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Bernstein CN, Dolovich C, Prichodko M, Fisk JD, Graff LA, Patten SB, Bolton J, Hitchon C, Marrie RA. Perceived Need for Mental Health Care in a Cohort of Persons With Inflammatory Bowel Disease. J Clin Gastroenterol 2024; 58:464-470. [PMID: 37725433 DOI: 10.1097/mcg.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Psychiatric comorbidity is common in inflammatory bowel disease (IBD) and can negatively affect disease outcomes. We explored the perceived need for mental health care among persons with IBD. STUDY Persons with IBD completed self-report questionnaires, including the Hospital Anxiety and Depression Scale (HADS), and reported whether they wanted help with their mood. Each was also assessed using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (SCIDs). We used logistic regression analyses to determine factors associated with the perceived need for mental health care. RESULTS Of 245 participants, 28% met the criteria for a past diagnosis of depression or anxiety disorder by SCID, and nearly 23% met the criteria for a current diagnosis of depression or anxiety disorder. One-third (n = 74) reported a perceived need for mental health care. Among those meeting criteria for a current SCID diagnosis of depression or anxiety, only 58% reported needing mental health care. Need for mental health care was reported by 79% of persons currently treated for either depression or 71% treated for anxiety. Persons with a perceived need for mental health care had higher mean HADS for depression and HADS for anxiety scores and also higher IBD symptom activity scores. Of those reporting no perceived need for mental health care, 13% had a current diagnosis of depression or anxiety disorder by SCID; even fewer had symptoms of depression or anxiety. CONCLUSIONS Symptoms of depression or anxiety are more important than a formal diagnosis of depression or anxiety in predicting which persons with IBD will perceive a need for mental health care.
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Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | - Casandra Dolovich
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | | | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Nova Scotia Health, Dalhousie University, Halifax
| | - Lesley A Graff
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Department of Community Health Sciences
| | | | - James Bolton
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carol Hitchon
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | - Ruth Ann Marrie
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg
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Friesen EL, Mataruga A, Bolton J, Kurdyak P. Characterizing the clinical subgroups of individuals who present to the emergency department for alcohol-related harms in Ontario, Canada: A latent class analysis. Psychiatry Res 2024; 333:115726. [PMID: 38224632 DOI: 10.1016/j.psychres.2024.115726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 01/17/2024]
Abstract
Alcohol-related emergency department (ED) visits are common and associated with adverse clinical outcomes, including premature mortality. This population-based retrospective cohort study identified clinically distinct subgroups of individuals who experience alcohol-related ED visits and characterized differences in the risk of adverse outcomes between them. 73,658 individuals who experienced an alcohol-related ED visit in Ontario, Canada between 2017 and 2018 were identified. Latent class analysis (LCA) revealed five clinically distinct subgroups within the overall cohort. These subgroups followed a severity gradient from low-frequency service use for acute intoxication to high-frequency service use for alcohol use disorder (AUD) and related comorbidities. Relative to those presenting for acute intoxication, those presenting for AUD and comorbidities had a much higher risk of hospital admission (adjusted odds ratio [aOR]: 8.26, 95 % confidence interval [CI]: 7.81-8.75) and post-discharge mortality (adjusted hazard ratio [aHR]: 3.07, 95 % CI: 2.81-3.37). There was a subgroup of individuals with a history of high frequency alcohol-related health service use who were at the highest risk of experiencing another alcohol-related ED visit after the index event (aHR: 4.76, 95 % CI: 4.55-4.99). Individuals who experience alcohol-related ED visits are not a homogenous population, but a constellation of subgroups with different clinical characteristics and risk of adverse outcomes.
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Affiliation(s)
- Erik Loewen Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
| | | | - James Bolton
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
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Rudoler D, Lavergne MR, Marshall EG, Zaheer J, Etches S, Good KP, Grudniewicz A, Katz A, Kurdyak P, Bolton J, Kaoser R, Moravac C, Morrison J, Mulsant B, Peterson S, Tibbo PG. Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study. BMJ Open 2023; 13:e073183. [PMID: 37463812 PMCID: PMC10357719 DOI: 10.1136/bmjopen-2023-073183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workforce planning require further study. A qualitative exploration of psychiatrists' preferences for practice style and the practice choices that result is also lacking. The goal of this study is to inform psychiatrist workforce planning to improve access to psychiatric care by: (1) developing and evaluating comparable indicators of supply of psychiatric care across provinces, (2) analysing variations and changes in the characteristics of the psychiatrist workforce, including demographics and practice style and (3) studying psychiatrist practice choices and intentions, and the factors that lead to these choices. METHODS AND ANALYSIS A cross-provincial mixed-methods study will be conducted in the Canadian provinces of British Columbia, Manitoba, Ontario and Nova Scotia. We will analyse linked-health administrative data within three of the four provinces to develop comparable indicators of supply and characterise psychiatric services at the regional level within provinces. We will use latent profile analysis to estimate the probability that a psychiatrist is in a particular practice style and map the geographical distribution of psychiatrist practices overlayed with measures of need for psychiatric care. We will also conduct in-depth, semistructured qualitative interviews with psychiatrists in each province to explore their preferences and practice choices and to inform workforce planning. ETHICS AND DISSEMINATION This study was approved by Ontario Tech University Research Ethics Board (16637 and 16795) and institutions affiliated with the study team. We built a team comprising experienced researchers, psychiatrists, medical educators and policymakers in mental health services and workforce planning to disseminate knowledge that will support effective human resource policies to improve access to psychiatric care in Canada.
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Affiliation(s)
- David Rudoler
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Juveria Zaheer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Selene Etches
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Agnes Grudniewicz
- Telfer School of Management University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ridhwana Kaoser
- Faculty of Health Sciences, Simon Fraser University at Harbour Centre, Vancouver, British Columbia, Canada
| | - Catherine Moravac
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Phil G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Almweisheer S, Bernstein CN, Graff LA, Patten SB, Bolton J, Fisk JD, Hitchon CA, Marriott JJ, Marrie RA. Well-being and flourishing mental health in adults with inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis in Manitoba, Canada: a cross-sectional study. BMJ Open 2023; 13:e073782. [PMID: 37295825 PMCID: PMC10277148 DOI: 10.1136/bmjopen-2023-073782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES Among people with immune-mediated inflammatory disease (IMID), including multiple sclerosis (MS), inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) most research has focused on mental illness rather than on mental health. We assessed dimensions of mental health among persons with IMID and compared them across IMID. We also evaluated demographic and clinical characteristics associated with flourishing mental health. DESIGN Participants: Adults with an IMID (MS, 239; IBD, 225; RA 134; total 598) who were participating in a cohort study. SETTING Tertiary care centre in Manitoba, Canada. PRIMARY OUTCOME MEASURE Participants completed the Mental Health Continuum Short-Form (MHC-SF), which measures emotional, psychological and social well-being, and identifies flourishing mental health. This outcome was added midway through the study on the advice of the patient advisory group. Depression, anxiety, pain, fatigue and physical function were also assessed. RESULTS Total MHC-SF and subscale scores were similar across IMID groups. Nearly 60% of participants were considered to have flourishing mental health, with similar proportions across disease types (MS 56.5%; IBD 58.7%; RA 59%, p=0.95). Older age was associated with a 2% increased odds of flourishing mental health per year of age (OR 1.02; 95% CI: 1.01 to 1.04). Clinically meaningful elevations in anxiety (OR 0.25; 95% CI: 0.12 to 0.51) and depressive symptoms (OR 0.074; 95% CI: 0.009 to 0.61) were associated with lower odds. Higher levels of pain, anxiety and depressive symptoms were associated with lower total Mental Health Continuum scores at the 50th quantile. CONCLUSIONS Over half of people with MS, IBD and RA reported flourishing mental health, with levels similar across the disease groups. Interventions targeting symptoms of depression and anxiety, and upper limb impairments, as well as resilience training may help a higher proportion of the IMID population achieve flourishing mental health.
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Affiliation(s)
- Shaza Almweisheer
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott B Patten
- Community Health Sciences & Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carol A Hitchon
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - James J Marriott
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
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Kowalec K, Fitzgerald KC, Salter A, Dolovich C, Harder A, Bernstein CN, Bolton J, Cutter GR, Graff LA, Hägg S, Hitchon CA, Lu Y, Lublin F, McKay KA, Patten SB, Patki A, Tiwari HK, Wolinsky JS, Marrie RA. Polygenicity of Comorbid Depression in Multiple Sclerosis. Neurology 2023:WNL.0000000000207457. [PMID: 37290970 PMCID: PMC10401690 DOI: 10.1212/wnl.0000000000207457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/13/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Depression is common in multiple sclerosis (MS); and is associated with faster disability progression. The etiology of comorbid depression in MS remains poorly understood. Identification of individuals with a high risk for depression, via polygenic scores (PGS), may facilitate earlier identification. Previous genetic studies of depression considered depression as a primary disorder, not a comorbidity, and thus findings may not generalize to MS. Body mass index (BMI) is a risk factor for both MS and depression and its association may highlight differences in depression in MS. To improve the understanding of comorbid depression in MS, we will investigate PGS in people with MS, with the hypothesis that higher depression PGS is associated with increased odds for comorbid depression in MS. METHODS Samples from three sources (Canada, UK Biobank, and the United States) were used. Individuals were grouped into cases (MS/comorbid depression) and compared to three control groups: MS/no depression, depression/no immune disease, and healthy persons. We employed three depression definitions: lifetime clinical diagnoses, self-reported diagnoses, and depressive symptoms. The PGS were tested in association with depression using regression. RESULTS 106,682 individuals of European genetic ancestry were used: Canada (n=370; 213 with MS), UK Biobank (n=105,734; 1,390 MS), and USA (n=578 MS). Meta-analyses revealed individuals with MS and depression had a higher depression PGS compared to both MS without depression (odds ratio range per standard deviation [SD]: 1.29-1.38, P<0.05) and healthy controls (odds ratio range per SD: 1.49-1.53, P<0.025), regardless of the definition applied and when sex-stratified. The BMI PGS was associated with depressive symptoms (P≤.001). The depression PGS did not differ between depression occurring as a comorbid condition with MS or as the primary condition (odds ratio range per SD: 1.03-1.13, all P>0.05). DISCUSSION Higher depression genetic burden was associated with ∼30-40% increased odds of depression in European genetic ancestry participants with MS compared to those without depression and was no different compared to those with depression and no comorbid immune disease. This study paves the way for further investigations into the possible use of PGS for assessing psychiatric disorder risk in MS and its application to non-European genetic ancestries.
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Affiliation(s)
- Kaarina Kowalec
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Canada
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden
| | | | - Amber Salter
- Department of Neurology, UT Southwestern, Dallas, TX, USA
| | - Casandra Dolovich
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Arvid Harder
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Sara Hägg
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden
| | - Carol Ann Hitchon
- Department of Rheumatology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Yi Lu
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden
| | - Fred Lublin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kyla A McKay
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Amit Patki
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerry S Wolinsky
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
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Barr CE, Sergeant JC, Agnew HJ, Bolton J, McVey RJ, Crosbie EJ. Serum HE4 predicts progestin treatment response in endometrial cancer and atypical hyperplasia: A prognostic study. BJOG 2023. [PMID: 36715558 DOI: 10.1111/1471-0528.17417] [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: 08/10/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate serum human epididymis-4 (HE4) as a predictive biomarker of intrauterine progestin response in endometrial cancer and atypical endometrial hyperplasia (AEH). DESIGN Prospective prognostic factor study. SETTING Consecutive sample of women attending a tertiary gynaecological oncology centre in northwest England. POPULATION Women with AEH or early-stage, low-grade endometrial cancer who were unfit for or declined primary surgical management. METHODS A total of 76 women, 32 with AEH and 44 with endometrial cancer, were treated with a levonorgestrel intrauterine system (LNG-IUS) for 12 months. Endometrial biopsies and imaging were performed to assess treatment response. Pretreatment serum HE4 was analysed by chemiluminescence immunoassay and diagnostic accuracy and logistic regression analyses were performed. MAIN OUTCOME MEASURES Progestin response at 12 months defined by histology and imaging. RESULTS The median age and body mass index (BMI) of the final cohort were 52 years (interquartile range [IQR] 33-62 years) and 46 kg/m2 (IQR 38-54 kg/m2 ), respectively. Baseline serum HE4 was significantly higher in non-responders than responders (119.2 pmol/L, IQR 94.0-208.4 pmol/L versus 71.8 pmol/L, IQR 56.1-84.2 pmol/L, p < 0.001). Older age (odds ratio [OR] 0.96, 95% CI 0.93-0.99, p = 0.02), baseline serum HE4 (OR 0.97, 95% CI 0.96-0.99, p = 0.001) and endometrial cancer histology (OR 0.22, 95% CI 0.72-0.68, p = 0.009) were associated with a lower likelihood of progestin treatment response. Serum HE4 remained independently associated with progestin treatment failure when adjusted for age and histology (adjusted hazard ratio 0.97, 95% CI 0.96-0.99, p = 0.008). CONCLUSION Serum HE4 shows promise as a predictive biomarker of progestin treatment response in endometrial cancer and AEH.
