherapy'). In a meta-analysis of endometrial cancer trials, distant recurrence rates were reduced with 4+ chemotherapy cycles but not with 3 cycles (p=0.01). CONCLUSION Chemotherapy before radiation sequencing for stage IIIC endometrial cancer was associated with a high proportion of patients completing 4+ chemotherapy cycles and low locoregional lymphatic recurrence rate, despite delaying radiotherapy until after 3-6 cycles of chemotherapy and not administering concurrent cisplatin.
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Affiliation(s)
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michaela McGree
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amanika Kumar
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Carrie Langstraat
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ivy Petersen
- Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrea Mariani
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Beck BD, Meyer SL, Simonsen E, Søgaard U, Petersen I, Arnfred SMH, Tellier T, Moe T. Music therapy was noninferior to verbal standard treatment of traumatized refugees in mental health care: Results from a randomized clinical trial. Eur J Psychotraumatol 2021; 12:1930960. [PMID: 34285768 PMCID: PMC8266250 DOI: 10.1080/20008198.2021.1930960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Many people with refugee backgrounds suffer from trauma-related complex social and psychological problems, and compliance with standard psychological treatment tends to be low. More culturally adaptable treatment options seem to be needed. Objective: We aimed to investigate whether the music therapy method: 'trauma-focused music and imagery' (tr-MI), characterized by a particular focus on arousal and affect regulation, would be equally effective as the standard psychological talk therapies for ameliorating trauma symptoms in Danish refugees. Methods: A pragmatic, noninferiority, parallel, randomized controlled trial with six-month follow-up was carried out at three clinics for refugees in the public mental health services of the Psychiatry (DK). Seventy-four adults diagnosed with posttraumatic stress disorder (PTSD) were allocated to either music therapy sessions (tr-MI, N = 39) or psychological treatment as usual (TAU, N = 35). Western classical music, new age music, and music from the participants' own national culture were used to generate inner imagery, following a phased treatment protocol. Homework entailed listening to music. The primary outcome was the measurement of trauma symptoms by the Harvard Trauma Questionnaire, section IV (HTQ-IV); secondary measures were somatoform and psychoform dissociation (DSS-20), SDQ-20), attachment (RAAS), and well-being (WHO-5). Treatment effects reflected by primary and secondary measures were estimated using linear mixed models. Results: Tr-MI was noninferior to TAU (mean difference at follow-up HTQ-IV: 0.14, CI (-0.10; 0.38), with a - 0.3 noninferiority margin). A high dropout rate of 40% occurred in the TAU group, compared to 5% in the music therapy group. Secondary measures generated small to medium effect sizes in both groups, with significant medium effect sizes for well-being and psychoform dissociation at follow-up in tr-MI. Conclusions: Tr-MI is an innovative form of psychological treatment in refugee mental health services. Trials comparing music therapy to standardized therapy are needed to substantiate the evidence base for tr-MI therapy.
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Affiliation(s)
- B D Beck
- Institute for Communication and Psychology, Aalborg University, Aalborg, Denmark.,Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - S L Meyer
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - E Simonsen
- Psychiatric Research Unit, Region Zealand; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - U Søgaard
- Psychiatric Research Unit, Region Zealand; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I Petersen
- Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S M H Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T Tellier
- Psychiatric Centre North Zealand, Mental health services in the Capital Region of Denmark
| | - T Moe
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
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Zani B, Fairall L, Petersen I, Folb N, Bhana A, Thornicroft G, Hanass-Hancock J, Lund C, Bachmann M. Predictors of receiving a diagnosis, referral and treatment of depression in people on antiretroviral therapy in South African primary care: a secondary analysis of data from a randomised trial. Trop Med Int Health 2020; 25:1450-1466. [PMID: 32985080 PMCID: PMC7756779 DOI: 10.1111/tmi.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care. Methods This is a secondary analysis of data from a randomised controlled trial of an intervention intended to improve detection and treatment of depression in primary care patients receiving ART. In this analysis, we combined cross‐sectional and longitudinal data from the intervention and control arms. Using regression models and adjusting for intra‐cluster correlation of outcomes, we investigated associations between socioeconomic characteristics, depressive symptoms, stress, disability and stigma, and receipt of a diagnosis, referral and treatment for depression. Results Of 2002 participants enrolled, 18% reported a previous diagnosis of depression by a healthcare worker and 10% reported having received counselling from a specialist mental health worker. Diagnosis, referral and counselling during the follow‐up period were appropriately targeted, being independently more frequent in participants with higher enrolment scores for depressive symptoms, stress or disability. Participants with higher stigma scores at enrolment were independently less likely to receive counselling. Severe socio‐economic deprivation was common but was not associated with treatment. Conclusion While the receipt of a diagnosis, referral and treatment for depression were uncommon, they seemed to be appropriately targeted. Socio‐economic deprivation was not associated with treatment.
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Affiliation(s)
- B Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - L Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,King's Global Health Institute, King's College London, London, UK.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - I Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - N Folb
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - A Bhana
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.,Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - G Thornicroft
- Centre for Global Mental Health, King's College London, London, UK
| | - J Hanass-Hancock
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.,School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C Lund
- Centre for Global Mental Health, King's College London, London, UK.,Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
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15
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Blackwell J, Saxena S, Jayasooriya N, Bottle A, Petersen I, Hotopf M, Alexakis C, Pollok RC. Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study. J Crohns Colitis 2020; 15:jjaa146. [PMID: 32667962 DOI: 10.1093/ecco-jcc/jjaa146] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD). AIMS To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn's Disease (CD) and ulcerative colitis (UC). METHODS Case-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016. RESULTS We identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98). CONCLUSIONS There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.
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Affiliation(s)
- J Blackwell
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - S Saxena
- School of Public Health, Imperial College London, London, UK
| | - N Jayasooriya
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - A Bottle
- School of Public Health, Imperial College London, London, UK
| | - I Petersen
- Dept. Primary Care and Population Health, University College London, London, UK
- Dept. Clinical Epidemiology, Aarhus University, Denmark
| | - M Hotopf
- Institute of Psychiatry, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - C Alexakis
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
| | - R C Pollok
- Dept. Gastroenterology, St George's Healthcare NHS Trust, St George's University London, UK
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16
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Narasimhulu DM, Cope A, Riaz IB, Petersen I, Cliby W, Langstraat C, Glaser G, Kumar A, Cappuccio S, Murad MH, West C, Mariani A. External beam radiotherapy versus vaginal brachytherapy in patients with stage II endometrial cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2020; 30:797-805. [DOI: 10.1136/ijgc-2020-001199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe choice of adjuvant treatment for women with stage II endometrial cancer is challenging, given the known increase in morbidity with external beam radiation compared with vaginal brachytherapy, and the lack of consensus on its benefits. We summarized the evidence on survival and recurrence for stage II endometrial cancer, defined as cervical stromal invasion, after adjuvant postoperative external beam radiotherapy and vaginal brachytherapy.MethodsWe searched the MEDLINE, EMBASE, CENTRAL, and Scopus databases from inception to January 2019 to identify studies that compared adjuvant postoperative external beam radiotherapy with or without vaginal brachytherapy and vaginal brachytherapy alone in stage II endometrial cancer. Our primary outcome was the locoregional recurrence rate, defined as recurrence in the pelvis or vagina. Secondary outcomes included the rate of recurrence at any site, distant recurrence rate, vaginal recurrence rate, pelvic recurrence rate, and 5 year overall survival. Study selection, assessment, and data abstraction were performed by an independent set of reviewers. Random effects models were used to synthesize quantitative data.ResultsWe included 15 cohort studies reporting data on 1070 women. Most women with stage II endometrial cancer (848/1070, 79.3%) were treated with external beam radiotherapy with or without vaginal brachytherapy. Subgroup analysis was stratified by whether >90% of the women included underwent pelvic lymph node assessment (sampling or full dissection). Locoregional recurrence (pelvic and vaginal recurrence) was significantly reduced with external beam radiotherapy with or without vaginal brachytherapy compared with vaginal brachytherapy alone (14 studies (n=1057); odds ratio (OR) 0.33 (95% confidence interval (CI) 0.16 to 0.68); I2=5%) regardless of pelvic lymph node assessment. Most women (81.8%) who recurred locoregionally had a least one uterine risk factor (grade 3 tumor, myometrial invasion >50%, or lymphovascular invasion). There was no difference in overall survival with external beam radiotherapy with or without vaginal brachytherapy compared with vaginal brachytherapy alone (five studies (n=463); OR 0.78 (95% CI 0.34 to 1.80); I2=48%).ConclusionsExternal beam radiotherapy with or without vaginal brachytherapy decreased the locoregional recurrence threefold for stage II endometrial cancer, regardless of pelvic lymph node assessment. Most women who suffered recurrence locoregionally had a least one high risk factor. Vaginal brachytherapy alone may be sufficient therapy for node negative stage II endometrial cancer without uterine risk factors, while those with uterine risk factors should be considered for external beam radiotherapy with or without vaginal brachytherapy to improve locoregional control.
