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Allen V, Mahieu A, Kasireddy E, Shouman W, Pourrahmat MM, Collet JP, Cherkas A. Humanistic burden of pediatric type 1 diabetes on children and informal caregivers: systematic literature reviews. Diabetol Metab Syndr 2024; 16:73. [PMID: 38515123 PMCID: PMC10956250 DOI: 10.1186/s13098-024-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Diagnosis of children with type 1 diabetes (T1D) imposes an unprecedented burden on children and their caregivers. OBJECTIVE To assess the burden of T1D on children and their informal caregivers, both after a recent diagnosis or after a longer duration of disease. METHODS A series of systematic literature reviews were performed to explore the burden of T1D on children with the disease and their primary informal caregivers, based on the time of diagnosis. After the extraction of the qualitative and quantitative data from the included studies, two literature-based conceptual frameworks were developed: on the burden of pediatric T1D on children, and on informal caregivers. A third conceptual framework on the shared burden of pediatric T1D on both children and informal caregivers as part of the same family unit was also developed. RESULTS The review of literature has identified a series of factors that affect the quality of life of children with T1D and their informal caregivers, with a direct impact on physical, emotional, and social outcomes. Generally, female patients and older adolescents experience more worry and stress that affects their quality of life. Other categories of factors affecting the child's and caregiver's burden include social, emotional, and physical factors, treatment-related and disease-related factors, as well as their coping abilities. Anxiety, depression, stress, and worry were commonly found among children and caregivers, starting with the diagnosis of T1D and continuing over time in relation to new challenges pertaining to aging or the disease duration. CONCLUSION T1D causes a significant burden to affected children and their caregivers, both independently and through transactional interaction within the family unit. Disease burden can be reduced by strengthening individuals for the benefit of the whole family.
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Affiliation(s)
| | | | | | - Walid Shouman
- Evidinno Outcomes Research Inc., Vancouver, BC, Canada
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Wang Q, Collet JP, Mei J, Chen G, Huang S, Yang Y, Wang W, Ding F. Complex interactive multimodal intervention to improve personalized stress management among healthcare workers in China: A knowledge translation protocol. Digit Health 2023; 9:20552076231184052. [PMID: 37545629 PMCID: PMC10399255 DOI: 10.1177/20552076231184052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/07/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives Numerous stress management interventions have been implemented in the workplace, but few are adapted to the healthcare setting. Due to the nature of their jobs, healthcare workers (HCWs) may find it difficult to adopt recommended stress management strategies. We present the protocol for a 12-week personalized stress management intervention among HCWs to change their behavior as well as improve physiological/psychological outcomes. Methods It is a pragmatic quasi-experimental study involving stressed HCWs from two general hospitals in Wuhan, China. The intervention group will receive a complex interactive multimodal intervention, including advanced education via mobile connection, participation in a web-based social network, tailored feedback, and the support of a nurse coach, while the control group will engage in self-guided stress management. Results The primary outcome is centered on behavioral measures, namely improvements in stress management practice frequency after a 12-week intervention. The secondary outcomes are the changes in stress-related physiological indices (i.e. high frequency variability and normalized unit assessed by Holter) and psychological indicators (scores on the Perceived Stress Scale and Depression, Anxiety, Stress Scale) following 12 weeks of treatment. Conclusion The knowledge translation intervention builds on a body of work defining the role of individualized instruction and feedback intervention, as well as group intervention through WeChat social network and personalized coaching. We believe this novel intervention will help HCWs promote their stress management awareness and skills, and ultimately benefit their long-term health. Trial Registration ClinicalTrials.gov., NCT05239065. Registered 14 February 2022-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05239065.
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Affiliation(s)
- Quan Wang
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Nursing College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jean-Paul Collet
- UBC Department of Pediatrics and Children's Hospital Research Institute, Vancouver, Canada
| | - Junhua Mei
- Department of Neurology, The First Hospital of Wuhan City, Wuhan, China
| | - Guohua Chen
- Department of Neurology, The First Hospital of Wuhan City, Wuhan, China
| | - Sufang Huang
- Nursing College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengfei Ding
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Guedeney P, Mesnier J, Michel M, Hauguel-Moreau M, Silvain J, Houde C, Alperi A, Panagides V, Collet JP, Wallet T, Rouanet S, Hammoudi N, Rodes-Cabau J, Montalescot G. Outcomes following patent foramen ovale percutaneous closure according to the delay from last ischemic event. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Randomized controlled trials evaluating patent foramen ovale (PFO) percutaneous closure only included patients with recent embolic event. We aimed to evaluate outcomes following percutaneous PFO closure outcomes according to the delay from the last embolic episode.