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Affiliation(s)
- Chloe E Barr
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jamie C Sergeant
- Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Biostatistics, University of Manchester, Manchester, UK.,Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Heather J Agnew
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - James Bolton
- Department of Histopathology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhona J McVey
- Department of Histopathology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma J Crosbie
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Chartier M, Munro G, Jiang D, McCulloch S, Au W, Brownell M, Santos R, Turner F, Boyd L, Murdock N, Bolton J, Sareen J. Is PAX-Good Behaviour Game (PAX) Associated with Better Mental Health and Educational Outcomes for First Nations Children? Int J Popul Data Sci 2022. [PMCID: PMC9644983 DOI: 10.23889/ijpds.v7i3.1957] [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: 11/27/2022] Open
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Hamad A, Monchka B, Roos L, Bolton J, University A, Elgendi M, Lix L. The Intergenerational Transfer of Mental Disorders: A Population-based Multigenerational Linkage Study. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesMental disorders are a major public health concern. Genetic and environmental factors, both reflected in family health histories, jointly contribute to the onset of mental disorders. We examined the intergenerational transmission of mental disorders using objectively-measured family health histories from three generations.
ApproachA population-based cohort study was conducted using administrative healthcare databases from Manitoba, Canada. The cohort included offspring who were 18 years or older between 1977 and 2020 with linkage to 1+ parent and 1+ grandparent. Mental disorders were identified using diagnosis codes from hospitalization and outpatient physician visit records and included mood and anxiety, psychotic, and substance use disorders. Logistic regression models were mutually adjusted for mental disorder history in grandparents, parents and/or siblings in addition to offspring demographics: sex, region, decade of birth and income quintile, and comorbidity. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated.
ResultsOut of 125,070 individuals, 59.1% were females and 57.8% were urban residents. 41,552 (33.2%) had a mental disorder during study period and 108,682 (86.9%) had a family member with a mental disorder history. Individuals were more likely to have a mental disorder if they had a family history: mother (OR 1.52, 95% CI 1.48-1.56), father (OR 1.21, 95% CI 1.17-1.25), sibling (OR 1.33, 95% CI 1.28-1.39), grandparent (OR 1.06, 95% CI 1.03-1.09). Compared with other mental disorders, psychotic disorders had the strongest association with family history: mother (OR 2.37, 95% CI 2.00-2.82), father (OR 3.00, 95% CI 2.40-3.76), sibling (OR 2.34, 95% CI 1.79-3.05). However, there was no association between psychotic disorders and grandparent history (OR 1.00, 95% CI 0.90-1.11).
ConclusionsWe observed a strong association between mental disorders family history across three generations and the risk of the mental disorders in offspring. This association was observed for all the investigated mental disorders. This work highlights the value of multigenerational data linkage in understanding the intergenerational transfer of mental disorders.
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10
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Hallet J, Sutradhar R, Isenberg-Grzeda E, Noel CW, Mahar AL, Vigod SN, Bolton J, Deleemans J, Chan WC, Coburn NG, Eskander A. Association of Patient-Reported Outcomes With Subsequent Nonfatal Self-injury After a New Cancer Diagnosis. JAMA Oncol 2022; 8:e220203. [PMID: 35357419 DOI: 10.1001/jamaoncol.2022.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Nonfatal self-injury (NFSI) is a patient-centered manifestation of severe distress occurring in 3 out of 1000 patients after cancer diagnosis. How to identify patients at risk for NFSI remains unknown. Objective To examine the associations between patient-reported outcome measures and subsequent NFSI in patients with cancer. Design, Setting, and Participants This population-based matched case-control study included adults with a new cancer diagnosis reporting an Edmonton Symptom Assessment System (ESAS) score within 36 months of diagnosis in Ontario, Canada, 2007 to 2019. Data analysis was performed January 2007 to December 2019. Main Outcomes and Measures Cases included patients with NFSI, and controls were patients without NFSI. Cases and controls were matched 1:4. Multivariable conditional logistic regression assessed the association between moderate to severe ESAS symptom scores and total ESAS (t-ESAS, range 0-90) score with NFSI in the subsequent 180 days. Results Of 408 858 patients reporting 1 or more ESAS assessments, 425 patients experienced NFSI and reported an ESAS score in the preceding 180 days. Of those, 406 cases were matched to 1624 control patients without an NFSI. Cases reported a higher proportion of moderate to severe symptoms and higher t-ESAS score than controls prior to the event. After adjustment, moderate to severe anxiety (odds ratio [OR], 1.61; 95% CI, 1.14-2.27), depression (OR, 1.66; 95% CI, 1.20-2.31), and shortness of breath (OR, 1.65; 95% CI, 1.18-2.31) and each 10-point increase in t-ESAS score (OR, 1.51; 95% CI, 1.40-1.63) were independently associated with higher odds of subsequent NFSI. Conclusions and Relevance In this case-control study, reporting moderate to severe anxiety, depression, and shortness of breath and an increasing t-ESAS score after cancer diagnosis were associated with higher odds of NFSI in the following 180 days. These data support the prospective use of routine ESAS screening as a means of identifying patients at higher risk for NFSI to improve supportive care.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Elie Isenberg-Grzeda
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Psychosocial Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Alyson L Mahar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Deleemans
- Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
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11
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Strumpf E, Austin N, Lang A, Derksen S, Bolton J, Brownell M, Gregory P, Chateau D, Heaman M. The effects of early pregnancy loss on health outcomes and health care utilization and costs. Health Serv Res 2022; 57:786-795. [PMID: 35076944 PMCID: PMC9264463 DOI: 10.1111/1475-6773.13941] [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: 09/10/2020] [Revised: 11/21/2021] [Accepted: 12/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the effects of early pregnancy loss on subsequent health care use and costs. Data Sources Linked administrative health databases from Manitoba, Canada. Study Design This was a population‐based cohort study. The exposure of interest was first recorded ectopic pregnancy or miscarriage (EPM). Outcomes included visits to all ambulatory care providers, family physicians (FPs), specialists, and hospitals, as well as the costs associated with these visits. We also assessed the impact of EPM on a global measure of health service utilization and the incidence and costs of psychotropic medications. Data Collection/Extraction Methods We identified women who experienced their first recorded loss (EPM) from 2003–2012 and created a propensity score model to match these women to women who experienced a live birth, with outcome measures available through 31 December 2014. We used a difference in differences approach with multivariable negative binomial models and generalized estimating equations (GEE) to assess the impact of EPM on the aforementioned health care utilization indicators. Principal Findings EPM was associated with a short‐term increase in visits to, and costs associated with, certain ambulatory care providers. These findings were driven in large part by increased visits/costs to FPs (rate difference [RD]: $19.92 [95% CI: $16.33, $23.51]) and obstetrician‐gynecologists (OB‐GYNs) (RD $9.41 [95% CI: $8.42, $10.40]) in the year immediately following the loss, excluding care associated with the loss itself. We also detected an increase in hospital stays and costs and a decrease in the use of psychotropic medications relative to matched controls. Conclusion Pregnancy loss may lead to subsequent increases in certain types of health care utilization. While the absolute costs associated with post‐EPM care are relatively small, the observed patterns of service utilization are informative for providers and policy makers seeking to support women following a loss.
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Affiliation(s)
- E. Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health & Department of Economics. Leacock Building McGill University Montreal QC Canada
| | - N. Austin
- School of Health Administration Dalhousie University Halifax Nova Scotia Canada
| | - A. Lang
- School of Nursing McGill University Quebec Canada
| | - S. Derksen
- University of Manitoba, Manitoba Centre for Health Policy Manitoba Canada
| | - J. Bolton
- Department of Psychiatry and Manitoba Centre for Health Policy University of Manitoba Winnipeg Manitoba Canada
| | - M. Brownell
- Department of Community Health Sciences & Manitoba Centre for Health Policy, Max Rady College of Medicine, Community Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - P. Gregory
- Red River College, Nursing Department School of Health Sciences and Community Services Winnipeg Manitoba Canada
| | - D. Chateau
- Department of Community Health Sciences & Manitoba Centre for Health Policy University of Manitoba Manitoba Canada
| | - M. Heaman
- College of Nursing & Department of Obstetrics, Gynecology and Reproductive Sciences, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba University of Manitoba Winnipeg Manitoba Canada
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12
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Naqvi A, MacKintosh ML, Derbyshire AE, Tsakiroglou AM, Walker TDJ, McVey RJ, Bolton J, Fergie M, Bagley S, Ashton G, Pemberton PW, Syed AA, Ammori BJ, Byers R, Crosbie EJ. The impact of obesity and bariatric surgery on the immune microenvironment of the endometrium. Int J Obes (Lond) 2021; 46:605-612. [PMID: 34857870 PMCID: PMC8872994 DOI: 10.1038/s41366-021-01027-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence of endometrial cancer is rising in parallel with the obesity epidemic. Obesity increases endometrial cancer risk and weight loss is protective, but the underlying mechanisms are incompletely understood. We hypothesise that the immune microenvironment may influence susceptibility to malignant transformation in the endometrium. The aim of this study was to measure the impact of obesity and weight loss on the immunological landscape of the endometrium. METHODS We conducted a prospective cohort study of women with class III obesity (body mass index, BMI ≥ 40 kg/m2) undergoing bariatric surgery or medically-supervised low-calorie diet. We collected blood and endometrial samples at baseline, and two and 12 months after weight loss intervention. Serum was analysed for inflammatory markers CRP, IL-6 and TNF-α. Multiplex immunofluorescence was used to simultaneously identify cells positive for immune markers CD68, CD56, CD3, CD8, FOXP3 and PD-1 in formalin-fixed paraffin-embedded endometrial tissue sections. Kruskal-Wallis tests were used to determine whether changes in inflammatory and immune biomarkers were associated with weight loss. RESULTS Forty-three women with matched serum and tissue samples at all three time points were included in the analysis. Their median age and BMI were 44 years and 52 kg/m2, respectively. Weight loss at 12 months was greater in women who received bariatric surgery (n = 37, median 63.3 kg) than low-calorie diet (n = 6, median 12.8 kg). There were significant reductions in serum CRP (p = 3.62 × 10-6, r = 0.570) and IL-6 (p = 0.0003, r = 0.459), but not TNF-α levels, with weight loss. Tissue immune cell densities were unchanged except for CD8+ cells, which increased significantly with weight loss (p = 0.0097, r = -0.323). Tissue CD3+ cell density correlated negatively with systemic IL-6 levels (p = 0.0376; r = -0.318). CONCLUSION Weight loss is associated with reduced systemic inflammation and a recruitment of protective immune cell types to the endometrium, supporting the concept that immune surveillance may play a role in endometrial cancer prevention.