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Petersen I. [Thoracic pathology news : Report of the DGP working group 2019]. Pathologe 2019; 40:396-398. [PMID: 31720746 DOI: 10.1007/s00292-019-00681-y] [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: 11/28/2022]
Affiliation(s)
- I Petersen
- Zentrum für Pathologie und Zytodiagnostik Gera, SRH Poliklinik Gera GmbH, Straße des Friedens 122, 07548, Gera, Deutschland.
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18
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Brückner C, Straube E, Petersen I, Sachse S, Keller P, Layher F, Matziolis G, Spiegl U, Zajonz D, Edel M, Roth A. Low-grade infections as a possible cause of arthrofibrosis after total knee arthroplasty. Patient Saf Surg 2019; 13:1. [PMID: 30647774 PMCID: PMC6327456 DOI: 10.1186/s13037-018-0181-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Arthrofibrosis after total knee arthroplasty represents a considerable burden for the patient and a therapeutic challenge for the practitioner. One possible cause discussed in the literature is a low-grade infection. This hypothesis should be examined within the scope of this retrospective study. Patients and methods Nineteen patients with clinical symptoms of arthrofibrosis after primary total knee arthroplasty were examined between January, 1999 and January, 2012. Incorrect positioning was radiologically ruled out. All patients were examined clinically (score of Freeman as well as Blauth and Jäger), radiologically (component and leg alignment, patella height according to Insall and Salvati), microbiologically (culture-based procedures), molecular biologically (PCR) and histologically in the course of an open revision of the prosthesis. Results According to the score of Freeman et al. (1977), a highly significant improvement in pain (p = 0.007) and in the overall score (p = 0.003) was shown. The knee joint mobility did not change significantly (p = 0.795). PCR was negative in 17 patients. One patient showed a PCR-positive result of the synovial membrane for Corynebacterium spp., while Staphylococcus warneri was detected in the culture. Another patient had a positive result of synovia PCR for Enterococcus cecorum as well as Corynebacterium spp. However, this culture was sterile. In 16 patient samples, no bacterial growth was detectable. Two samples were not evaluable. The main histopathological findings were synovialitis and fibrosis. Conclusion The hypothesis of low-grade-infection-induced arthrofibrosis after total knee arthroplasty could not be confirmed in this study. However, based on this small study population the conclusion needs to be confirmed by new and larger studies, ideally prospectively designed including a control group.
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Affiliation(s)
- C Brückner
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - E Straube
- 2Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Jena, Germany
| | - I Petersen
- 3Institute of Pathology, Friedrich-Schiller-University Jena, Jena, Germany.,4Institute of Pathology, SRH Waldklinikum Gera, Gera, Germany
| | - S Sachse
- 2Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Keller
- 2Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Jena, Germany.,5Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - F Layher
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - G Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - U Spiegl
- 6Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - D Zajonz
- 6Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - M Edel
- ZESBO - Center for research on musculoskeletal systems, Leipzig, Germany
| | - A Roth
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany.,6Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.,8Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich Endoprothetik/Orthopädie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103 Leipzig, Germany
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19
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Jordans M, Rathod S, Fekadu A, Medhin G, Kigozi F, Kohrt B, Luitel N, Petersen I, Shidhaye R, Ssebunnya J, Patel V, Lund C. Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study. Epidemiol Psychiatr Sci 2018; 27:393-402. [PMID: 28202089 PMCID: PMC5559346 DOI: 10.1017/s2045796017000038] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [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: 08/26/2016] [Accepted: 01/20/2017] [Indexed: 11/07/2022] Open
Abstract
AimsSuicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC. METHODS Twelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder. RESULTS We found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5-11.1% in community samples and 5.0-14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries. CONCLUSION The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.
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Affiliation(s)
- M. Jordans
- Research and Development Department, HealthNet TPO-Amsterdam, Netherlands
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - S. Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A. Fekadu
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - G. Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - F. Kigozi
- Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
| | - B. Kohrt
- Duke Global Health Institute, Duke University, Durham, USA
- Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
| | - N. Luitel
- Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
| | - I. Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - R. Shidhaye
- Centre for the Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India; Sangath, India
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - J. Ssebunnya
- Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
| | - V. Patel
- Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
- Sangath, Goa, India
| | - C. Lund
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
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20
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Patel P, Petersen I, Haddock M, Deufel C. Preliminary Results of Brachytherapy Using a Modified MIAMI Brachytherapy Applicator for Treatment of Upper/Apical Vaginal Tumors. Brachytherapy 2018. [DOI: 10.1016/j.brachy.2018.04.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Blackburn R, Osborn D, Walters K, Nazareth I, Petersen I. Statin prescribing for prevention of cardiovascular disease amongst people with severe mental illness: Cohort study in UK primary care. Schizophr Res 2018; 192:219-225. [PMID: 28599749 DOI: 10.1016/j.schres.2017.05.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Severe mental illness (SMI) is associated with excess cardiovascular disease (CVD) morbidity, but little is known on provision of preventative interventions. We investigated statin initiation for primary CVD prevention in individuals with and without SMI. METHODS We used primary care data from The Health Improvement Network from 2006 to 2015 for UK patients aged 30-99years with no pre-existing CVD conditions and selected individuals with schizophrenia (n=13,252) or bipolar disorder (n=11,994). In addition, we identified samples of individuals without schizophrenia (n=66,060) and bipolar disorder (n=59,765), but with similar age and gender distribution. Missing data on CVD covariates were estimated using multiple imputation. Statin prescribing differences between individuals with and without SMI were investigated using multivariable Poisson regression models. RESULTS Initiation of statin prescribing was between 2 and 3 fold higher in people aged 30-59years with SMI than in those without after adjusting for CVD covariates. The rates in those aged 60-74years with SMI were similar or slightly higher relative to those without SMI. The incidence rate ratio (IRR) was 1.15 (95% CI 1.03-1.28) for bipolar disorder and 1.00 (0.91-1.11) for schizophrenia. The rate of statin prescribing was lower (IRR 0.81 (0.66-0.98)) amongst the oldest (aged 75+years) with schizophrenia relative to those without schizophrenia. CONCLUSIONS Despite higher rates of new statin prescriptions to younger individuals with SMI relative to individuals without SMI, there was evidence of lower rates of statin initiation for older individuals with schizophrenia, and this group may benefit from additional measures to prevent CVD.