Methods
This international ambispective cohort included consecutive patients from two centers in France and Canada undergoing PFO percutaneous closure for secondary prevention of paradoxical embolic event. The primary endpoint was the composite of stroke or transient ischemic attack (TIA). Logistic regression model was used to evaluate determinants of late PFO closure procedures.
Results
A total of 1,179 patients (mean age 49±12.7 years; 44.4% female) underwent PFO closure from 2001 to 2021 (Figure 1). The median delay from last embolic event to procedure was 6.0 (3.4–11.2) months. Determinants of late PFO closure procedure were the center (France versus Canada) adjusted Odds Ratio (aOR) 1.65 95% confidence interval (CI) 1.25–2.19, year of procedure (≥2018 versus <2018) aOR 1.43 95% CI 1.08–1.90, female sex aOR 1.63 95% CI 1.28–2.07 and lower RoPE score aOR 1.10 95% CI 1.03–1.19. After a median follow-up of 2.61 (1.13–7.25) years, the incidence rate of first stroke or TIA did not differ between early and late PFO procedures with 0.51 versus 0.29 events per 100 patient-years, respectively, incidence rate ratio 1.74 95% CI 0.66–5.08, p=0.25 (Figure 2). In univariate analysis, late PFO percutaneous closure was not associated with the occurrence of stroke or TIA, with hazard ratio 0.54 95% CI 0.22–1.34 p=0.17.
Conclusion
This analysis provides indirect evidence that delay from last ischemic event does not impact outcomes following PFO percutaneous closure for secondary prevention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - J Mesnier
- Quebec Heart and Lung Institute , Quebec , Canada
| | - M Michel
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, Cardiology , Boulogne Billancourt , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - C Houde
- Hospital Affiliated with the University of Quebec , Quebec , Canada
| | - A Alperi
- Quebec Heart and Lung Institute , Quebec , Canada
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - T Wallet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | | | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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Zeitouni M, Sulman D, Silvain J, Kerneis M, Guedeney P, Barthelemy O, Procopi N, Collet JP, Montalescot G. Have the ESC guidelines improved the identification and prevention of individuals at risk of premature myocardial infarction? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Over the last 20 years, the proportion of young patients admitted for MI has increased. It is unknown whether the 5-year changes in ESC/EAS guidelines and the new SCORE2 can improve the detection and treatment of individuals at risk of premature MI.
Purpose
To determine how consecutive changes in the ESC/EAS guidelines affected the identification and treatment of young adults premature STEMI.
Methods
Patients admitted for a first STEMI in the ePARIS between 2010 and 2018 were included (n=2757) and stratified by age categories (<55 y-o; 55–65 y-o; >65 y-o). Using baseline characteristics, we evaluated whether patients in each age group would have been detected as high risk and treated with primary prevention statins before their first STEMI based on the 2021 EAS/ESC guidelines versus 2019 and 2016 guidelines (class I, IIA and IIB recommandations). Eligibility for intensive lipid-lowering therapy in secondary prevention according to age was also assessed.
Results
Among the 2757 individuals admitted for a first STEMI, 1253 (45,7%) were <55 y.o, 633 (22.9%) were [55–65] and 871 (31.4%) were >65. Only 17% and 18% of young individuals would have been considered as high risk and eligible for primary prevention statins prior to their first STEMI according to 2016 and 2019 EAS/ESC guidelines respectively, compared with individuals aged 55–65 years (41% and 35%) and >65 years old (21% and 72%), p<0.01. Following 2021 ESC guidelines, 62.5% of individuals aged <55 y.o would have been detected as eligible for primary prevention statins, without difference with individuals aged 55 to 65 years old (61.7%) and >65 y.o (62.1%) (figure). At discharge, based on the expected reduction of baseline LDL-C with maximal dose statins and ezetimibe, 47% of patients with premature STEMI would be eligible for PCSK9i compared with 50% and 37% in individuals aged 55–65 y-o and >65 y-o, respectively.