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Affiliation(s)
- Anie Naqvi
- The University of Manchester Medical School, Oxford Road, Manchester, M13 9PL, UK
| | - Michelle L MacKintosh
- Division of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Abigail E Derbyshire
- Division of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Anna-Maria Tsakiroglou
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Thomas D J Walker
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Rhona J McVey
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - James Bolton
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Martin Fergie
- Division of Informatics, Imaging & Data Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Steven Bagley
- CRUK Manchester Institute, The University of Manchester, Alderley Park, Alderley Edge, SK10 4TG, UK
| | - Garry Ashton
- CRUK Manchester Institute, The University of Manchester, Alderley Park, Alderley Edge, SK10 4TG, UK
| | - Philip W Pemberton
- Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Akheel A Syed
- Department of Obesity Medicine, Diabetes & Endocrinology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Stott Lane, Salford, M6 8HD, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Basil J Ammori
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.,Department of Surgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Stott Lane, Salford, M6 8HD, UK
| | - Richard Byers
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.,Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Emma J Crosbie
- Division of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK. .,Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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13
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Barr CE, Ryan NA, Derbyshire A, Wan YL, MacKintosh ML, McVey RJ, Bolton J, Fitzgerald C, Awad D, Slade RJ, Syed AA, Ammori BJ, Crosbie EJ. Weight Loss During Intrauterine Progestin Treatment for Obesity-associated Atypical Hyperplasia and Early-Stage Cancer of The Endometrium. Cancer Prev Res (Phila) 2021; 14:1041-1050. [PMID: 34348914 PMCID: PMC9306269 DOI: 10.1158/1940-6207.capr-21-0229] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/23/2021] [Accepted: 07/20/2021] [Indexed: 01/07/2023]
Abstract
Intrauterine progestin is a treatment option for women with atypical hyperplasia or low-risk endometrial cancer who wish to preserve their fertility, or whose poor surgical fitness precludes safe hysterectomy. We hypothesized that in such women with obesity, weight loss during progestin treatment may improve oncological outcomes. We conducted a prospective nonrandomized study of women with obesity and atypical hyperplasia or low-grade stage 1a endometrial cancer undergoing progestin treatment. Women with a body mass index (BMI) ≥ 35 kg/m2 were offered bariatric surgery; those who declined and those with a BMI of 30 to 34.9 kg/m2 were encouraged to lose weight by low-calorie diet. We assessed uptake of bariatric surgery; weight lost during progestin treatment; and the impact of more than 10% total body weight loss on progestin treatment response at 12 months. 71 women [median age 58 years (interquartile range; IQR 35-65); mean BMI 48 kg/m2 (SD 9.3)] completed the study. Twenty-three women (32%) had bariatric surgery, on average 5 months (IQR 3-8) after progestin treatment commenced. Weight change during progestin treatment was -33.4 kg [95% confidence interval (CI) -42.1, -24.7] and -4.6 kg (95% CI -7.8, -1.4) in women receiving bariatric surgery and low-calorie diet, respectively (P < 0.001). Forty-three women (61%) responded to progestin, while 23 (32%) showed stabilized and 5 (7%) progressive disease. Response at 12 months was not predicted by age or baseline BMI, but women who lost more than 10% of their total body weight were more likely to respond to progestin than those who did not (adjusted odds ratio 3.95; 95% CI 1.3, 12.5; P = 0.02). Thus weight loss may improve oncological outcomes in women with obesity-associated endometrial neoplastic abnormalities treated with progestin. PREVENTION RELEVANCE: This study found that weight loss improves response rates in women with obesity and atypical hyperplasia or low-risk endometrial cancer undergoing conservative management with intrauterine progestin. Given the additional benefits of weight loss for fertility, cardiovascular health and quality of life, future research should focus on how best to accomplish it.
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Affiliation(s)
- Chloe E. Barr
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Neil A.J. Ryan
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - A.E. Derbyshire
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Y. Louise Wan
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Michelle L. MacKintosh
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rhona J. McVey
- Department of Histopathology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - James Bolton
- Department of Histopathology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Cheryl Fitzgerald
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Dina Awad
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Richard J. Slade
- Department of Gynaecological Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Akheel A. Syed
- Department of Obesity Medicine, Diabetes & Endocrinology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Basil J. Ammori
- Department of Obesity Medicine, Diabetes & Endocrinology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Emma J. Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Corresponding Author: Emma J. Crosbie, Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester M13 9PL, United Kingdom. Phone: 4416-1701-6942; E-mail:
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14
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Ryan NAJ, Walker TDJ, Bolton J, ter Haar N, Van Wezel T, Glaire MA, Church DN, Evans DG, Bosse T, Crosbie EJ. Histological and Somatic Mutational Profiles of Mismatch Repair Deficient Endometrial Tumours of Different Aetiologies. Cancers (Basel) 2021; 13:4538. [PMID: 34572765 PMCID: PMC8469577 DOI: 10.3390/cancers13184538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mismatch repair deficient (MMRd) tumours may arise from somatic events acquired during carcinogenesis or in the context of Lynch syndrome (LS), an inherited cancer predisposition condition caused by germline MMR pathogenic variants. Our aim was to explore whether sporadic and hereditary MMRd endometrial cancers (EC) display distinctive tumour biology. METHODS Clinically annotated LS-EC were collected. Histological slide review was performed centrally by two specialist gynaecological pathologists. Mutational analysis was by a bespoke 75- gene next-generation sequencing panel. Comparisons were made with sporadic MMRd EC. Multiple correspondence analysis was used to explore similarities and differences between the cohorts. RESULTS After exclusions, 135 LS-EC underwent independent histological review, and 64 underwent mutational analysis. Comparisons were made with 59 sporadic MMRd EC. Most tumours were of endometrioid histological subtype (92% LS-EC and 100% sporadic MMRd EC, respectively, p = NS). Sporadic MMRd tumours had significantly fewer tumour infiltrating lymphocytes (p ≤ 0.0001) and showed more squamous/mucinous differentiation than LS-EC (p = 0.04/p = 0.05). PTEN mutations were found in 88% sporadic MMRd and 61% LS-EC, respectively (p < 0.001). Sporadic MMRd tumours had significantly more mutations in PDGFRA, ALK, IDH1, CARD11, CIC, MED12, CCND1, PTPN11, RB1 and KRAS, while LS-EC showed more mutations affecting SMAD4 and ARAF. LS-EC showed a propensity for TGF-β signalling disruption. Cluster analysis found that wild type PTEN associates predominantly with LS-EC, whilst co-occurring mutations in PTEN, PIK3CA and KRAS predict sporadic MMRd EC. CONCLUSIONS Whilst MMRd EC of hereditary and sporadic aetiology may be difficult to distinguish by histology alone, differences in infiltrating immune cell counts and mutational profile may predict heterogenous responses to novel targeted therapies and warrant further study.
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Affiliation(s)
- Neil A. J. Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (N.A.J.R.); (T.D.J.W.)
- Division of Evolution and Genomic Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK;
| | - Thomas D. J. Walker
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (N.A.J.R.); (T.D.J.W.)
| | - James Bolton
- Manchester Academic Health Science Centre, Department of Pathology, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK;
| | - Natalja ter Haar
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (N.t.H.); (T.V.W.); (T.B.)
| | - Tom Van Wezel
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (N.t.H.); (T.V.W.); (T.B.)
| | - Mark A. Glaire
- Tumour Genomics and Immunology Group, Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7DQ, UK; (M.A.G.); (D.N.C.)
| | - David N. Church
- Tumour Genomics and Immunology Group, Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7DQ, UK; (M.A.G.); (D.N.C.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7DQ, UK
| | - D. Gareth Evans
- Division of Evolution and Genomic Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK;
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (N.t.H.); (T.V.W.); (T.B.)
| | - Emma J. Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (N.A.J.R.); (T.D.J.W.)
- Manchester Academic Health Science Centre, Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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15
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Noel CW, Eskander A, Sutradhar R, Mahar A, Vigod SN, Isenberg-Grzeda E, Bolton J, Deleemans J, Chan WC, Vasdev R, Zuk V, Haas B, Mason S, Coburn NG, Hallet J. Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada. JAMA Netw Open 2021; 4:e2126822. [PMID: 34559226 PMCID: PMC8463938 DOI: 10.1001/jamanetworkopen.2021.26822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. OBJECTIVE To examine the risk of NFSI after a cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada. EXPOSURES Demographic and clinical factors. MAIN OUTCOMES AND MEASURES Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. RESULTS In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (<0.1%) died by suicide. The 5-year cumulative incidence of NFSI was 0.27% (95% CI, 0.25%-0.28%). After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care (subdistribution hazard ratio [sHR], 12.6; 95% CI, 10.5-15.2) or outpatient care (sHR, 7.5; 95% CI, 6.5-8.8), and prior self-injury (sHR, 6.6; 95% CI, 5.5-8.0) were associated with increased risk of NFSI. Young adults (age 18-39 years) had the highest NFSI rates relative to individuals aged 70 years or older (sHR, 5.4; 95% CI, 4.5-6.5). The magnitude of association between prior inpatient psychiatric illness and NFSI was greatest for young adults (sHR, 17.6; 95% CI, 12.0-25.8). Certain cancer subsites were also associated with increased risk, including head and neck cancer (sHR, 1.5; 95% CI, 1.2-1.9). CONCLUSIONS AND RELEVANCE In this study, patients with cancer had a higher incidence of NFSI than suicide after diagnosis. Younger age, history of severe psychiatric illness, and prior self-injury were independently associated with risk of NFSI. These exposures appeared to act synergistically, placing young adults with a prior mental health history at the greatest risk of NFSI. These factors should be used to identify at-risk patients.
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Affiliation(s)
- Christopher W. Noel
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
| | - Alyson Mahar
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Simone N. Vigod
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elie Isenberg-Grzeda
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - James Bolton
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Deleemans
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ravleen Vasdev
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Victoria Zuk
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Barbara Haas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Stephanie Mason
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Julie Hallet
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
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16
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Hallet J, Sutradhar R, Isenberg-Grzeda E, Noel C, Mahar A, Vigod S, Bolton J, Deleemans J, Chan W, Zuk V, Coburn NG, Eskander A. Patient-reported outcomes predicting non-fatal self-injury after a cancer diagnosis: A population-based case-control study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18583] [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: 11/20/2022] Open
Abstract
e18583 Background: Psychological distress is key in cancer care. Non-fatal self-injury (NFSI) represents a patient-centred, objectively measured manifestation of the greatest level of distress occurring in 3 out of 1,000 patients after a new cancer diagnosis. How to identify patients at high risk for NFSI remains unknown. We examined the relationships between routinely collected patient-reported outcomes measures and the risk of subsequent NFSI following a cancer diagnosis. Methods: We conducted a population-based case-control study of patients with a new cancer diagnosis (2007-2019) reporting a Edmonton Symptom Assessment (ESAS) score within 36 months of diagnosis. Cases were patients with NFSI within 36 months of diagnosis and controls those without NFSI (assigned a dummy index date corresponding to the case’s NFSI). Cases and controls were matched 1:4 on time from cancer diagnosis, ESAS record in 180 days prior index, age, sex, cancer site, and history of self-injury. Multivariable conditional logistic regression assessed the association between moderate-to-severe ESAS symptoms and total ESAS (t-ESAS) score with NFSI within 180 days. Results: Of 408,858 patients reporting >1 ESAS within 36 months of cancer diagnosis, 748 patients had a NFSI, including 425 patients with an ESAS score within 180 days preceding the NFSI event. Of those 406 cases were matched to 1,624 controls without NFSI. Cases reported a higher proportion of moderate-to-severe symptoms and higher t-ESAS than controls prior to the event (p < 0.01 for all). After adjusting for psychiatric illness history and cancer therapy received, reporting of moderate-to-severe anxiety (odds ratio – OR 1.61, 95%CI 1.14-2.27), depression (OR 1.66, 95%CI 1.2-2.31), and shortness of breath (OR 1.65, 955CI 1.18-2.31) were independently associated with higher risk of NFSI within 180 days. Each 10-point increase in t-ESAS (score 0-90) was independently associated with increased risk of NFSI within 180 days (OR 1.51; 95%CI 1.40-1.63). Conclusions: Reporting moderate-to-severe anxiety, depression, and shortness of breath, and increasing t-ESAS after cancer diagnosis are associated with higher odds of NFSI in the following 180 days. These data support the prospective identification of patients at high risk for NFSI via routine ESAS screening to improve supportive care. Patients with at-risk ESAS scores should receive tailored assessment, management, and longitudinal follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Natalie G. Coburn
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada
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17
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Noel C, Eskander A, Sutradhar R, Mahar A, Vigod S, Isenberg-Grzeda E, Bolton J, Deleemans J, Chan W, Zuk V, Haas B, Mason S, Coburn NG, Hallet J. Non-fatal self-injury after a diagnosis of cancer: A population-based study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18577] [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: 11/20/2022] Open
Abstract
e18577 Background: Psychological distress is a key construct of patient-centred cancer care. While an increased risk of suicide for cancer patients has been reported, more frequent consequences of distress after a cancer diagnosis, such as non-fatal self-injury (NFSI), remain largely unknown. We examined the risk for NFSI after a cancer diagnosis. Methods: Using linked administrative databases we identified adults diagnosed with cancer between 2007-2019. Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed accounting for the competing-risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. Results: Of 806,910 included patients, 2,482 had NFSI and 182 died by suicide. 5-year cumulative incidence of NFSI was 0.27% [95%CI 0.25-0.28%]. After adjusting for key confounders, prior severe psychiatric illness whether requiring inpatient care (sub-distribution hazard ratio (sHR) 12.6, [95% CI 10.5-15.2]) or outpatient care (sHR 7.5, 95% CI 6.48-8.84), and prior self-injury (sHR 6.6 [95% CI 5.5-8.0]) were associated with increased risk of NFSI. Young adults (age 18-39) had the highest NFSI rates, relative to individuals >70 (sHR 5.4, [95% CI 4.5-6.5]). The magnitude of association between prior severe psychiatric illness and NFSI was greatest for young adults (interaction term p < 0.01). Certain cancer subsites were also at increased risk, including head and neck (sHR1.52, [95%CI 1.19-1.93]). Conclusions: Patients with cancer have higher incidence of NFSI than suicide after diagnosis. Younger age, prior severe psychiatric illness, and prior self-injury were independently associated with NFSI. These exposures act synergistically, placing young adults with a prior mental health history at greatest risk for NFSI events. Those factors should be used to identify at-risk patients for psycho-social assessment and intervention.