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Affiliation(s)
- R Blackburn
- Division of Psychiatry, W1T 7NF and Institute for Health Informatics, UCL, NW1 2DA, UK.
| | - D Osborn
- Psychiatric Epidemiology, Division of Psychiatry, UCL, W1T 7NF and Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - K Walters
- Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Nazareth
- Primary Care and Population Health, UCL, NW3 2PF, UK; Primary Care and Population Science, Primary Care and Population Health, UCL, NW3 2PF, UK
| | - I Petersen
- Primary Care and Population Health, UCL, NW3 2PF, UK; Epidemiology and Statistics, Primary Care and Population Health, UCL, NW3 2PF, Department of Clinical Epidemiology, Aarhus University, 8200 Aarhus N, Denmark
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Martín-Merino E, Petersen I, Hawley S, Álvarez-Gutierrez A, Khalid S, Llorente-Garcia A, Delmestri A, Javaid MK, Van Staa TP, Judge A, Cooper C, Prieto-Alhambra D. Risk of venous thromboembolism among users of different anti-osteoporosis drugs: a population-based cohort analysis including over 200,000 participants from Spain and the UK. Osteoporos Int 2018; 29:467-478. [PMID: 29199359 DOI: 10.1007/s00198-017-4308-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/27/2017] [Accepted: 11/07/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED The venous thromboembolism risk among anti-osteoporotics is unknown. In this primary care study, the risk with other bisphosphonates [1.05 (0.94-1.18) and 0.96 (0.78-1.18)], strontium [0.90 (0.61-1.34) and 1.19 (0.82-1.74)], in the UK and Spain respectively, and denosumab [1.77 (0.25-12.66)] and teriparatide [1.27 (0.59-2.71)] in Spain, did not differ versus alendronate. INTRODUCTION Most of the known adverse drug reactions described for anti-osteoporosis medication (AOM) have been described in studies comparing AOM users to non-users. We aimed to compare the risk of venous thromboembolism (VTE) among incident users of different AOM compared to alendronate (first line therapy). METHODS Two cohort studies were performed using data from the UK (CPRD) and Spain (BIFAP) primary care records separately. All patients aged ≥ 50 years with at least 1 year of data available and a new prescription or dispensation of AOM (date for therapy initiation) during 2000-2014 (CPRD) or 2001-2013 (BIFAP) were included. Users of raloxifene/bazedoxifene were excluded from both databases. Five exposure cohorts were identified according to first treatment: (1) alendronate, (2) other bisphosphonates, (3) strontium ranelate, (4) denosumab, and (5) teriparatide. Participants were followed from the day after therapy initiation to the earliest of a treated VTE (cases), end of AOM treatment (defined by a refill gap of 180 days), switching to an alternative AOM, drop-out, death, or end of study period. Incidence rates of VTE were estimated by cohort. Adjusted hazard ratios (HR 95%CI) were estimated according to drug used. RESULTS Overall, 2035/159,209 (1.28%) in CPRD and 401/83,334 (0.48%) in BIFAP had VTE. Compared to alendronate, adjusted HR of VTE were 1.05 (0.94-1.18) and 0.96 (0.78-1.18) for other bisphosphonates, and 0.90 (0.61-1.34) and 1.19 (0.82-1.74) for strontium in CPRD and BIFAP, respectively; 1.77 (0.25-12.66) for denosumab and 1.27 (0.59-2.71) for teriparatide in BIFAP. CONCLUSIONS VTE risk during AO therapy did not differ by AOM drug use. Our data does not support an increased risk of VTE associated with strontium ranelate use in the community.
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Affiliation(s)
- E Martín-Merino
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Calle Campezo 1, Edif. 8, 28022, Madrid, Spain.
| | - I Petersen
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - S Hawley
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - A Álvarez-Gutierrez
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Calle Campezo 1, Edif. 8, 28022, Madrid, Spain
| | - S Khalid
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - A Llorente-Garcia
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Calle Campezo 1, Edif. 8, 28022, Madrid, Spain
| | - A Delmestri
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - M K Javaid
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - T P Van Staa
- Health eResearch Centre, University of Manchester, Vaughan House, Portsmouth Street, Manchester, M13 9GB, UK
| | - A Judge
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Elsie Widdowson Laboratory Oxford NIHR Musculoskeletal Biomedical Research Unit, MRC Human Nutrition Research, University of Oxford, Southampton, UK
| | - D Prieto-Alhambra
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autonoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
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Fardet L, Nazareth I, Petersen I. Effects of chronic exposure of hydroxychloroquine/chloroquine on the risk of cancer, metastasis, and death: a population-based cohort study on patients with connective tissue diseases. Clin Epidemiol 2017; 9:545-554. [PMID: 29138600 PMCID: PMC5679565 DOI: 10.2147/clep.s143563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Indexed: 12/12/2022] Open
Abstract
Background Hydroxychloroquine and chloroquine may reduce the risk of cancer as they inhibit autophagy, in particular, in people with connective tissue diseases. Methods The hazard ratios of cancers, metastases, and death were assessed in adults with connective tissue diseases prescribed hydroxychloroquine/chloroquine for at least 1 year in comparison with unexposed individuals with the same underlying conditions. A competing risk survival regression analysis was performed. Data were extracted from the Health Improvement Network UK primary care database. Results Eight thousand nine hundred and ninety-nine individuals exposed to hydroxychloroquine (98.6%) or chloroquine (1.4%) and 24,118 unexposed individuals were included in the study (median age: 56 [45–66] years, women: 76.8%). When compared to the unexposed group, individuals exposed to hydroxychloroquine/chloroquine were not at lower risk of non-skin cancers (adjusted sub-distribution hazard ratio [sHR]: 1.04 [0.92–1.18], p=0.54), hematological malignancies (adjusted sHR: 1.00 [0.73–1.38], p=0.99), or skin cancers (adjusted sHR: 0.92 [0.78–1.07], p=0.26). The risk of metastasis was not significantly different between the two groups. However, it was significantly lower during the exposure period when compared with the unexposed (adjusted sHR: 0.64 [0.44–0.95] for the overall population and 0.61 [0.38–1.00] for those diagnosed with incident cancers). The risk of death was also significantly lower in those exposed to hydroxychloroquine/chloroquine (adjusted HR: 0.90 [0.81–1.00] in the overall population and 0.78 [0.64–0.96] in those diagnosed with incident cancer). Conclusion Individuals on long-term exposure to hydroxychloroquine/chloroquine are not at lower risk of cancer. However, hydroxychloroquine/chloroquine may lower the risk of metastatic cancer and death.
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Affiliation(s)
- L Fardet
- Department of Primary Care and Population Health, University College London, UK.,Department of Dermatology, Henri Mondor Hospital AP-HP, Créteil, France.,Equipe d'Accueil 7379 EpiDermE, Université Paris Est Créteil, Créteil, France
| | - I Nazareth
- Department of Primary Care and Population Health, University College London, UK
| | - I Petersen
- Department of Primary Care and Population Health, University College London, UK
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Das‐Munshi J, Ashworth M, Dewey ME, Gaughran F, Hull S, Morgan C, Nazroo J, Petersen I, Schofield P, Stewart R, Thornicroft G, Prince MJ. Type 2 diabetes mellitus in people with severe mental illness: inequalities by ethnicity and age. Cross-sectional analysis of 588 408 records from the UK. Diabet Med 2017; 34:916-924. [PMID: 27973692 PMCID: PMC5484374 DOI: 10.1111/dme.13298] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/13/2022]
Abstract
AIMS To investigate whether the association of severe mental illness with Type 2 diabetes varies by ethnicity and age. METHODS We conducted a cross-sectional analysis of data from an ethnically diverse sample of 588 408 individuals aged ≥18 years, registered to 98% of general practices (primary care) in London, UK. The outcome of interest was prevalent Type 2 diabetes. RESULTS Relative to people without severe mental illness, the relative risk of Type 2 diabetes in people with severe mental illness was greatest in the youngest age groups. In the white British group the relative risks were 9.99 (95% CI 5.34, 18.69) in those aged 18-34 years, 2.89 (95% CI 2.43, 3.45) in those aged 35-54 years and 1.16 (95% CI 1.04, 1.30) in those aged ≥55 years, with similar trends across all ethnic minority groups. Additional adjustment for anti-psychotic prescriptions only marginally attenuated the associations. Assessment of estimated prevalence of Type 2 diabetes in severe mental illness by ethnicity (absolute measures of effect) indicated that the association between severe mental illness and Type 2 diabetes was more marked in ethnic minorities than in the white British group with severe mental illness, especially for Indian, Pakistani and Bangladeshi individuals with severe mental illness. CONCLUSIONS The relative risk of Type 2 diabetes is elevated in younger populations. Most associations persisted despite adjustment for anti-psychotic prescriptions. Ethnic minority groups had a higher prevalence of Type 2 diabetes in the presence of severe mental illness. Future research and policy, particularly with respect to screening and clinical care for Type 2 diabetes in populations with severe mental illness, should take these findings into account.