Conclusions
While 2016 and 2019 ESC guidelines poorly detected young individuals at risk of premature MI, the 2021 ESC guidelines using the new SCORE2 allowed a much better detection of young individuals at risk for a first STEMI. Young patients were also more likely to be eligible for intensive lipid-lowering therapy after their first premature STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere , Paris , France
| | - D Sulman
- Hospital Pitie-Salpetriere , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere , Paris , France
| | - M Kerneis
- Hospital Pitie-Salpetriere , Paris , France
| | - P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | | | - N Procopi
- Hospital Pitie-Salpetriere , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere , Paris , France
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Guedeney P, Roule V, Mesnier J, Chapelle C, Portal JJ, Laporte S, Ollier E, Zeitouni M, Kerneis M, Barthelemy O, Sorrentino S, Silvain J, Vicaut E, Montalescot G, Collet JP. Comparison of the safety and efficacy of antithrombotic regimens following TAVR in patients without having an indication for chronic oral anticoagulation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
To compare the safety and efficacy of antithrombotic regimens following transcatheter aortic valve replacement (TAVR) in patients without having an indication for chronic oral anticoagulation
Methods and results
We conducted a Prospero-registered systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVR antithrombotic regimens up to March 2021. We estimated the relative risk and 95% confidence intervals using a fixed effect model in a frequentist pairwise and network metanalytic approach. We included 6 studies comprising of 3,777 patients with a mean weighted follow-up of 13.3 months. Single antiplatelet therapy (SAPT) was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95% confidence interval [CI]: 0.28–0.69), apixaban (RR: 0.47, 95% CI 0.26–0.84) and low-dose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI: 0.16–0.57). Risk of all-cause death was significantly reduced with DAPT compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI: 0.41–0.88) and a consistent reduction was observed with SAPT and DAPT compared to apixaban (RR: 0.60, 95% CI: 0.31–1.16 and RR: 0.58, 95% CI: 0.32–1.04, respectively). There were no differences between the various regimens with respect to myocardial infarction and stroke. Apixaban significantly reduced the risk of pulmonary embolism, valve thrombosis and grade 3 or 4 reduced leaflet motion.
Conclusion
Following TAVR in patients without an indication for chronic oral anticoagulant, SAPT was associated with the lowest risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - V Roule
- University Hospital of Caen, Department of Cardiology , Caen , France
| | - J Mesnier
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Cardiology , Paris , France
| | - C Chapelle
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - J J Portal
- Lariboisiere APHP Site of Saint Louis University Hospital, Unité de Recherche Clinique , Paris , France
| | - S Laporte
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - E Ollier
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere , Paris , France
| | - M Kerneis
- Hospital Pitie-Salpetriere , Paris , France
| | | | - S Sorrentino
- Magna Graecia University of Catanzaro, Cardiology , Catanzaro , Italy
| | - J Silvain
- Hospital Pitie-Salpetriere , Paris , France
| | - E Vicaut
- Lariboisiere APHP Site of Saint Louis University Hospital, Unité de Recherche Clinique , Paris , France
| | | | - J P Collet
- Hospital Pitie-Salpetriere , Paris , France
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Alamowitch S, Sabben C, Deltour S, Benyounes N, Obadia M, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patients-reported symptomatic episodes, thus true incidence and timing of AF after PFO closure remain unknown.
Objective
To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring.
Methods
Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model.
Results
A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2).