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Affiliation(s)
- Christopher Noel
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | - Natalie G. Coburn
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada
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18
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Evans DG, Lalloo F, Ryan NA, Bowers N, Green K, Woodward ER, Clancy T, Bolton J, McVey RJ, Wallace AJ, Newton K, Hill J, McMahon R, Crosbie EJ. Advances in genetic technologies result in improved diagnosis of mismatch repair deficiency in colorectal and endometrial cancers. J Med Genet 2021; 59:328-334. [PMID: 33452216 PMCID: PMC8961751 DOI: 10.1136/jmedgenet-2020-107542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/04/2022]
Abstract
Background Testing cancers for mismatch repair deficiency (dMMR) by immunohistochemistry (IHC) is a quick and inexpensive means of triaging individuals for germline Lynch syndrome testing. The aim of this study was to evaluate tumour dMMR and the prevalence of Lynch syndrome in patients referred to the Manchester Centre for Genomic Medicine, which serves a population of 5.6 million. Methods Tumour testing used IHC for MMR proteins with targeted BRAF and MLH1 promotor methylation testing followed by germline mutation and somatic testing as appropriate. Results In total, 3694 index tumours were tested by IHC (2204 colorectal cancers (CRCs), 739 endometrial cancers (ECs) and 761 other), of which 672/3694 (18.2%) had protein loss, including 348 (9.4%) with MLH1 loss. MLH1 loss was significantly higher for 739 ECs (15%) vs 2204 CRCs (10%) (p=0.0003) and was explained entirely by higher rates of somatic MLH1 promoter hypermethylation (87% vs 41%, p<0.0001). Overall, 65/134 (48.5%) patients with MLH1 loss and no MLH1 hypermethylation or BRAF c.1799T>A had constitutional MLH1 pathogenic variants. Of 456 patients with tumours showing loss of MSH2/MSH6, 216 (47.3%) had germline pathogenic variants in either gene. Isolated PMS2 loss was most suggestive of a germline MMR variant in 19/26 (73%). Of those with no germline pathogenic variant, somatic testing identified likely causal variants in 34/48 (71%) with MLH1 loss and in MSH2/MSH6 in 40/47 (85%) with MSH2/MSH6 loss. Conclusions Reflex testing of EC/CRC leads to uncertain diagnoses in many individuals with dMMR following IHC but without germline pathogenic variants or MLH1 hypermethylation. Tumour mutation testing is effective at decreasing this by identifying somatic dMMR in >75% of cases.
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Affiliation(s)
- D Gareth Evans
- Division of Evolution and Genomic Medicine, The University of Manchester, Manchester, UK.,Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Fiona Lalloo
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Neil Aj Ryan
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Naomi Bowers
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Kate Green
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Emma R Woodward
- Division of Evolution and Genomic Medicine, The University of Manchester, Manchester, UK.,Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Tara Clancy
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - James Bolton
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Rhona J McVey
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Andrew J Wallace
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Katy Newton
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - James Hill
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Raymond McMahon
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Emma J Crosbie
- Division of Cancer Sciences, The University of Manchester, Manchester, UK .,Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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Thompson T, Brophy T, Uddin M, Bolton J, Napier-Hemy R. Immunoglobulin G4–related disease of the paratestis: Can we avoid radical treatment? Journal of Clinical Urology 2020. [DOI: 10.1177/2051415820982778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas Thompson
- Department of Urology, Central Manchester University Hospitals Foundation Trust, UK
| | - Thomas Brophy
- Department of Urology, Central Manchester University Hospitals Foundation Trust, UK
| | - Mohsin Uddin
- Department of Urology, Central Manchester University Hospitals Foundation Trust, UK
| | - James Bolton
- Department of Histopathology, Central Manchester University Hospitals Foundation Trust, UK
| | - Richard Napier-Hemy
- Department of Urology, Central Manchester University Hospitals Foundation Trust, UK
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20
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Derbyshire AE, Allen JL, Gittins M, Lakhiani B, Bolton J, Shaw J, Pemberton PW, Needham M, MacKintosh ML, Edmondson RJ, Kitchener HC, Crosbie EJ. PROgesterone Therapy for Endometrial Cancer Prevention in Obese Women (PROTEC) Trial: A Feasibility Study. Cancer Prev Res (Phila) 2020; 14:263-274. [PMID: 32998940 DOI: 10.1158/1940-6207.capr-20-0248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/22/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022]
Abstract
Obesity is the major etiologic driver for endometrial cancer. The levonorgestrel intrauterine system (LNG-IUS) reduces the risk of endometrial cancer and its precursor, atypical hyperplasia. We assessed feasibility and uptake of the LNG-IUS for primary prevention of endometrial cancer in high-risk women and its impact on endometrial tissue biomarkers. Women with class-III obesity [body mass index (BMI) > 40 kg/m2] and histologically normal endometrium were invited to participate in a clinical trial of the LNG-IUS for endometrial protection. Recruitment, successful LNG-IUS insertion, and adherence to trial procedures were recorded. We measured impact of the LNG-IUS on circulating biomarkers of endometrial cancer risk, endometrial proliferation (Ki-67, pAKT, PTEN), endometrial hormone receptor status [estrogen receptor and progesterone receptor (PR)], mental wellbeing, and menstrual function. At 6 months, women chose to keep their LNG-IUS or have it removed. In total, 103 women were approached, 54 were offered a participant information sheet, 35 agreed to participate, and 25 received a LNG-IUS. Their median age and BMI were 54 years [interquartile range (IQR) 52-57] and 47 kg/m2 (IQR 44-51), respectively. Three women (3/35, 9%) were ineligible due to atypical hyperplasia/endometrial cancer on their baseline biopsy. The LNG-IUS was well tolerated and had a positive overall effect on bleeding patterns and mental wellbeing. The LNG-IUS was associated with endometrial morphologic change, reduced Ki-67, and PR expression, but circulating biomarkers of endometrial cancer risk were unchanged. All but one woman (96%) kept her LNG-IUS. The LNG-IUS appears to be acceptable to some women with class-III obesity for primary prevention of endometrial cancer, which could provide a strategy for a prevention trial.Prevention Relevance: Novel strategies are urgently needed to prevent the rise in endometrial cancer diagnoses predicted by escalating obesity rates. Here, we show that women with class III obesity are willing to engage in risk reduction with a levonorgestrel intrauterine system, which could provide a strategy for an endometrial cancer prevention trial.
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Affiliation(s)
- Abigail E Derbyshire
- Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jennifer L Allen
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Matthew Gittins
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Bhavna Lakhiani
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - James Bolton
- Department of Histopathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Joseph Shaw
- Department of Histopathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Philip W Pemberton
- Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Michelle Needham
- Sleep Apnoea Service, Salford Royal Hospitals NHS Foundation Trust, Salford, United Kingdom
| | - Michelle L MacKintosh
- Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Richard J Edmondson
- Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Henry C Kitchener
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Emma J Crosbie
- Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom. .,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
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21
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Crosbie EJ, Ryan NAJ, McVey RJ, Lalloo F, Bowers N, Green K, Woodward ER, Clancy T, Bolton J, Wallace AJ, McMahon RF, Evans DG. Assessment of mismatch repair deficiency in ovarian cancer. J Med Genet 2020; 58:687-691. [PMID: 32917768 PMCID: PMC8479746 DOI: 10.1136/jmedgenet-2020-107270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
Background Hereditary causes of ovarian cancer include Lynch syndrome, which is due to inherited pathogenic variants affecting one of the four mismatch repair genes involved in DNA repair. The aim of this study was to evaluate tumour mismatch repair deficiency and prevalence of Lynch syndrome in high-risk women referred to the Manchester Centre for Genomic Medicine with ovarian cancer over the past 20 years. Methods Women with ovarian cancer diagnosed before the age of 35 years and/or with a suggestive personal or family history of Lynch syndrome cancers underwent tumour testing with immunohistochemistry for mismatch repair deficiency and, where indicated, MLH1 promoter methylation testing followed by constitutional testing for Lynch syndrome. Results In total, 261 ovarian cancers were tested and 27 (10.3%; 95% CI 6.9% to 14.7%) showed mismatch repair deficiency by immunohistochemistry. Three of 7 with MLH1 loss showed MLH1 promoter hypermethylation, and 18 of the remaining 24 underwent constitutional testing for Lynch syndrome. A further 15 women with mismatch repair proficient tumours underwent constitutional testing because of a strong family history of Lynch syndrome cancers. Pathogenic variants were identified in 9/33 (27%) women who underwent constitutional testing, aged 33–59 years (median 48 years), including one whose tumour was mismatch repair proficient. Most Lynch syndrome tumours were of endometrioid histological subtype. Conclusions Tumour mismatch repair deficiency identified by immunohistochemistry is a useful prescreen for constitutional testing in women with ovarian cancer with personal or family histories suggestive of Lynch syndrome.
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Affiliation(s)
- Emma J Crosbie
- Division of Cancer Sciences, The University of Manchester, Manchester M13 9WL, UK .,Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Neil A J Ryan
- Division of Cancer Sciences, The University of Manchester, Manchester M13 9WL, UK.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.,Division of Evolution and Genomic Medicine, The University of Manchester, Manchester M13 9WL, UK
| | - Rhona J McVey
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Naomi Bowers
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Kate Green
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Emma R Woodward
- Division of Evolution and Genomic Medicine, The University of Manchester, Manchester M13 9WL, UK.,Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Tara Clancy
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - James Bolton
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Andrew J Wallace
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Raymond F McMahon
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - D Gareth Evans
- Division of Evolution and Genomic Medicine, The University of Manchester, Manchester M13 9WL, UK.,Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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22
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Ryan NAJ, McMahon R, Tobi S, Snowsill T, Esquibel S, Wallace AJ, Bunstone S, Bowers N, Mosneag IE, Kitson SJ, O’Flynn H, Ramchander NC, Sivalingam VN, Frayling IM, Bolton J, McVey RJ, Evans DG, Crosbie EJ. The proportion of endometrial tumours associated with Lynch syndrome (PETALS): A prospective cross-sectional study. PLoS Med 2020; 17:e1003263. [PMID: 32941469 PMCID: PMC7497985 DOI: 10.1371/journal.pmed.1003263] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Lynch syndrome (LS) predisposes to endometrial cancer (EC), colorectal cancer, and other cancers through inherited pathogenic variants affecting mismatch-repair (MMR) genes. Diagnosing LS in women with EC can reduce subsequent cancer mortality through colonoscopic surveillance and aspirin chemoprevention; it also enables cascade testing of relatives. A growing consensus supports LS screening in EC; however, the expected proportion of test positives, and optimal testing strategy is uncertain. Previous studies from insurance-based healthcare systems were limited by narrow selection criteria, failure to apply reference standard tests consistently, and poor conversion to definitive testing. The aim of this study was to establish the prevalence of LS and the diagnostic accuracy of LS testing strategies in an unselected EC population. METHODS AND FINDINGS This was a prospective cross-sectional study carried out at a large United Kingdom gynaecological cancer centre between October 2015 and January 2017. Women diagnosed with EC or atypical hyperplasia (AH) were offered LS testing. Tumours underwent MMR immunohistochemistry (IHC), microsatellite instability (MSI), and targeted MLH1-methylation testing. Women <50 years, with strong family histories and/or indicative tumour molecular features, underwent MMR germline sequencing. Somatic MMR sequencing was performed when indicative molecular features were unexplained by LS or MLH1-hypermethylation. The main outcome measures were the prevalence of LS in an unselected EC population and the diagnostic accuracy of clinical and tumour testing strategies for risk stratifying women with EC for MMR germline sequencing. In total, 500 women participated in the study; only 2 (<1%) declined. Germline sequencing was indicated and conducted for 136 and 135 women, respectively. A total of 16/500 women (3.2%, 95% CI 1.8% to 5.1%) had LS, and 11 more (2.2%) had MMR variants of uncertain significance. Restricting testing to age <50 years, indicative family history (revised Bethesda guidelines or Amsterdam II criteria) or endometrioid histology alone would have missed 9/16 (56%), 8/13 (62%) or 9/13 (69%), and 5/16 (31%) cases of LS, respectively. In total 132/500 tumours were MMR deficient by IHC of which 83/132 (63%) had MLH1-hypermethylation, and 16/49 (33%) of the remaining patients had LS (16/132 with MMR deficiency, 12%). MMR-IHC with targeted MLH1-methylation testing was more discriminatory for LS than MSI with targeted methylation testing, with 100% versus 56.3% (16/16 versus 9/16) sensitivity (p = 0.016) and equal 97.5% (468/484) specificity; 64% MSI-H and 73% MMR deficient tumours unexplained by LS or MLH1-hypermethylation had somatic MMR mutations. The main limitation of the study was failure to conduct MMR germline sequencing for the whole study population, which means that the sensitivity and specificity of tumour triage strategies for LS detection may be overestimated, although the risk of LS in women with no clinical or tumour predictors is expected to be extremely low. CONCLUSIONS In this study, we observed that age, family history, and histology are imprecise clinical correlates of LS-EC. IHC outperformed MSI for tumour triage and reliably identified both germline and somatic MMR mutations. The 3.2% proportion of LS-EC is similar to colorectal cancer, supporting unselected screening of EC for LS.