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Affiliation(s)
- J. Das‐Munshi
- Department of Health Service and Population ResearchInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondon
| | - M. Ashworth
- Department of Primary Care and Public Health SciencesKing's College LondonLondon
| | - M. E. Dewey
- Department of Health Service and Population ResearchInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondon
| | - F. Gaughran
- South London and Maudsley NHS Foundation TrustLondon
| | - S. Hull
- Blizard InstituteBarts and London School of Medicine and DentistryLondon
| | - C. Morgan
- Department of Health Service and Population ResearchInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondon
| | - J. Nazroo
- Cathie Marsh Institute for Social ResearchUniversity of ManchesterManchester
| | - I. Petersen
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - P. Schofield
- Department of Primary Care and Public Health SciencesKing's College LondonLondon
| | - R. Stewart
- Department of Health Service and Population ResearchInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondon
| | - G. Thornicroft
- Department of Health Service and Population ResearchInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondon
| | - M. J. Prince
- Department of Health Service and Population ResearchInstitute of PsychiatryPsychology & NeuroscienceKing's College LondonLondon
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Osborn D, Marston L, Nazareth I, King MB, Petersen I, Walters K. Relative risks of cardiovascular disease in people prescribed olanzapine, risperidone and quetiapine. Schizophr Res 2017; 183:116-123. [PMID: 27884434 DOI: 10.1016/j.schres.2016.11.009] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/28/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022]
Abstract
UNLABELLED Antipsychotics may confer long term benefits and risks, including cardiovascular disease (CVD) risk. Several studies using routine clinical data have reported associations between antipsychotics and CVD but potential confounding factors and unclear classification of drug exposure limits their interpretation. METHOD We used data from The Health Improvement Network, a large UK primary care database to determine relative risks of (CVD) comparing similar groups of people only prescribed olanzapine versus either risperidone or quetiapine. We included participants over 18 between 1995 and 2011. To assess confounding factors we created propensity scores for being prescribed each antipsychotic. We used propensity score matching and Poisson regression to calculate the CVD incidence rate ratios for olanzapine versus the other two drugs. RESULTS We identified 18,319 people who received a single antipsychotic during follow-up (n=5090 risperidone, 7797 olanzapine and 4613 quetiapine). In unmatched analyses, the CVD incidence rate ratio (IRR) for olanzapine versus risperidone was 0.63 (0.51-0.77) but the propensity score matched IRR was 0.78 (0.61-1.02). In the unmatched olanzapine versus quetiapine analysis the IRR adjusted for age and sex for olanzapine was 1.52 (1.16-1.98) but the propensity score matched analysis gave an IRR of 1.08 (0.79-1.46). CONCLUSIONS After propensity score matching, we found no statistical differences in CVD incidence between olanzapine and either risperidone or quetiapine. Analyses which did not account for confounding factors produced very different results. Researchers must address confounding factors when designing observational studies to assess adverse outcomes of drugs, including antipsychotics.
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Affiliation(s)
- Dpj Osborn
- UCL Division of Psychiatry, UCL, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - L Marston
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - I Nazareth
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - M B King
- UCL Division of Psychiatry, UCL, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - I Petersen
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - K Walters
- Research Department of Primary Care and Population Health, UCL, London, UK; Department of Clinical Epidemiology, Aarhus University, Denmark
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Abstract
OBJECTIVES To estimate the 'real-world effectiveness of statins for primary prevention of cardiovascular disease (CVD) and for lipid modification in people with severe mental illnesses (SMI), including schizophrenia and bipolar disorder. DESIGN Series of staggered cohorts. We estimated the effect of statin prescribing on CVD outcomes using a multivariable Poisson regression model or linear regression for cholesterol outcomes. SETTING 587 general practice (GP) surgeries across the UK reporting data to The Health Improvement Network. PARTICIPANTS All permanently registered GP patients aged 40-84 years between 2002 and 2012 who had a diagnosis of SMI. Exclusion criteria were pre-existing CVD, statin-contraindicating conditions or a statin prescription within the 24 months prior to the study start. EXPOSURE One or more statin prescriptions during a 24-month 'baseline' period (vs no statin prescription during the same period). MAIN OUTCOME MEASURES The primary outcome was combined first myocardial infarction and stroke. All-cause mortality and total cholesterol concentration were secondary outcomes. RESULTS We identified 2944 statin users and 42 886 statin non-users across the staggered cohorts. Statin prescribing was not associated with significant reduction in CVD events (incident rate ratio 0.89; 95% CI 0.68 to 1.15) or all-cause mortality (0.89; 95% CI 0.78 to 1.02). Statin prescribing was, however, associated with statistically significant reductions in total cholesterol of 1.2 mmol/L (95% CI 1.1 to 1.3) for up to 2 years after adjusting for differences in baseline characteristics. On average, total cholesterol decreased from 6.3 to 4.6 in statin users and 5.4 to 5.3 mmol/L in non-users. CONCLUSIONS We found that statin prescribing to people with SMI in UK primary care was effective for lipid modification but not CVD events. The latter finding may reflect insufficient power to detect a smaller effect size than that observed in randomised controlled trials of statins in people without SMI.
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Affiliation(s)
- R Blackburn
- Institute for Health Informatics, UCL, London, UK
| | - D Osborn
- Division of Psychiatry, UCL, London, UK
| | - K Walters
- Primary Care and Population Health, UCL, London, UK
| | - M Falcaro
- Primary Care and Population Health, UCL, London, UK
| | - I Nazareth
- Primary Care and Population Health, UCL, London, UK
| | - I Petersen
- Primary Care and Population Health, UCL, London, UK
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Mall S, Hailemariam M, Selamu M, Fekadu A, Lund C, Patel V, Petersen I, Hanlon C. 'Restoring the person's life': a qualitative study to inform development of care for people with severe mental disorders in rural Ethiopia. Epidemiol Psychiatr Sci 2017; 26:43-52. [PMID: 26961343 PMCID: PMC6998647 DOI: 10.1017/s2045796015001006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 07/07/2015] [Accepted: 10/29/2015] [Indexed: 11/06/2022] Open
Abstract
AIMS In low-income countries, care for people with severe mental disorders (SMDs) who manage to access treatment is usually emergency-based, intermittent or narrowly biomedical. The aim of this study was to inform development of a scalable district-level mental health care plan to meet the long-term care needs of people with SMD in rural Ethiopia. METHODS The present study was carried out as formative work for the Programme for Improving Mental health CarE which seeks to develop, implement and evaluate a district level model of integrating mental health care into primary care. Six focus group discussions and 25 in-depth interviews were conducted with service planners, primary care providers, traditional and religious healers, mental health service users, caregivers and community representatives. Framework analysis was used, with findings mapped onto the domains of the Innovative Care for Chronic Conditions (ICCC) framework. RESULTS Three main themes were identified. (1) Focused on 'Restoring the person's life', including the need for interventions to address basic needs for food, shelter and livelihoods, as well as spiritual recovery and reintegration into society. All respondents considered this to be important, but service users gave particular emphasis to this aspect of care. (2) Engaging with families, addressed the essential role of families, their need for practical and emotional support, and the importance of equipping families to provide a therapeutic environment. (3) Delivering collaborative, long-term care, focused on enhancing accessibility to biomedical mental health care, utilising community-based health workers and volunteers as an untapped resource to support adherence and engagement with services, learning from experience of service models for chronic communicable diseases (HIV and tuberculosis) and integrating the role of traditional and religious healers alongside biomedical care. Biomedical approaches were more strongly endorsed by health workers, with traditional healers, religious leaders and service users more inclined to see medication as but one component of care. The salience of poverty to service planning was cross-cutting. CONCLUSIONS Stakeholders prioritised interventions to meet basic needs for survival and endorsed a multi-faceted approach to promoting recovery from SMD, including social recovery. However, sole reliance on this over-stretched community to mobilise the necessary resources may not be feasible. An adapted form of the ICCC framework appeared highly applicable to planning an acceptable, feasible and sustainable model of care.