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Affiliation(s)
- Neil A. J. Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
- Division of Evolution and Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Raymond McMahon
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Simon Tobi
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Tristan Snowsill
- Health Economics Group, University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Shona Esquibel
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Andrew J. Wallace
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sancha Bunstone
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Naomi Bowers
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ioana E. Mosneag
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Sarah J. Kitson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Helena O’Flynn
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Neal C. Ramchander
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Vanitha N. Sivalingam
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Ian M. Frayling
- Inherited Tumour Syndromes Research Group, Institute of Cancer & Genetics, Cardiff University, Cardiff, United Kingdom
| | - James Bolton
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rhona J. McVey
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - D. Gareth Evans
- Division of Evolution and Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
- Manchester Centre for Genomic Medicine, North-West Genomics Laboratory Hub, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma J. Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- * E-mail:
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Hensel J, Graham R, Isaak C, Ahmed N, Sareen J, Bolton J. A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation: Un nouveau programme de télépsychiatrie d'urgence en milieu urbain canadien: Identifier et aborder les obstacles perçus d'une mise en œuvre réussie. Can J Psychiatry 2020; 65:559-567. [PMID: 31969011 PMCID: PMC7492888 DOI: 10.1177/0706743719900465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. METHODS We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided. RESULTS Survey respondents (N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers. CONCLUSIONS By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.
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Affiliation(s)
- Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Reid Graham
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Naweed Ahmed
- Department of Family Practice, University of British Columbia, Victoria, British Columbia, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kitson SJ, Bafligil C, Ryan NAJ, Lalloo F, Woodward ER, Clayton RD, Edmondson RJ, Bolton J, Crosbie EJ, Evans DG. BRCA1 and BRCA2 pathogenic variant carriers and endometrial cancer risk: A cohort study. Eur J Cancer 2020; 136:169-175. [PMID: 32698099 PMCID: PMC7441309 DOI: 10.1016/j.ejca.2020.05.030] [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] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022]
Abstract
Background An association between BRCA pathogenic variants and an increased endometrial cancer risk, specifically serous-like endometrial cancer, has been postulated but remains unproven, particularly for BRCA2 carriers. Mechanistic evidence is lacking, and any link may be related to tamoxifen exposure or testing bias. Hysterectomy during risk-reducing bilateral salpingo-oophorectomy is, therefore, of uncertain benefit. Data from a large, prospective cohort will be informative. Methods Data on UK BRCA pathogenic variant carriers were interrogated for endometrial cancer diagnoses. Standardised incidence ratios (SIRs) were calculated in four distinct cohorts using national endometrial cancer rates; either from 1/1/1980 or age 20, prospectively from date of personal pathogenic variant report, date of family pathogenic variant report or date of risk-reducing salpingo-oophorectomy. Somatic BRCA sequencing of 15 serous endometrial cancers was performed to detect pathogenic variants. Results Fourteen cases of endometrial cancer were identified in 2609 women (1350 BRCA1 and 1259 BRCA2), of which two were prospectively diagnosed. No significant increase in either overall or serous-like endometrial cancer risk was identified in any of the cohorts examined (SIR = 1.70, 95% confidence interval = 0.74–3.33; no cases of serous endometrial cancer diagnosed). Results were unaffected by the BRCA gene affected, previous breast cancer or tamoxifen use. No BRCA pathogenic variants were detected in any of the serous endometrial cancers tested. Conclusions Women with a BRCA pathogenic variant do not appear to have a significant increased risk of all-type or serous-like endometrial cancer compared with the general population. These data provide some reassurance that hysterectomy is unlikely to be of significant benefit if performed solely as a preventive measure. Endometrial cancer risk was not increased in BRCA1/2 pathogenic variant carriers. Results were unaffected by BRCA gene, previous breast cancer or tamoxifen use. No specific increase in serous-like endometrial cancer risk was identified. Sequencing of 15 serous endometrial tumours revealed no pathogenic BRCA1/2 variants.
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Affiliation(s)
- Sarah J Kitson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Cemsel Bafligil
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Neil A J Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma R Woodward
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Evolution and Genomic Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Richard D Clayton
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Richard J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - James Bolton
- Department of Histopathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Evolution and Genomic Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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25
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Affiliation(s)
- Harvey Max Chochinov
- Department of Psychiatry, Research Institute of Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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26
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Hitchon CA, Zhang L, Peschken CA, Lix LM, Graff LA, Fisk JD, Patten SB, Bolton J, Sareen J, El-Gabalawy R, Marriott J, Bernstein CN, Marrie RA. Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:1130-1139. [PMID: 31199570 PMCID: PMC7496677 DOI: 10.1002/acr.24011] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 02/12/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
Abstract
Objective To test the validity and reliability of screening instruments for depression and anxiety in rheumatoid arthritis (RA). Methods Participants with RA completed the Patient Health Questionnaire (PHQ‐2 or PHQ‐9), the Patient Reported Outcomes Measurement Information System depression short form 8a and anxiety short form 8a, the Hospital Anxiety and Depression Scale anxiety score (HADS‐A) and depression score (HADS‐D), the Overall Anxiety Severity and Impairment Scale, the Generalized Anxiety Disorder 2‐ and 7‐item scales, and the Kessler‐6 scale. Clinical depression and anxiety disorders were confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders (SCID‐1) research version. We reported sensitivity, specificity, positive predictive value, and negative predictive value using SCID‐1 diagnoses as the criterion standard. Test–retest reliability was assessed with the intraclass correlation coefficient. Results Of 150 participants, 11.3% had SCID‐1–diagnosed depression, 7.3% had SCID‐1–diagnosed generalized anxiety disorder, and 19.3% had any SCID‐1–diagnosed anxiety disorder. For depression, sensitivity ranged from HADS‐D (cut point 11; 35%) to PHQ‐2 (88%) and PHQ‐9 (87%). Specificity ranged from PHQ‐9 (77%) and PHQ‐2 (84%) to HADS‐D (cut point 11; 94%). Positive predictive value ranged from 30% to 43%. Negative predictive value ranged from 92% to 98%. For generalized anxiety disorder, sensitivity ranged from HADS‐A (cut point 11; 45%) to HADS‐A (cut point 8; 91%). Specificity ranged from 81% to 89% for all measures except the HADS‐A (cut point 8; 63%). Intraclass correlation coefficient estimates ranging from 0.69 to 0.88 confirmed good test–retest reliability. Conclusion Depression screening instruments had good diagnostic performance; anxiety instruments were more variable. Identified depression and anxiety require clinical confirmation.
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Affiliation(s)
- Carol A Hitchon
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lixia Zhang
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine A Peschken
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott B Patten
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Bolton
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Marriott
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Wan YL, Sapra P, Bolton J, Chua JX, Durrant LG, Stern PL. Combination Treatment with an Antibody-Drug Conjugate (A1mcMMAF) Targeting the Oncofetal Glycoprotein 5T4 and Carboplatin Improves Survival in a Xenograft Model of Ovarian Cancer. Target Oncol 2020; 14:465-477. [PMID: 31332693 PMCID: PMC6684567 DOI: 10.1007/s11523-019-00650-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Recurrence occurs in over 75% of women with epithelial ovarian cancer despite optimal treatment. Selectively killing tumour cells thought to initiate relapse using an antibody–drug conjugate could prolong progression-free survival and offer an improved side-effect profile. A1mcMMAF is an antibody–drug conjugate designed to target cells expressing the tumour-associated antigen 5T4. It has shown to be efficacious in various cell line models and have a greater impact when combined with routine chemotherapeutic regimes. Objectives This study aims to explore the potential for the use of a 5T4 antibody–drug conjugate in women with ovarian cancer both as a monotherapy and in combination with platinum-based chemotherapy. Methods Immunohistochemical analysis was used to assess 5T4 expression in tumours from patients with ovarian cancer. Effectiveness of A1mcMMAF therapy as a single agent and in combination with carboplatin was assessed in vitro in the ovarian cancer cell line SKOV3 and confirmed in vivo using a serial bioluminescence assay in a SKOV3 xenograft model of ovarian cancer. Results 5T4 is confirmed as suitably expressed in epithelial ovarian cancers prior to adjuvant therapy and is an independent predictor of poor survival. A1mcMMAF showed specific activity, both in vitro and in vivo, against SKOV3 ovarian cancer cells. When used in combination with carboplatin, in vivo tumour growth was inhibited resulting in prolonged survival in a SKOV3 xenograft model. Conclusions These data support further investigation of A1mcMMAF in combination with platinum-based chemotherapy in ovarian and other cancer treatments. Electronic supplementary material The online version of this article (10.1007/s11523-019-00650-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Y Louise Wan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Puja Sapra
- Oncology Research and Development, Pfizer Inc., 401 N. Middletown Road, Pearl River, NY, 10954, USA
| | - James Bolton
- Department of Histopathology, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Jia Xin Chua
- Academic Clinical Oncology, The University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Lindy G Durrant
- Academic Clinical Oncology, The University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Peter L Stern
- Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
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28
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Lozano O, García-Rivas G, Ramos M, Vázquez-Garza E, Chapoy-Villanueva H, Rubio N, Treviño V, Bolton J, Torre-Amione G. CARDIOPROTECTIVE EFFECT OF CANNABIDIOL IN A NON ISCHEMIC MODEL OF HEART FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31332-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Lozano O, García-Rivas G, Vázquez-Garza E, García N, Chapoy-Villanueva H, Ramos M, Bolton J, Torre-Amione G. NANO ENCAPSULATED CYCLOSPORINE-A REDUCES THE CARDIAC INFLAMMATION AND MITOCHONDRIAL DYSFUNCTION IN A NON-ISCHEMIC MODEL OF CARDIOMYOPATHY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31331-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Behrouzi R, Ryan NAJ, Barr CE, Derbyshire AE, Wan YL, Maskell Z, Stocking K, Pemberton PW, Bolton J, McVey RJ, Crosbie EJ. Baseline Serum HE4 But Not Tissue HE4 Expression Predicts Response to the Levonorgestrel-Releasing Intrauterine System in Atypical Hyperplasia and Early Stage Endometrial Cancer. Cancers (Basel) 2020; 12:cancers12020276. [PMID: 31979212 PMCID: PMC7073190 DOI: 10.3390/cancers12020276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 01/01/2023] Open
Abstract
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a conservative management option for atypical hyperplasia (AH) and low grade early stage endometrial cancer (EEC), but around 1 in 3 patients fail to respond to treatment. The aim of this study was to investigate if serum and/or tissue HE4 expression could predict response to LNG-IUS therapy. Patients with AH or presumed Stage I EEC had serum and endometrial samples taken at baseline and at 3-month intervals over 12 months post-insertion of LNG-IUS. 74 patients were recruited and baseline demographics recorded. Of 57 patients for whom response was histologically determinable, 39 (68%) were responders and 18 (32%) non-responders. Mean baseline serum HE4 was significantly lower in responders (62.1 ± 1.1 pM, 95% confidence interval (CI) 52.7–73.2), compared to non-responders (125.6 ± 1.3 pM, 95% CI 74.5–211.7, p = 0.014), including when considering age, BMI, menopausal status, smoking status, and histological grade as covariables (p = 0.005). Baseline tissue HE4 expression was not significantly different in responders compared to non-responders (p = 0.999). Responders showed a significant mean reduction (−9.8 ± 3.4%, 95% CI −16.7 to −2.8%, p = 0.008) in serum HE4 between baseline and 3 months (p = 0.008), whereas non-responders showed no significant change (p = 0.676). Neither responders nor non-responders showed a significant percentage change in serum HE4 from baseline beyond 3 months (p > 0.05). Change in serum HE4 between baseline and 3 and 6 months and tissue HE4 tissue expression between baseline and 3, 6, and 12 months was not significantly different in responders compared to non-responders (p > 0.05). This study suggests that baseline serum HE4, but not baseline tissue HE4 expression, is independently predictive of response to the LNG-IUS and could be used to guide management decisions.
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Affiliation(s)
- Roya Behrouzi
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK;
| | - Neil A. J. Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester M13 9WL, UK; (N.A.J.R.); (Y.L.W.); (Z.M.)
| | - Chloe E. Barr
- Department of Obstetrics and Gynaecology, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; (C.E.B.); (A.E.D.)
| | - Abigail E. Derbyshire
- Department of Obstetrics and Gynaecology, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; (C.E.B.); (A.E.D.)
| | - Y. Louise Wan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester M13 9WL, UK; (N.A.J.R.); (Y.L.W.); (Z.M.)
| | - Zoe Maskell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester M13 9WL, UK; (N.A.J.R.); (Y.L.W.); (Z.M.)
| | - Katie Stocking
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK;
| | - Philip W. Pemberton
- Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK;
| | - James Bolton
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; (J.B.); (R.J.M.)
| | - Rhona J. McVey
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; (J.B.); (R.J.M.)
| | - Emma J. Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester M13 9WL, UK; (N.A.J.R.); (Y.L.W.); (Z.M.)
- Department of Obstetrics and Gynaecology, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK; (C.E.B.); (A.E.D.)
- Correspondence:
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Ramchander NC, Ryan NAJ, Walker TDJ, Harries L, Bolton J, Bosse T, Evans DG, Crosbie EJ. Distinct Immunological Landscapes Characterize Inherited and Sporadic Mismatch Repair Deficient Endometrial Cancer. Front Immunol 2020; 10:3023. [PMID: 31998307 PMCID: PMC6970202 DOI: 10.3389/fimmu.2019.03023] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023] Open
Abstract
Around 30% of endometrial cancers (EC) are mismatch repair (MMR) deficient, mostly as a consequence of mutations acquired during tumorigenesis, but a significant minority is caused by Lynch syndrome (LS). This inherited cancer predisposition syndrome primes an anti-cancer immune response, even in healthy carriers. We sought to explore the intra-tumoral immunological differences between genetically confirmed LS-associated MMR-deficient (MMRd), sporadic MMR-deficient, and MMR-proficient (MMRp) EC. Endometrial tumors from women with known LS were identified (n = 25). Comparator tumors were recruited prospectively and underwent microsatellite instability (MSI) testing, immunohistochemistry (IHC) for MMR expression and MLH1 methylation testing. Those found to have MLH1 hypermethylation formed the sporadic MMR-deficient group (n = 33). Those found to be mismatch repair proficient and microsatellite stable formed the MMR-proficient group (n = 35). A fully automated monoplex IHC panel was performed on sequential formalin-fixed paraffin-embedded tumor sections to identify CD3+, CD8+, CD45RO+, FoxP3+, and PD-1+ immune cells, and PD-L1 expression by tumor/immune cells. Two independent observers quantified immune marker expression at the tumor center and invasive margin. Mean and overall compartmental T-cell counts generated standard (binary: Low/High) and higher resolution (quaternary: 0-25, 25-50, 50-75, 75-100%) immune scores, which were used as explanatory features in neural network, support vector machine, and discriminant predictive modeling. Overall T-cell counts were significantly different between the three cohorts: CD3+ (p = <0.0001), CD8+ (p = <0.0001), CD45RO+ (<0.0001), FoxP3+ (p = <0.0001), and PD1+ (p = <0.0001), with LS-associated MMR-deficient tumors having highest infiltrations. There were significant differences in CD8+ (p = 0.02), CD45RO+ (p = 0.007), and PD-1+ (p = 0.005) T-cell counts at the invasive margin between LS-associated and sporadic MMR-deficient tumors, but not between sporadic MMR-deficient and MMR-proficient tumors. Predictive modeling could accurately determine MMR status based on CD8+ T-cell counts within the tumor center alone. This study shows that LS-associated and sporadic MMR-deficient EC are distinct immunological entities, which has important implications for treatment and prognosis.
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Affiliation(s)
- Neal C Ramchander
- University of Manchester Medical School, Manchester, United Kingdom.,Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Neil A J Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Division of Evolution and Genomic Medicine, Faculty of Biology, Medicine and Health, St. Mary's Hospital, University of Manchester, Manchester, United Kingdom
| | - Thomas D J Walker
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lauren Harries
- Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - James Bolton
- Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - D G Evans
- Division of Evolution and Genomic Medicine, Faculty of Biology, Medicine and Health, St. Mary's Hospital, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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32
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Katz C, Roos LE, Wang Y, Bolton J, Hwang SW, Katz LY, Bourque J, Adair CE, Somers JM, Sareen J. Predictive Validity of the MINI Suicidality Subscale for Suicide Attempts in a Homeless Population With Mental Illness. Suicide Life Threat Behav 2019; 49:1630-1636. [PMID: 30907470 DOI: 10.1111/sltb.12544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Suicide is a leading cause of death, yet the accurate prediction of suicidal behavior is an elusive target for clinicians and researchers. The current paper examines the predictive validity of the Mini Neuropsychiatric Interview (MINI) Suicidality subscale for suicide attempts (SAs) for a homeless population with mental illness. METHODS Two thousand two hundred and fifty-five homeless individuals with mental illness across five Canadian cities enrolled in the At Home/Chez Soi Housing First trial interviewed at baseline using the MINI Suicidality subscale with 2-year follow-up of self-reported SAs. RESULTS Two thousand two hundred and twenty-one participants were included in the analysis. High rates of mood and substance use disorders were present (56.5% and 67.4%, respectively). The mean MINI Suicidality subscale score was 7.71. Among 1,700 participants with follow-up data, 11.4% reported a SA over the 2-year study period. MINI Suicidality subscale scores were predictive of SAs (AUC ≥ 0.70) among those with and without a history of SAs, even among those with missing answers. A positive predictive value of 0.20 and a negative predictive value of 0.95 were demonstrated, with a relatively low number needed to assess of 4.5-5. CONCLUSION The MINI Suicidal subscale shows promise as an easy to use and accurate suicide risk prediction tool among homeless individuals with mental illness.
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Affiliation(s)
- Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Yunqiao Wang
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Laurence Y Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jimmy Bourque
- Faculty of Education, Université de Moncton, Moncton, NB, Canada
| | - Carol E Adair
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Julian M Somers
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Wan YL, Sapra P, Bolton J, Chua JX, Durrant LG, Stern PL. Correction to: Combination Treatment with an Antibody-Drug Conjugate (A1mcMMAF) Targeting the Oncofetal Glycoprotein 5T4 and Carboplatin Improves Survival in a Xenograft Model of Ovarian Cancer. Target Oncol 2019; 14:769. [PMID: 31583515 PMCID: PMC6875511 DOI: 10.1007/s11523-019-00677-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y Louise Wan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Puja Sapra
- Oncology Research and Development, Pfizer Inc., 401 N. Middletown Road, Pearl River, NY, 10954, USA
| | - James Bolton
- Department of Histopathology, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Jia Xin Chua
- Academic Clinical Oncology, The University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Lindy G Durrant
- Academic Clinical Oncology, The University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Peter L Stern
- Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
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MacKintosh ML, Derbyshire AE, McVey RJ, Bolton J, Nickkho‐Amiry M, Higgins CL, Kamieniorz M, Pemberton PW, Kirmani BH, Ahmed B, Syed AA, Ammori BJ, Renehan AG, Kitchener HC, Crosbie EJ. The impact of obesity and bariatric surgery on circulating and tissue biomarkers of endometrial cancer risk. Int J Cancer 2019; 144:641-650. [PMID: 30289975 PMCID: PMC6519061 DOI: 10.1002/ijc.31913] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/21/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023]
Abstract
Obesity is the strongest risk factor for endometrial cancer (EC). To inform targeted screening and prevention strategies, we assessed the impact of obesity and subsequent bariatric surgery-induced weight loss on endometrial morphology and molecular pathways implicated in endometrial carcinogenesis. Blood and endometrial tissue were obtained from women with class III-IV obesity (body mass index ≥40 and ≥50 kg/m2 , respectively) immediately prior to gastric bypass or sleeve gastrectomy, and at two and 12 months' follow up. The endometrium underwent pathological examination and immunohistochemistry was used to quantify proliferation (Ki-67), oncogenic signaling (PTEN, pAKT, pERK) and hormone receptor (ER, PR) expression status. Circulating biomarkers of insulin resistance, reproductive function and inflammation were also measured at each time point. Seventy-two women underwent bariatric surgery. At 12 months, the mean change in total and excess body weight was -32.7 and -62.8%, respectively. Baseline endometrial biopsies revealed neoplastic change in 10 women (14%): four had EC, six had atypical hyperplasia (AH). After bariatric surgery, most cases of AH resolved (5/6) without intervention (3/6) or with intrauterine progestin (2/6). Biomarkers of endometrial proliferation (Ki-67), oncogenic signaling (pAKT) and hormone receptor status (ER, PR) were significantly reduced, with restoration of glandular PTEN expression, at 2 and 12 months. There were reductions in circulating biomarkers of insulin resistance (HbA1c, HOMA-IR) and inflammation (hsCRP, IL-6), and increases in reproductive biomarkers (LH, FSH, SHBG). We found an unexpectedly high prevalence of occult neoplastic changes in the endometrium of women undergoing bariatric surgery. Their spontaneous reversal and accompanying down-regulation of PI3K-AKT-mTOR signaling with weight loss may have implications for screening, prevention and treatment of this disease.
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Affiliation(s)
- Michelle L. MacKintosh
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Abigail E. Derbyshire
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Rhona J. McVey
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - James Bolton
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Mahshid Nickkho‐Amiry
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Catherine L. Higgins
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Martyna Kamieniorz
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Philip W. Pemberton
- Department of Clinical BiochemistryManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Bilal H. Kirmani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUnited Kingdom
| | - Babur Ahmed
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
| | - Akheel A. Syed
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Basil J. Ammori
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Andrew G. Renehan
- Obesity and Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthManchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, University of ManchesterManchesterUnited Kingdom
| | - Henry C. Kitchener
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Emma J. Crosbie
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
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Brennan-Olsen SL, Taillieu TL, Turner S, Bolton J, Quirk SE, Gomez F, Duckham RL, Hosking SM, Duque G, Green D, Afifi TO. Arthritis in adults, socioeconomic factors, and the moderating role of childhood maltreatment: cross-sectional data from the National Epidemiological Survey on Alcohol and Related Conditions. Osteoporos Int 2019; 30:363-373. [PMID: 30132028 DOI: 10.1007/s00198-018-4671-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/13/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history. INTRODUCTION CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis. METHODS Data were drawn from Wave 2 (2004-2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis. RESULTS Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis. CONCLUSIONS Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.
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Affiliation(s)
- S L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia.
| | - T L Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J Bolton
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S E Quirk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - F Gomez
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - R L Duckham
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - S M Hosking
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - G Duque
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - D Green
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - T O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Montastier E, Bolton J, Valsesia A, Hager J, Langin D, Viguerie N. Profil d’expression des microARNs du tissu adipeux de patients obèses associés à la restriction calorique. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.167] [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: 10/27/2022]
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Abstract
Paratesticular leiomyosarcoma is a rare tumour. It is seldom diagnosed pre-operatively and subsequent secondary resection is often required. Current treatment consensus comprises inguinal radical orchidectomy with high ligation of the spermatic cord. We present a case of a 74-year-old male with a 3-year history of a painless right-sided scrotal mass which following excision was found to be an epididymal leiomyosarcoma. A review of literature and treatment is presented in this article.