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Affiliation(s)
- S. Mall
- Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Rondebosch, South Africa
| | - M. Hailemariam
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - M. Selamu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - A. Fekadu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Affective Disorders Research Group, SE5 8AF, London
| | - C. Lund
- Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Rondebosch, South Africa
- Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, SE5 8AF, London
| | - V. Patel
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, WC1E 7HT, London
- Public Health Foundation of India, Centre for Chronic Conditions and Injuries, New Delhi, India
- Sangath Centre, Goa, India
| | - I. Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C. Hanlon
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, SE5 8AF, London
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Rabinovitch R, Moughan J, Vicini F, Pass H, Wong J, Chafe S, Petersen I, Arthur DW, White J. Long-Term Update of NRG Oncology RTOG 0319: A Phase 1 and 2 Trial to Evaluate 3-Dimensional Conformal Radiation Therapy Confined to the Region of the Lumpectomy Cavity for Stage I and II Breast Carcinoma. Int J Radiat Oncol Biol Phys 2016; 96:1054-1059. [PMID: 27869081 DOI: 10.1016/j.ijrobp.2016.08.042] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/02/2016] [Accepted: 09/20/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE NRG Oncology RTOG 0319 was the first cooperative group trial in the United States to evaluate 3-dimensional conformal radiation therapy (3D-CRT) accelerated partial breast irradiation (APBI). This report updates secondary endpoints of toxicity and efficacy. METHODS AND MATERIALS Patients with stage I or II invasive breast cancer (tumor size ≤3 cm, ≤3 positive lymph nodes, negative margins) were eligible for 3D-CRT APBI: 38.5 Gy in 10 twice-daily fractions. Patient characteristics and treatment details have previously been reported. Adverse events were graded with CTCAE v3.0 (National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0). This analysis updates the rates of ipsilateral breast recurrence (IBR), contralateral breast recurrence, ipsilateral node recurrence (INR), metastatic sites (distant metastases [DM]), mastectomy, disease-free survival, mastectomy-free survival, and overall survival. RESULTS Of 58 enrolled patients, 52 were eligible, with a median age of 61 years; 94% had stage I cancer and 83% had estrogen receptor positive disease. The median follow-up period was 8 years (minimum-maximum, 1.7-9.0 years). The 7-year estimate of isolated IBR (no DM) was 5.9%. The 7-year estimates of all IBRs, INR, mastectomy rate, and DM were 7.7%, 5.8%, 7.7%, and 7.7%, respectively. All 4 IBRs were invasive, of which 3 had a component within the planning target volume. The patterns of failure were as follows: 3 IBRs, 1 INR, 2 DM, 1 INR plus DM, and 1 IBR plus INR plus DM. The 7-year estimates of mastectomy-free survival, disease-free survival, and overall survival were 71.2%, 71.2%, and 78.8%, respectively. Thirteen patients died: 3 of breast cancer and 10 of other causes. Grade 3 (G3) treatment-related adverse events were reported by 4 patients (7.7%). No G3 pain or pulmonary or cardiac toxicities were reported. CONCLUSIONS This phase 1 and 2 trial of 3D-CRT APBI continues to show durable tumor control and minimal G3 toxicity, comparable to other APBI techniques. Mature phase 3 results will determine the appropriateness and limitations of this noninvasive APBI technique.
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Affiliation(s)
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Frank Vicini
- Radiation Oncology, St Joseph Mercy Oakland, Pontiac, Michigan
| | - Helen Pass
- Surgery, Stamford Hospital, Stamford, Connecticut
| | - John Wong
- Medical Physics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Chafe
- Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ivy Petersen
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Douglas W Arthur
- Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Julia White
- Radiation Oncology, The Ohio State University Medical Center, Columbus, Ohio
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Pillay Y, Petersen I. Current Practice Patterns of Clinical and Counselling Psychologists and Their Attitudes to Transforming Mental Health Polices in South Africa. South African Journal of Psychology 2016. [DOI: 10.1177/008124639602600202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current political changes in South Africa and the realization that there is a need to transform many institutions have resulted in strident calls for changes to mental health policies. However, it is also recognized that these changes must be coherent, and should enjoy the support of all interested constituencies. The authors surveyed members of the mental health professions, namely, Clinical and Counselling Psychologists to elicit their opińions regarding these changes. The aim was to obtain data on their current practice patterns and attitudes to change in mental health policies designed to meet the needs of the majority of South Africans. In this article the authors discuss results of the survey and emphasize some of the issues that need to be addressed if the mental health needs of the population are to be met. Die huidige politieke veranderinge in Suid-Afrika en die besef dat daar 'n behoefte is om instellings te transformeer het gelei tot ernstige beroepe om die geestegesondheidsbeleid ter verander. Nietemin word daar besef dat die veranderinge samehangend moet wees, en moet die ondersteuning van alle belangstellende groepe geniet. Om die nodige standpunte van hierdie verskillende groepe te bekom, was die lede van die Kliniese en Raadgewende Sielkundiges oor hul meinings gevra. Die doel was om data te bekom oor die huidige modelle en houdinge in die uitoefening van die beroep met betrekking tot veranderinge tot geestgesondheidsbeleid wat geruk is op die geestegesondheids behoeftes van die meerheid van Suid-Afrikaners. In hierdie artikel bespreek die outeurs die resultante van hierdie ondersoek en beklemtoon sommige van die vraagstukke waarmee rekening gehou moet word indien aan die geestegesondheidsbeloftes van die meerderheid van die bevolking voldoen moet word.
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Affiliation(s)
- Y.G. Pillay
- Department of Psychology, University of Durban-Westville, Private Bag X54001, Durban 4000, South Africa
| | - I. Petersen
- Department of Psychology, University of Durban-Westville, Private Bag X54001, Durban 4000, South Africa
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Salah FS, Ebbinghaus M, Muley VY, Zhou Z, Al-Saadi KRD, Pacyna-Gengelbach M, O'Sullivan GA, Betz H, König R, Wang ZQ, Bräuer R, Petersen I. Tumor suppression in mice lacking GABARAP, an Atg8/LC3 family member implicated in autophagy, is associated with alterations in cytokine secretion and cell death. Cell Death Dis 2016; 7:e2205. [PMID: 27124579 PMCID: PMC4855672 DOI: 10.1038/cddis.2016.93] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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] [Received: 08/09/2015] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 01/04/2023]
Abstract
GABARAP belongs to an evolutionary highly conserved gene family that has a fundamental role in autophagy. There is ample evidence for a crosstalk between autophagy and apoptosis as well as the immune response. However, the molecular details for these interactions are not fully characterized. Here, we report that the ablation of murine GABARAP, a member of the Atg8/LC3 family that is central to autophagosome formation, suppresses the incidence of tumor formation mediated by the carcinogen DMBA and results in an enhancement of the immune response through increased secretion of IL-1β, IL-6, IL-2 and IFN-γ from stimulated macrophages and lymphocytes. In contrast, TGF-β1 was significantly reduced in the serum of these knockout mice. Further, DMBA treatment of these GABARAP knockout mice reduced the cellularity of the spleen and the growth of mammary glands through the induction of apoptosis. Gene expression profiling of mammary glands revealed significantly elevated levels of Xaf1, an apoptotic inducer and tumor-suppressor gene, in knockout mice. Furthermore, DMBA treatment triggered the upregulation of pro-apoptotic (Bid, Apaf1, Bax), cell death (Tnfrsf10b, Ripk1) and cell cycle inhibitor (Cdkn1a, Cdkn2c) genes in the mammary glands. Finally, tumor growth of B16 melanoma cells after subcutaneous inoculation was inhibited in GABARAP-deficient mice. Together, these data provide strong evidence for the involvement of GABARAP in tumorigenesis in vivo by delaying cell death and its associated immune-related response.