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Affiliation(s)
- Sean Rezvani
- Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - James Bolton
- Department of Pathology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Ann Crump
- Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
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Wall-Wieler E, Bolton J, Liu C, Wilcox H, Roos LL, Hjern A. Intergenerational involvement in out-of-home care and death by suicide in Sweden: A population-based cohort study. J Affect Disord 2018; 238:506-512. [PMID: 29936388 DOI: 10.1016/j.jad.2018.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 03/16/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals involved in out-of-home care are at higher risk of death by suicide. We aimed to determine whether parents with two generations of involvement in out-of-home care (themselves as children, and their own children) are at increased risk of death by suicide than parents with no involvement or parents with one generation of involvement in out-of-home care. METHOD This population-based cohort study included all individuals born in Sweden between 1973 and 1980 who had at least one child between 1990 and 2012 (n = 487,948). Women (n = 259,275) and men (n = 228,673) were examined separately. RESULTS When compared with mothers with no involvement in out-of-home care, mothers with two generations of involvement were at more than five times greater risk of death by suicide (aHR = 5.52; 95% CI 2.91-10.46); mothers with one generation of involvement were also at significantly higher risk of death by suicide (mothers were in care as children: aHR = 2.35; 95% CI 1.27-4.35; child was placed in care: aHR = 3.23; 95% CI 1.79-5.83). Involvement in out-of-home care (in either generation) did not affect risk of death by suicide for fathers. LIMITATIONS Reason for placement in out-of-home care is not known; these reasons could also be associated with risk of death by suicide Conclusion: Mothers with involvement in out-of-home care, either as children or when their child was placed in care, are at significantly higher risk of death by suicide. Mental health services should be provided to individuals involved in out-of-home care.
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Affiliation(s)
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Can Liu
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Holly Wilcox
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Center for Health Policy, Winnipeg, Canada
| | - Anders Hjern
- Department of Public Health Sciences, Stockholm Univesity, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Alkabbani W, Marrie RA, Bugden S, Alessi-Severini S, Daeninck P, Bolton J, Sareen J, Leong C. Pharmaceutical cannabinoid use in Manitoba, 2004/05 to 2014/15: a population-based cross-sectional study. CMAJ Open 2018; 6:E637-E642. [PMID: 30563919 PMCID: PMC6298870 DOI: 10.9778/cmajo.20180109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pharmaceutically derived cannabinoids are used for several indications, particularly pain management. The extent of their use from a population perspective is unknown; hence, the aim of this study was to evaluate trends in pharmaceutical cannabinoid use in Manitoba. METHODS This was a retrospective population-based cross-sectional study using administrative data from the Manitoba Centre for Health Policy. Pharmaceutical cannabinoid users residing in Manitoba from Apr. 1, 2004, to Mar. 31, 2015 were identified. We assessed the annual prevalence and incidence of pharmaceutical cannabinoid use, and the sociodemographic characteristics and medical conditions of users. RESULTS We identified 5181 people who received at least 1 prescription for a pharmaceutical cannabinoid over the study period, 5033 of whom received their first prescription after Apr. 1, 2004. Nabilone accounted for 73 650 (96.0%) of all prescriptions dispensed; dronabinol was discontinued during the study period. The annual prevalence rate of use increased by 527.2%, from 21.5 (95% confidence interval [CI] 21.4-21.6) users per 100 000 people in 2004/05 to 134.9 (95% CI 134.7-135.1) users per 100 000 people in 2014/15. The annual incidence rate increased by 413.3%, from 12.1 (95% CI 12.1-12.2) users per 100 000 person-years in 2004/05 to 62.2 (95% CI 62.1-62.4) users per 100 000 person-years in 2014/15. The highest use was among older adults aged 46-64 years, females and urban area residents. One-third of incident users (1775 [35.3%]) had a diagnosis of fibromyalgia in a 2-year period before their first cannabinoid prescription. General practitioners initiated almost half (2350 [46.7%]) of first prescriptions, and anesthesiologists/pain specialists initiated one-quarter (1299 [25.8%]). INTERPRETATION The prevalence and incidence of pharmaceutical cannabinoid use increased over time. These findings provide insight into the use of cannabinoids before the introduction of recreational marijuana, which may affect this trend.
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Affiliation(s)
- Wajd Alkabbani
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - Ruth Ann Marrie
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - Shawn Bugden
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - Silvia Alessi-Severini
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - Paul Daeninck
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - James Bolton
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - Jitender Sareen
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld
| | - Christine Leong
- College of Pharmacy (Alkabbani, Bugden, Alessi-Severini, Leong), Rady Faculty of Health Sciences; Max Rady College of Medicine (Marrie, Daeninck, Bolton, Sareen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; School of Pharmacy (Bugden), Memorial University of Newfoundland, St. John's, Nfld.
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Nickel N, Leong C, Prior H, Konrad G, Bolton J, MacWilliam L, Ekuma O, Paille M, Valdivia J. Patterns of pharmacotherapies used to treat alcohol use disorders: A population-based administrative data study. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionAlcohol use disorders (AUDs) – mental and/or physical health diagnoses due to harmful alcohol consumption – are associated with compromised quality of life for the individual. Over the past two decades, pharmacotherapies have been developed to treat alcohol addiction and may help mitigate the harmful outcomes linked with excessive alcohol.
Objectives and ApproachThe objectives were to examine the pharmacotherapy dispensation patterns among individuals with an AUD and their mental health comorbidities. We used ICD codes from medical claims and hospital discharge data to identify anyone with a physical / mental health diagnosis due to harmful alcohol consumption – AUD, April 1, 1996-March 31, 2015. We identified mental health comorbidities using administrative health records. Drug dispensation data were used to identify all first-time prescriptions for acamprosate, naltrexone, or disulfiram occurring after an initial AUD diagnosis. Generalized linear models tested for predictors of receiving a prescription and to identify differences in mental health comorbidities.
ResultsWe identified 53,556 treatment niave individuals with an AUD who were eligible to receive one of these three prescriptions. 493 of these received a prescription for acamprosate, naltrexone, or disulfiram. The majority of prescriptions came from general practitioners from urban centers. Those with a prescription were significantly more likely to have a comorbid mood or anxiety diagnosis. Those with a prescription were more likely to have a physician visit for a mental health issue a year to two years before diagnosis compared with those who did not have a prescription; and, they were more likely to be dispensed a selective serotonin, a sedative, and an anti-anxiety medication prior to receiving an AUD diagnosis.
Conclusion/ImplicationsDrug therapies to aid in the recovery from AUD are being underutilized. Diagnosis of and treatment for mental health disorders is more common among those dispensed these medications. Programs that study clinicians’ use of AUD-targeted drug therapies should be considered, while psychiatric services in addiction care require significant improvement.
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Turner S, Mota N, Bolton J, Sareen J. Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depress Anxiety 2018; 35:851-860. [PMID: 29999576 PMCID: PMC6175215 DOI: 10.1002/da.22771] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The comorbidity of mood and anxiety disorders (MD and AD) with substance use disorders (SUD) is common. One explanation for this comorbidity is the self-medication hypothesis, which posits that individuals with MD or AD use substances to cope with the difficult symptoms associated with the disorder. Over time, self-medication (SM) can develop into an independent SUD. This narrative review will present the prevalence and correlates of SM with alcohol and/or drugs for MD and AD and the relationship between SM and subsequent SUD using both cross-sectional and longitudinal epidemiological data. METHODS Scopus and PsycINFO were searched from January 1997 to April 2018 to identify original research articles that examined the prevalence and correlates of SM and the temporal relationship between MD/AD and SUD in the general population (n = 22). RESULTS The prevalence of SM with alcohol and/or drugs among those with MD or AD ranged from 21.9% to 24.1%. Male sex, younger age, being separated, divorced or widowed, and being Caucasian were characteristics associated with higher proportions of respondents endorsing SM with alcohol/drugs for MD and AD. Longitudinal data supports the temporal onset of primary MD/AD and secondary SUD among those who self-report SM. CONCLUSION Providing and promoting alternate coping strategies for those with MD/AD may reduce SM, the development of SUD, and the comorbidity of MD/AD with SUD. The concurrent treatment of MD/AD and substance use is the current "gold standard" model of care, and the results of this review support its use.
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Affiliation(s)
- Sarah Turner
- Department of Psychiatry and Community Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Natalie Mota
- Department of Clinical Health PsychologyUniversity of ManitobaWinnipegManitobaCanada
| | - James Bolton
- Department of PsychiatryPsychology and Community Health SciencesWinnipegManitobaCanada
| | - Jitender Sareen
- Department of PsychiatryPsychology and Community Health SciencesWinnipegManitobaCanada
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Wall-Wieler E, Roos L, Bolton J. Duration of maternal mental health-related outcomes after an infant’s death: A retrospective matched-cohort study using linkable administrative data. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionMothers have increased mental illness such as anxiety and depression after the death of a child.
Objectives and ApproachThe mental health of all mothers who experience the death of an infant (< 1 years old) in Manitoba, Canada between April 1, 1999, and March 31, 2011 (n = 534) is examined in the four years leading up to, and the four years following, the death of their child to determine how long increased levels of mental-health realted outcomes remain elevated after the death of an infant. Mental
health-related outcomes of these mothers are compared with a matched (3:1) cohort of mothers who did not experience the death of a child (n = 1,602).
ResultsCompared with mothers who did not experience the death of a child, mothers experiencing this event had higher rates of anxiety diagnoses and psychotropic prescriptions starting 6 months before the death. Elevated rates of anxiety continued for the first year and elevated rates of psychotropic prescriptions continued for six months after the death of the child. Mothers who experienced the death of a child had higher rates of depression diagnoses in the year after the death. Relative rates (RR) of depression (RR = 4.94), anxiety (RR = 2.21), and psychotropic medication use (RR = 3.18) were highest in the six months after the child’s death.
Conclusion/ImplicationsElevated rates of depression, anxiety, and psychotropic medication use after the death of a child end within one year of the child’s death.
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Chartier M, Bolton J, Ekuma O, Mota N, Hensel J, MacWilliam L, Nie Y, McDougall C. Childhood Mental Disorders and Subsequent Adverse Outcomes in Early Adulthood: A Population-Based Longitudinal Study. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionThe relationship between childhood/adolescent mental disorders and adult outcomes has been studied using surveys and clinical samples. These studies are prone to selection, recall and self-reporting biases. No previous studies have used population-based administrative databases linking individual-level data that could address these biases and further elucidate this relationship.
Objectives and ApproachUsing de-identified administrative databases housed at the Manitoba Centre for Health Policy, we aimed to determine whether people diagnosed with mental disorders in childhood/adolescence, compared to those without, were at higher risk of early adverse adult outcomes. We created a birth cohort of 60,838 residents of Manitoba, Canada, born from fiscal years 1980/81 to 1984/85 and followed them to the end of study period in 2014/15. Through a scrambled health identifier, health, education, social services and justice system data were linked at an individual level. Survival analysis was used to test for differences controlling for key childhood covariates.
ResultsWe found that 16.5% of the cohort had a diagnosed mental disorder at some point in their childhood/adolescence. Having a diagnosed mental disorder in childhood/adolescence increased the risk of being diagnosed with the same disorder in early adulthood (at age 30 to 34 years old). It also increased the risk of suicidal death (hazard ratio (HR): 2.41), suicide attempts (HR: 3.05), public housing use (HR: 1.44), income assistance use (HR: 2.07), criminal accusation (HR:1.53), and criminal victimization (HR:1.54) in adulthood. Similarly, but to a greater extent, suicide attempts in adolescence increased the risk of suicidal death (HR: 3.65), suicide attempts (HR: 5.68), public housing use (HR: 1.64), income assistance use (HR: 1.68), criminal accusation (HR: 2.18), or criminal victimization (HR: 2.43) in adulthood.
Conclusion/ImplicationsYoung people’s mental health has significant influence on their health and well-being trajectories into adulthood. This knowledge could directly inform policy and practice to provide better population-based mental health promotion, prevention and early interventions for children/adolescents with mental disorders and subsequently prevent adverse adult outcomes in the future.