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Affiliation(s)
- F S Salah
- Institute of Pathology, University Hospital - Friedrich Schiller University Jena, Ziegelmühlenweg 1, Jena D-07743, Germany.,Iraqi Centre for Cancer and Medical Genetics Research, Al-Mustansiriya University, Baghdad, Iraq
| | - M Ebbinghaus
- Institute of Physiology 1, University Hospital - Friedrich Schiller University Jena, Teichgraben 8, Jena D-07743, Germany
| | - V Y Muley
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstrasse 11, Jena D-07745, Germany.,Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, Jena D-07747, Germany
| | - Z Zhou
- Leibniz Institute for Age Research - Fritz Lipmann Institute (FLI), Beutenbergstrasse 11, Jena D-07745, Germany
| | - K R D Al-Saadi
- Iraqi Centre for Cancer and Medical Genetics Research, Al-Mustansiriya University, Baghdad, Iraq
| | - M Pacyna-Gengelbach
- Institute of Pathology, University Medicine Berlin, Campus Charité Mitte, Berlin D-10098, Germany
| | - G A O'Sullivan
- Department of Neurochemistry, Max-Planck Institute for Brain Research, Deutschordenstrasse 46, Frankfurt D-60528, Germany
| | - H Betz
- Department of Neurochemistry, Max-Planck Institute for Brain Research, Deutschordenstrasse 46, Frankfurt D-60528, Germany.,Max-Planck Institute for Medical Research, Jahnstrasse 29, Heidelberg D-69120, Germany
| | - R König
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstrasse 11, Jena D-07745, Germany.,Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, Jena D-07747, Germany
| | - Z-Q Wang
- Leibniz Institute for Age Research - Fritz Lipmann Institute (FLI), Beutenbergstrasse 11, Jena D-07745, Germany.,Faculty of Biology and Pharmacy, Friedrich Schiller University Jena, Bachstrasse 18k, Jena D-07743, Germany
| | - R Bräuer
- Institute of Pathology, University Hospital - Friedrich Schiller University Jena, Ziegelmühlenweg 1, Jena D-07743, Germany
| | - I Petersen
- Institute of Pathology, University Hospital - Friedrich Schiller University Jena, Ziegelmühlenweg 1, Jena D-07743, Germany
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Zomer E, Osborn D, Nazareth I, Blackburn R, Burton A, Hardoon S, Holt R, King M, Marston L, Morris S, Omar R, Petersen I, Walters K, Hunter R. Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionCardiovascular risk prediction tools are important for cardiovascular disease (CVD) prevention, however, which algorithms are appropriate for people with severe mental illness (SMI) is unclear.Objectives/aimsTo determine the cost-effectiveness using the net monetary benefit (NMB) approach of two bespoke SMI-specific risk algorithms compared to standard risk algorithms for primary CVD prevention in those with SMI, from an NHS perspective.MethodsA microsimulation model was populated with 1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years without CVD. Four cardiovascular risk algorithms were assessed; (1) general population lipid, (2) general population BMI, (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those high-risk (> 10%) were assumed to be prescribed statin therapy, others received usual care. Individuals entered the model in a ‘healthy’ free of CVD health state and with each year could retain their current health state, have cardiovascular events (non-fatal/fatal) or die from other causes according to transition probabilities.ResultsThe SMI-specific BMI and general population lipid algorithms had the highest NMB of the four algorithms resulting in 12 additional QALYs and a cost saving of approximately £37,000 (US$ 58,000) per 1000 patients with SMI over 10 years.ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of a SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Abstract
We determined prescribing rates of neuraminidase inhibitors (NIs) for influenza in UK primary care since 2009 in relation to national prescribing guidelines. All NI prescriptions issued during the influenza seasons between October 2010 and May 2013 were extracted from The Health Improvement Network (THIN), a large UK primary-care database. We calculated NI prescribing rates per 100,000 person-weeks (pw) by age group, sex, deprivation level, influenza season and presence of chronic conditions with 95% confidence intervals (CIs), and used negative binomial regression models to determine the independent association between these variables and NI prescribing. NI prescribing was rare. The prescribing rate was 1·7/100,000 pw (95% CI 1·7-1·8) during influenza-active periods, and 0·1/100,000 (95% CI 0·1-0·1) during non-active periods. Prescribing rates were highest in 25- to 44-year-olds in 2010/2011 and in persons aged ⩾85 years in 2011/2012 and 2012/2013. Individuals with chronic conditions had significantly higher prescribing rates than persons without (rate ratio 2·62, 95% CI 2·27-3·03). GPs are more likely to prescribe NIs to high-risk individuals and during influenza active periods, as per national guidelines. We could not assess the proportion of patients with influenza-like illness who were prescribed an NI.
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Affiliation(s)
- P Hardelid
- Population, Policy and Practice Programme, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - G Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - R Gilbert
- Population, Policy and Practice Programme, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - I Petersen
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus DK-8200, Denmark
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Gaffney DK, King B, Viswanathan AN, Barkati M, Beriwal S, Eifel P, Erickson B, Fyles A, Goulart J, Harkenrider M, Jhingran A, Klopp A, Koh WJ, Lim K, Petersen I, Portelance L, Small W, Stewart A, Wiebe E, Wolfson A, Yashar C, Bosch W. Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma. Int J Radiat Oncol Biol Phys 2016; 95:1191-200. [PMID: 27130794 DOI: 10.1016/j.ijrobp.2016.02.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/05/2016] [Accepted: 02/11/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. METHODS AND MATERIALS An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. RESULTS Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. CONCLUSIONS These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.
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Affiliation(s)
- David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, Utah.
| | - Bronwyn King
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre and Epworth Radiation Oncology, Melbourne, Victoria, Australia
| | - Akila N Viswanathan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Maroie Barkati
- Department of Radiation Oncology, Centre hospitalier de l'universite de Montreal, Montreal, Quebec, Canada
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Patricia Eifel
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Beth Erickson
- Department of Radiation Oncology, Proedtert and Medical College Clinical Cancer Center, Milwaukee, Wisconsin
| | - Anthony Fyles
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer Goulart
- Department of Radiation Oncology, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - Anuja Jhingran
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Ann Klopp
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Wui-Jin Koh
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Karen Lim
- Liverpool Cancer Therapy Centre, Radiation Oncology Unit, Sydney, New South Wales, Australia
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Lorraine Portelance
- Radiation Oncology Department, Miller School of Medicine, University of Miami, Miami, Florida
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - Alexandra Stewart
- St. Luke's Cancer Centre, Royal Surrey Country Hospital, Surrey, United Kingdom
| | - Ericka Wiebe
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Aaron Wolfson
- Radiation Oncology Department, Miller School of Medicine, University of Miami, Miami, Florida
| | - Catheryn Yashar
- Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Walter Bosch
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
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Walters K, Hardoon S, Petersen I, Iliffe S, Omar RZ, Nazareth I, Rait G. Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data. BMC Med 2016; 14:6. [PMID: 26797096 PMCID: PMC4722622 DOI: 10.1186/s12916-016-0549-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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: 09/30/2015] [Accepted: 12/16/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Existing dementia risk scores require collection of additional data from patients, limiting their use in practice. Routinely collected healthcare data have the potential to assess dementia risk without the need to collect further information. Our objective was to develop and validate a 5-year dementia risk score derived from primary healthcare data. METHODS We used data from general practices in The Health Improvement Network (THIN) database from across the UK, randomly selecting 377 practices for a development cohort and identifying 930,395 patients aged 60-95 years without a recording of dementia, cognitive impairment or memory symptoms at baseline. We developed risk algorithm models for two age groups (60-79 and 80-95 years). An external validation was conducted by validating the model on a separate cohort of 264,224 patients from 95 randomly chosen THIN practices that did not contribute to the development cohort. Our main outcome was 5-year risk of first recorded dementia diagnosis. Potential predictors included sociodemographic, cardiovascular, lifestyle and mental health variables. RESULTS Dementia incidence was 1.88 (95% CI, 1.83-1.93) and 16.53 (95% CI, 16.15-16.92) per 1000 PYAR for those aged 60-79 (n = 6017) and 80-95 years (n = 7104), respectively. Predictors for those aged 60-79 included age, sex, social deprivation, smoking, BMI, heavy alcohol use, anti-hypertensive drugs, diabetes, stroke/TIA, atrial fibrillation, aspirin, depression. The discrimination and calibration of the risk algorithm were good for the 60-79 years model; D statistic 2.03 (95% CI, 1.95-2.11), C index 0.84 (95% CI, 0.81-0.87), and calibration slope 0.98 (95% CI, 0.93-1.02). The algorithm had a high negative predictive value, but lower positive predictive value at most risk thresholds. Discrimination and calibration were poor for the 80-95 years model. CONCLUSIONS Routinely collected data predicts 5-year risk of recorded diagnosis of dementia for those aged 60-79, but not those aged 80+. This algorithm can identify higher risk populations for dementia in primary care. The risk score has a high negative predictive value and may be most helpful in 'ruling out' those at very low risk from further testing or intensive preventative activities.
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Affiliation(s)
- K Walters
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - S Hardoon
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - I Petersen
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - S Iliffe
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - R Z Omar
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - I Nazareth
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - G Rait
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
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Li XA, Chen X, Zhang Q, Kirsch DG, Petersen I, DeLaney TF, Freeman CR, Trotti A, Hitchcock Y, Bedi M, Haddock M, Salerno K, Dundas G, Wang D. Margin reduction from image guided radiation therapy for soft tissue sarcoma: Secondary analysis of Radiation Therapy Oncology Group 0630 results. Pract Radiat Oncol 2015; 6:e135-e140. [PMID: 26852173 DOI: 10.1016/j.prro.2015.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Six imaging modalities were used in Radiation Therapy Oncology Group (RTOG) 0630, a study of image guided radiation therapy (IGRT) for primary soft tissue sarcomas of the extremity. We analyzed all daily patient-repositioning data collected in this trial to determine the impact of daily IGRT on clinical target volume-to-planning target volume (CTV-to-PTV) margin. METHODS AND MATERIALS Daily repositioning data, including shifts in right-left (RL), superior-inferior (SI), and anterior-posterior (AP) directions and rotations for 98 patients enrolled in RTOG 0630 from 18 institutions were analyzed. Patients were repositioned daily on the basis of bone anatomy by using pretreatment images, including kilovoltage orthogonal images (KVorth), megavoltage orthogonal images (MVorth), KV fan-beam computed tomography (KVCT), KV cone beam CT (KVCB), MV fan-beam CT (MVCT), and MV cone beam CT (MVCB). Means and standard deviations (SDs) for each shift and rotation were calculated for each patient and for each IGRT modality. The Student's t tests and F-tests were performed to analyze the differences in the means and SDs. Necessary CTV-to-PTV margins were estimated. RESULTS The repositioning shifts and day-to-day variations were large and generally similar for the 6 imaging modalities. Of the 2 most commonly used modalities, MVCT and KVorth, there were no statistically significant differences in the shifts and rotations (P = .15 and .59 for the RL and SI shifts, respectively; and P = .22 for rotation), except for shifts in AP direction (P = .002). The estimated CTV-to-PTV margins in the RL, SI, and AP directions would be 13.0, 10.4, and 11.7 mm from MVCT data, respectively, and 13.1, 8.6, and 10.8 mm from KVorth data, respectively, indicating that margins substantially larger than 5 mm used with daily IGRT would be required in the absence of IGRT. CONCLUSIONS The observed large daily repositioning errors and the large variations among institutions imply that daily IGRT is necessary for this tumor site, particularly in multi-institutional trials. Otherwise, a CTV-to-PTV margin of 1.5 cm is required to account for daily setup variations.
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Affiliation(s)
- X Allen Li
- Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | | | | | - Andy Trotti
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - George Dundas
- Cross Cancer Institute - University of Alberta, Edmonton, Alberta, Canada
| | - Dian Wang
- Rush University Medical Center, Chicago, Illinois
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Barry MM, Clarke AM, Petersen I. Promotion of mental health and prevention of mental disorders: priorities for implementation. East Mediterr Health J 2015; 21:503-11. [PMID: 26442891 DOI: 10.26719/2015.21.7.503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 11/09/2022]
Abstract
There is compelling evidence from high-quality studies that mental health promotion and primary prevention interventions can reduce the risk of mental disorders, enhance protective factors for good mental and physical health, and lead to lasting positive effects on a range of social and economic outcomes. This paper reviews the available evidence in order to guide the implementation of mental health promotion and prevention interventions in the Eastern Mediterranean Region. The paper identifies a number of priority areas that can generate clear health and social gains in the population and be implemented and sustained at a reasonable cost. The interventions cover population groups across the lifespan from infancy to adulthood and include actions delivered across different settings and delivery platforms. "Best practices" were identified as interventions for which there is evidence not only of their effectiveness but also of their feasibility within resource constraints. The implications of the findings for capacity development are considered.
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Affiliation(s)
- M M Barry
- World Health Organization Collaborating Centre for Health Promotion Research, National University of Ireland Galway, Galway, Ireland
| | - A M Clarke
- World Health Organization Collaborating Centre for Health Promotion Research, National University of Ireland Galway, Galway, Ireland
| | - I Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
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Göbel H, Heinze-Kuhn K, Petersen I, Göbel C, Göbel A, Heinze A. [Classification and therapy of medication-overuse headache: impact of the third edition of the International Classification of Headache Disorders]. Schmerz 2015; 28:191-204; quiz 205-6. [PMID: 24718751 DOI: 10.1007/s00482-014-1393-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The diagnosis of medication-overuse headache (MOH) is of central importance because this secondary headache disorder can be treated very effectively and patients do not usually respond to headache prophylaxis as long as MOH persists. The article describes important changes in the diagnostic criteria of different MOH subtypes after publication of the International Classification of Headache Disorders (ICHD-3beta) in 2013. The new classification has a crucial and direct impact on prevention and treatment of MOH. In addition interactions exist with the new criteria of chronic migraine. With a controlled medication intake scheme according to the 10-20 rule and using a medication break, MOH usually remits in most patients. If patient education and advice does not lead to remission of MOH, a specialized managed medication break or withdrawal treatment becomes necessary. This can be done on an outpatient, day clinic or inpatient basis. In uncomplicated cases, the results of these three treatment settings do not differ. From a cost-effectiveness standpoint, the outpatient treatment should be given priority. In complicated cases, a fully inpatient withdrawal treatment using a multimodal treatment concept is significantly superior.
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Affiliation(s)
- H Göbel
- Migräne- und Kopfschmerzzentrum, Neurologisch-verhaltensmedizinische Schmerzklinik Kiel, Heikendorfer Weg 9-27, 24149, Kiel, Deutschland,
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Abstract
The diagnostics of pulmonary neoplasms has considerably changed in recent years. Based on large-scale molecular characterization studies and the development of targeted therapies, precise morphological, immunohistochemical and molecular pathological tumor subtyping is now of utmost importance for evidence-based treatment decisions. This review highlights recent developments in morphological and immunohistochemical subtyping of pulmonary neoplasms, concepts of tumor progression and provides a preview of relevant changes of the forthcoming new WHO classification, which is expected to be published in 2015. It becomes apparent that a 3-step diagnostic procedure based on morphology, immunohistochemistry and molecular pathology is important to meet the requirements of an increasingly more complex, interdisciplinary care of lung cancer patients and to allow reliable, clinically meaningful tumor diagnosis.
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Affiliation(s)
- I Petersen
- Institut für Pathologie, Universitätsklinikum Jena, Ziegelmühlenweg 1, 07743, Jena, Deutschland,
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Viswanathan AN, Erickson B, Gaffney DK, Beriwal S, Bhatia SK, Lee Burnett O, D'Souza DP, Patil N, Haddock MG, Jhingran A, Jones EL, Kunos CA, Lee LJ, Lin LL, Mayr NA, Petersen I, Petric P, Portelance L, Small W, Strauss JB, Townamchai K, Wolfson AH, Yashar CM, Bosch W. Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2014; 90:320-8. [PMID: 25304792 DOI: 10.1016/j.ijrobp.2014.06.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy. METHODS AND MATERIALS Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case. RESULTS For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR. CONCLUSION In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx.