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Keen O, Bolton J, Litter M, Bircher K, Oppenländer T. Standard reporting of Electrical Energy per Order (E
EO) for UV/H2O2 reactors (IUPAC Technical Report). PURE APPL CHEM 2018. [DOI: 10.1515/pac-2017-0603] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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
Abstract
The concept of Electrical Energy per Order (E
EO) was introduced in 2001 as a figure of merit for evaluating the energy requirements of ultraviolet-based advanced oxidation processes (UV AOPs) used for the degradation of various organic contaminants. The E
EO parameter represents the energy input into the reactor that can achieve an order of magnitude decrease in the concentration of a target contaminant in a unit volume. Since the introduction of this parameter, it has become increasingly popular among UV AOP researchers and practitioners. However, the E
EO is often reported without important details that affect the parameter, making its interpretation difficult. The E
EO depends on a variety of factors (e.g. the concentration and identity of the target contaminant and the amount of hydrogen peroxide added). Therefore, the E
EO parameter needs to be reported in the literature with several other experimental details affecting the reactor performance and in a way that proper comparisons can be made between reactors across studies or manufacturers. This paper discusses the proper application of the E
EO parameter for bench-, pilot-, and full-scale studies. Sucralose (artificial sweetener, C12H19Cl3O8) is proposed as a standard substance for reactor comparison.
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Affiliation(s)
- Olya Keen
- University of North Carolina at Charlotte , The William States Lee College of Engineering , Charlotte, NC , USA
| | - James Bolton
- Bolton Photosciences Inc., 628 Cheriton Cres., NW, Edmonton, AB , T6R 2M5 Alberta , Canada
| | - Marta Litter
- Atomic Energy Commission , Buenos Aires , Argentina
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Wall-Wieler E, Roos LL, Bolton J, Brownell M, Nickel N, Chateau D. Maternal Mental Health after Custody Loss and Death of a Child: A Retrospective Cohort Study Using Linkable Administrative Data. Can J Psychiatry 2018; 63:322-328. [PMID: 29082774 PMCID: PMC5912297 DOI: 10.1177/0706743717738494] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective was to compare mental illness diagnoses and treatment use among mothers who lost custody of their child through involvement with child protection services and those seen in mothers dealing with the death of a child. METHODS We studied mental health outcomes of a cohort of women whose first child was born in Manitoba, Canada between 1 April 1997 and 31 March 2015. Of these women, 5,792 had a child taken into care, and 1,143 mothers experienced the death of a child (<18 y old) before 31 March 2015. Adjusted relative rates (ARR) of 3 mental health diagnoses and 3 mental health treatment use outcomes between these 2 groups were examined. RESULTS Mothers with a child taken into care had significantly greater ARR of depression (ARR = 1.90; 95% CI, 1.82 to 1.98), anxiety (ARR = 2.51; 95% CI, 2.40 to 2.63), substance use (ARR = 8.54; 95% CI, 7.49 to 9.74), physician visits for mental illness (ARR = 3.01; 95% CI, 2.91 to 3.12), and psychotropic medication use (ARR = 4.95; 95% CI, 4.85 to 5.06) in the years after custody loss compared with mothers who experienced the death of a child. CONCLUSION Losing custody of a child to child protection services is associated with significantly worse maternal mental health than experiencing the death of a child. Greater acknowledgement and supportive services should be provided to mothers experiencing the loss of a child through the involvement of child protection services.
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Affiliation(s)
- Elizabeth Wall-Wieler
- 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - James Bolton
- 3 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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Wall-Wieler E, Roos LL, Bolton J. Duration of maternal mental health-related outcomes after an infant's death: A retrospective matched cohort study using linkable administrative data. Depress Anxiety 2018; 35:305-312. [PMID: 29451948 DOI: 10.1002/da.22729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/14/2018] [Accepted: 01/25/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Mothers have increased mental illness such as anxiety and depression after the death of a child. We examine the duration of this worsening of mental health. METHODS The mental health of all mothers who experience the death of an infant (< 1 years old) in Manitoba, Canada between April 1, 1999 and March 31, 2011 (n = 534) is examined in the 4 years leading up to, and the 4 years following, the death of their child. Mental health-related outcomes of these mothers are compared with a matched (3:1) cohort of mothers who did not experience the death of a child (n = 1,602). Three mental health-related outcomes are examined: depression diagnoses, anxiety diagnoses, and use of psychotropic medications. RESULTS Compared with mothers who did not experience the death of a child, mothers experiencing this event had higher rates of anxiety diagnoses and psychotropic prescriptions starting 6 months before the death. Elevated rates of anxiety continued for the first year and elevated rates of psychotropic prescriptions continued for 6 months after the death of the child. Mothers who experienced the death of a child had higher rates of depression diagnoses in the year after the death. Relative rates (RR) of depression (RR = 4.94), anxiety (RR = 2.21), and psychotropic medication use (RR = 3.18) were highest in the 6 months after the child's death. CONCLUSIONS Elevated rates of depression, anxiety, and psychotropic medication use after the death of a child end within 1 year of the child's death.
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Affiliation(s)
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Manitoba, Canada
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Fortier J, Chartier M, Turner S, Murdock N, Turner F, Sareen J, Afifi TO, Katz LY, Brownell M, Bolton J, Elias B, Isaak C, Woodgate R, Jiang D. Adapting and enhancing PAX Good Behavior Game for First Nations communities: a mixed-methods study protocol developed with Swampy Cree Tribal Council communities in Manitoba. BMJ Open 2018; 8:e018454. [PMID: 29449291 PMCID: PMC5829659 DOI: 10.1136/bmjopen-2017-018454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION High rates of mental health problems, such as suicidal behaviours, among First Nations youth in Canada are a major public health concern. The Good Behavior Game (GBG) is a school-based intervention that provides a nurturing environment for children and has been shown to promote positive outcomes. PAX Good Behavior Game (PAX GBG) is an adaptation and enhancement of the GBG. While PAX GBG has been implemented in Indigenous communities, little research exists examining the cultural and contextual appropriateness and effectiveness of the intervention in First Nations communities. METHODS AND ANALYSIS The present paper describes a protocol of the mixed-methods approach guided by an Indigenous ethical engagement model adopted to implement, adapt and evaluate PAX GBG in First Nations communities in Manitoba, Canada. First, implementation outcomes (eg, acceptability, adoption) of PAX GBG will be evaluated using qualitative interviews with teachers, principals and community members from Swampy Cree Tribal Council (SCTC) communities. Second, by linking administrative databases to programme data from schools in 38 First Nations communities, we will compare PAX GBG and control groups to evaluate whether PAX GBG is associated with improved mental health and academic outcomes. Third, the qualitative results will help inform a cultural and contextual adaptation of PAX GBG called First Nations PAX (FN PAX). Fourth, FN PAX will be implemented in a few SCTC communities and evaluated using surveys and qualitative interviews followed by the remaining communities the subsequent year. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Manitoba Health Research Ethics Board and will be obtained from the Health Information Privacy Committee and respective data providers for the administrative database linkages. Dissemination and knowledge translation will include community and stakeholder engagement throughout the research process, reports and presentations for policymakers and community members, presentations at scientific conferences and journal publications.
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Affiliation(s)
- Janique Fortier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Turner
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nora Murdock
- Manitoba First Nations Education Resource Centre, Winnipeg, Canada
| | - Frank Turner
- Cree Nation Tribal Health Centre, Manitoba, Canada
| | - Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laurence Y Katz
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James Bolton
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Brenda Elias
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Corinne Isaak
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Roberta Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Manitoba, Canada
| | - Depeng Jiang
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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48
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Marrie RA, Graff L, Walker JR, Fisk JD, Patten SB, Hitchon CA, Lix LM, Bolton J, Sareen J, Katz A, Berrigan LI, Marriott JJ, Singer A, El-Gabalawy R, Peschken CA, Zarychanski R, Bernstein CN. Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study. JMIR Res Protoc 2018; 7:e15. [PMID: 29343461 PMCID: PMC5792704 DOI: 10.2196/resprot.8794] [Citation(s) in RCA: 33] [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] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood. OBJECTIVE The objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants. METHODS Between November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations. RESULTS The final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001). CONCLUSIONS This paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.
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Affiliation(s)
| | | | | | | | | | | | - Lisa M Lix
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
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49
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Latif A, Chadwick AL, Kitson SJ, Gregson HJ, Sivalingam VN, Bolton J, McVey RJ, Roberts SA, Marshall KM, Williams KJ, Stratford IJ, Crosbie EJ. Monocarboxylate Transporter 1 (MCT1) is an independent prognostic biomarker in endometrial cancer. BMC Clin Pathol 2017; 17:27. [PMID: 29299023 PMCID: PMC5745908 DOI: 10.1186/s12907-017-0067-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/15/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Endometrial cancer (EC) is a major health concern due to its rising incidence. Whilst early stage disease is generally cured by surgery, advanced EC has a poor prognosis with limited treatment options. Altered energy metabolism is a hallmark of malignancy. Cancer cells drive tumour growth through aerobic glycolysis and must export lactate to maintain intracellular pH. The aim of this study was to evaluate the expression of the lactate/proton monocarboxylate transporters MCT1 and MCT4 and their chaperone CD147 in EC, with the ultimate aim of directing future drug development. METHODS MCT1, MCT4 and CD147 expression was examined using immunohistochemical analysis in 90 endometrial tumours and correlated with clinico-pathological characteristics and survival outcomes. RESULTS MCT1 and MCT4 expression was observed in the cytoplasm, the plasma membrane or both locations. CD147 was detected in the plasma membrane and associated with MCT1 (p = 0.003) but not with MCT4 (p = 0.207) expression. High MCT1 expression was associated with reduced overall survival (p = 0.029) and remained statistically significant after adjustment for survival covariates (p = 0.017). CONCLUSION Our data suggest that MCT1 expression is an important marker of poor prognosis in EC. MCT1 inhibition may have potential as a treatment for advanced or recurrent EC.
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Affiliation(s)
- Ayşe Latif
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Amy L. Chadwick
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Level 5 – Research, St Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Sarah J. Kitson
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Level 5 – Research, St Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Hannah J. Gregson
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Level 5 – Research, St Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Vanitha N. Sivalingam
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Level 5 – Research, St Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - James Bolton
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rhona J. McVey
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen A. Roberts
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kay M. Marshall
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kaye J. Williams
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ian J. Stratford
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emma J. Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Level 5 – Research, St Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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50
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Fiest KM, Hitchon CA, Bernstein CN, Peschken CA, Walker JR, Graff LA, Zarychanski R, Abou-Setta A, Patten SB, Sareen J, Bolton J, Marrie RA. Systematic Review and Meta-analysis of Interventions for Depression and Anxiety in Persons With Rheumatoid Arthritis. J Clin Rheumatol 2017; 23:425-434. [PMID: 28221313 PMCID: PMC5704737 DOI: 10.1097/rhu.0000000000000489] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Psychiatric comorbidities, such as depression and anxiety, are very common in persons with rheumatoid arthritis (RA) and can lead to adverse outcomes. By appropriately treating these comorbidities, disease-specific outcomes and quality of life may be improved. OBJECTIVE The aim of this study was to systematically review the literature from controlled trials of treatments for depression and anxiety in persons with RA. METHODS We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled trials conducted in persons with RA and depression or anxiety. Two independent reviewers extracted information including trial and participant characteristics. The standardized mean differences (SMDs) of depression or anxiety scores at postassessment were pooled between treatment and comparison groups, stratified by active versus inactive comparators. RESULTS From 1291 unique abstracts, we included 8 RA trials of depression interventions (6 pharmacological, 1 psychological, 1 both). Pharmacological interventions for depression with inactive comparators (n = 3 trials, 143 participants) did not reduce depressive symptoms (SMD, -0.21; 95% confidence interval [CI], -1.27 to 0.85), although interventions with active comparators (n = 3 trials, 190 participants) did improve depressive symptoms (SMD, -0.79; 95% CI, -1.34 to -0.25). The single psychological trial of depression treatment in RA did not improve depressive symptoms (SMD, -0.44; 95% CI, -0.96 to 0.08). Seven of the trials had an unclear risk of bias. CONCLUSIONS Few trials examining interventions for depression or anxiety in adults with RA exist, and the level of evidence is low to moderate because of the risk of bias and small number of trials.
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Affiliation(s)
- Kirsten M. Fiest
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol A. Hitchon
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N. Bernstein
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine A. Peschken
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R. Walker
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A. Graff
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed Abou-Setta
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott B. Patten
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- From the Departments of *Internal Medicine and †Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, and ‡George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, Manitoba, Canada; §Departments of Community Health Sciences and ∥Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and ¶Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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