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Affiliation(s)
- Akila N Viswanathan
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
| | | | - David K Gaffney
- University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah
| | - Sushil Beriwal
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | | | - David P D'Souza
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Nikhilesh Patil
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen L Jones
- University of North Carolina, Chapel Hill, North Carolina
| | | | - Larissa J Lee
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lilie L Lin
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nina A Mayr
- University of Washington, Seattle, Washington
| | | | - Primoz Petric
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Radiation Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | | | - William Small
- Loyola University Strich School of Medicine, Chicago, Illinois
| | - Jonathan B Strauss
- The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Kanokpis Townamchai
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aaron H Wolfson
- University of Miami Miller School of Medicine, Miami, Florida
| | - Catheryn M Yashar
- University of California, San Diego, California, Washington University, St. Louis, Missouri
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Göbel A, Göbel C, Heinze A, Heinze-Kuhn K, Petersen I, Meinecke C, Clasen S, Rasche D, Mehdorn HM, Göbel H. EHMTI-0389. Occipital nerve stimulation in the treatment of chronic migraine: experiences of two years. J Headache Pain 2014. [PMCID: PMC4182271 DOI: 10.1186/1129-2377-15-s1-m5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kaller T, Petersen I, Petermann F, Fischer L, Grabhorn E, Schulz KH. Family strain and its relation to psychosocial dysfunction in children and adolescents after liver transplantation. Pediatr Transplant 2014; 18:851-9. [PMID: 25307019 DOI: 10.1111/petr.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
Abstract
Parental functioning is essential to children's development. Therefore, this cross-sectional single-center study examined the prevalence of family strain in 181 parents and its associations to psychosocial functioning in their children after LT. Median age at LT was one yr. Mean time elapsed since LT was 5.8 yr. The IFS, and the SDQ were applied to parents. Family strain in the present sample was comparable to that in the German normative group of families with a chronically ill or disabled child, but families of LT recipients showed a significantly higher financial impact, impact on coping, and impact on siblings (p < 0.001). Younger age of patients at survey, a more severe clinical course, child's restrictions, and financial losses following LT were determined as significant predictors of family strain (R(2) = 0.42). Parents reported less family strain after living-related compared with deceased donation. Family strain was significantly correlated to psychosocial dysfunction in children post-LT. Present findings demonstrate a risk of maladjustment to the post-LT condition in families. They emphasize the importance of psychological assessment of parents and patients during transplant and follow-up to ensure the best achievable long-term outcome of patients.
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Affiliation(s)
- T Kaller
- Center of Clinical Psychology and Rehabilitation, University Bremen, Bremen, Germany
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Mutter R, Brown L, Hoeft K, Wurgler S, Childs S, Choo R, Petersen I, Pisansky T, Yan E, Beltran C, Remmes N. Single Field Spot-Scanning (SFSS) Is Dosimetrically Superior to 2-Field Intensity Modulated Proton Therapy (IMPT) for Proton Postmastectomy Radiation Therapy (PMRT). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.860] [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: 11/17/2022]
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Li A, Chen X, Zhang Q, Kirsch D, Petersen I, DeLaney T, Freeman C, Trotti A, Hitchcock Y, Wang D. A Comparison of 6 IGRT Modalities Used for Soft-Tissue Sarcoma of the Extremity in RTOG 0630. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2391] [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: 10/24/2022]
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Horsfall LJ, Nazareth I, Petersen I. OP56 Serum uric acid and the risk of respiratory disease: a population-based cohort study. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.59] [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: 11/03/2022]
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Brown L, Harmsen W, Blanchard M, Goetz M, Jakub J, Mutter R, Petersen I, Rooney J, Stauder M, Yan E, Laack N. Once-Daily Radiation Therapy for Inflammatory Breast Cancer. Int J Radiat Oncol Biol Phys 2014; 89:997-1003. [DOI: 10.1016/j.ijrobp.2014.01.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/23/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
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Bogani G, Dowdy S, Cliby B, Bakkum-Gamez J, Weaver A, Gostout B, Jatoi A, Petersen I, Podratz K, Mariani A. Efficacy of adjuvant therapy in women with stage IIIC2 endometrial cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.352] [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: 11/26/2022]
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Zhang Y, Brinkmann D, Pafundi D, Park S, Yan E, Choo R, Petersen I, Childs S, Pisansky T, Remmes N, Mutter R. SU-C-19A-04: Evaluation of Patient Positioning Reproducibility with Three Supine Breast Boards. Med Phys 2014. [DOI: 10.1118/1.4889703] [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: 11/07/2022] Open
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Petersen I, Hanass Hancock J, Bhana A, Govender K. A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study. J Affect Disord 2014; 158:78-84. [PMID: 24655769 DOI: 10.1016/j.jad.2014.02.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Co-morbid depression in HIV-positive patients on anti-retroviral (ART) treatment poses a public health threat. It compromises treatment adherence and accelerates disease progression. This study aimed to assess the feasibility of a group-based counselling intervention for depressed HIV-positive patients in primary health care (PHC) in South Africa using a task shifting approach. METHODS Using a randomized control design, 76 HIV-positive patients with co-morbid depression were initially recruited. This reduced to 34 in the final cohort. Participants were assessed using the Patient Health Questionnaire (PHQ9), Hopkins Symptom Checklist (HSCL-25) and Multidimensional Scale of Perceived Social Support (MSPSS) at baseline and 3-month follow-up. The intervention was adapted from a local group-based Interpersonal Therapy (IPT) intervention. Process evaluation interviews were held with the HIV counsellors who delivered the intervention and a sub-sample of participants. RESULTS Repeated measures ANOVA analysis showed significantly greater improvement on depression scores on the PHQ9 in the intervention group compared to the control group. A significant decline in the mean scores on the HSCL-25 was found for both groups although this was more pronounced for the intervention group. There was no significant improvement in the MSPSS scores. LIMITATIONS The small sample size of the final cohort affected the power of the study to detect significant differences between the intervention and control groups on the MSPSS. Longer term impact of the intervention is unknown. CONCLUSIONS These preliminary findings suggest that group-based counselling for depression in HIV-positive patients can potentially be effectively delivered by appropriately trained and supported lay HIV counsellors. The need for a larger trial is indicated.
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Affiliation(s)
- I Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, South Africa.
| | - J Hanass Hancock
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa
| | - A Bhana
- School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
| | - K Govender
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa
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Göbel H, Heinze-Kuhn K, Petersen I, Göbel A, Heinze A. [Integrated headache care network. Kiel Migraine and Headache Center and German National Headache Treatment Network]. Schmerz 2014; 27:149-65. [PMID: 23549863 DOI: 10.1007/s00482-013-1307-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Migraine and other headaches affect 54 million people in Germany. They rank among the ten most severely disabling complaints and the three most expensive neurological disorders. Nevertheless, they are not adequately recognized in the healthcare system with sketchy diagnoses and inadequate treatment. This inadequate care is not primarily due to a lack of medical and scientific knowledge on the development and treatment of headaches but is predominantly due to organizational deficits in the healthcare system and in the implementation of current knowledge. To overcome the organizational barriers the national headache treatment network was initiated in Germany. For the first time it allows national cross-sectoral and multidisciplinary links between inpatient and outpatient care. A hand in hand treatment programme, better education, better information exchange between all partners and combined efforts using clearly defined treatment pathways and goals are the basis for state of the art and efficient treatment results. The treatment network is geared towards the specialized treatment of severely affected patients with chronic headache disorders. A national network of outpatient and inpatient pain therapists in both practices and hospitals works hand in hand to optimally alleviate pain in a comprehensive cross-sectoral and multidisciplinary manner. For therapy refractive disorders, a high-intensive supraregional fully inpatient treatment can be arranged. This concept offers for the first time a nationwide coordinated treatment without limitation by specialization and bureaucratic remuneration sectors.
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Affiliation(s)
- H Göbel
- Migräne- und Kopfschmerzzentrum, Schmerzklinik Kiel, Heikendendorfer Weg 9-27, Kiel, Germany.
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