Conclusion
Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Laredo
- Hospital Pitie-Salpetriere , Paris , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, cardiology , Boulogne Billancourt , France
| | - T Wallet
- Hospital Pitie-Salpetriere , Paris , France
| | | | - C Sabben
- Fondation Rothschild, Neurology , Paris , France
| | - S Deltour
- Hopital Raymond Poincare, Neurology , Garches , France
| | - N Benyounes
- Fondation Rothschild, Cardiology , Paris , France
| | - M Obadia
- Fondation Rothschild, Neurology , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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Chakraborti M, Gitimoghaddam M, McKellin WH, Miller AR, Collet JP. Understanding the Implications of Peer Support for Families of Children With Neurodevelopmental and Intellectual Disabilities: A Scoping Review. Front Public Health 2021; 9:719640. [PMID: 34888278 PMCID: PMC8649771 DOI: 10.3389/fpubh.2021.719640] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Families are integrally involved in day-to-day caregiving of children with neurodevelopmental and intellectual disabilities (NDID). Given the widespread and increasing prevalence of children with NDID and the impact of family caregiving on psychological, social, and economic implications for both the child and family, understanding and supporting these families is an important public health concern. Objective: We conducted a scoping review on peer support networks to understand their implications on families. Considering increasing prevalence of NDID's, understanding the implications of existing networks is critical to improve and nurture future support networks that can complement and reduce the burden on existing formal support systems. Design: A comprehensive search of multiple databases was conducted. Articles were screened by two reviewers and any disagreements were resolved by a third reviewer. We explored existing research on parent-to-parent peer support networks, which included networks that developed informally as well as those that involved a formal facilitator for the group interpersonal processes. There were no limits on the study design, date and setting of the articles. We included all research studies in English that included an identifier for (i) "peer support networks," (ii) "children with neurodevelopmental and intellectual disabilities" and (iii) "family caregiver outcomes." Results: We identified 36 articles. Majority of the studies were conducted in North America, and were face to face networks. They included families of children with a wide range of NDIDs. Relevant information extracted from different studies highlighted peer support network characteristics and development process, needs of family caregivers attending these networks, factors affecting caregiver participation and the impact of peer support networks on family caregivers. These networks represent a way to strengthen family caregivers, developing resilience and social interactions. Family caregivers sharing similar experiences support one another and provide critical information to each other. Although results are encouraging, future studies incorporating improved study designs are needed to better evaluate the effectiveness of peer support networks. Furthermore, studies where peer support networks develop organically while the child is supported are warranted. Conclusion: Although results obtained are encouraging, our findings support the need for further research studies of peer support networks with better designs and more detailed description of the factors involved in the development.
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Affiliation(s)
- Michelle Chakraborti
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mojgan Gitimoghaddam
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William H. McKellin
- Department of Anthropology, University of British Columbia, Vancouver, BC, Canada
| | - Anton Rodney Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Kazi AM, Ahsan N, Jamal S, Khan A, Mughis W, Allana R, Kazi AN, Kalimuddin H, Ali SA, McKellin W, Collet JP. Characteristics of mobile phone access and usage among caregivers in Pakistan - A mHealth survey of urban and rural population. Int J Med Inform 2021; 156:104600. [PMID: 34638012 DOI: 10.1016/j.ijmedinf.2021.104600] [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: 04/05/2021] [Revised: 09/02/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Globally mobile ownership and access is becoming very common, and breakthroughs in mobile technology have shaped digital communication, with 7 billion mobile phone users globally. Developing countries account for 80% of newly purchased mobile phone devices with majority of such countries having low Routine Immunization coverage and a high risk of vaccine preventable diseases. The use of mobile phones provides a tremendous potential for public health involvement. OBJECTIVE The aim of this study is to assess the acceptability and usability of mobile phones among infant caregivers in a LMIC setup and to explore the role of mHealth to improve immunization uptake and coverage. METHODS This is a cross-sectional survey exploring the regional differences in mobile phone ownership, usability and preferences, along with level of trust with others while sharing a mobile phone. The study was conducted with caregivers of infants in an urban and rural sites of Pakistan. RESULTS A total of 4472 households were approached, of which 3337 participants were eligible for the study (74.61 %). The reasons for not participating in the study (n = 1135) included (i) household locked or refusal to participate for 594 families (52%), (ii) child older than 14 days of life in 409 cases (36%), (iii) 80 (7%) families did not have access to a functional mobile phone, (iv) 36 (3%)families did not provide a mobile phone number, and (v) 14 (1%) could not stay within the HDSS for 6 months. Access to mobile phone with SMS features was considerably high at both sites: 99.1% in Matiari (rural site) and 96.7% in Karachi (urban). In Matiari 96.6% of the respondents reported having daily access to the phone, contrasting with only 51.4% in Karachi. In Karachi, the predominant spoken language was Urdu, whereas majority of the respondents in Matiari spoke Sindhi (34.6% vs. 70.9%). CONCLUSION Our study indicates high access to mobile phone in both urban and rural setup, However access to smart phone is still limited, urban and rural setup. Further, the acceptance of overall health- and barrier-based child immunization messages through mobile phone were quite high in both settings. Lastly automated calls were preferred over SMS due to literacy and local settings. This bears important implications for improving child immunization uptake through mobile phones in developing regions such as Pakistan.
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Affiliation(s)
- Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Department of Experimental Medicine, University of British Columbia, Graduate and Postdoctoral Studies 170-6371 Crescent Road Vancouver, BC, V6T 1Z2, Canada.
| | - Nazia Ahsan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Saima Jamal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Ayub Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Waliyah Mughis
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Raheel Allana
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Abdul Nafey Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Hussain Kalimuddin
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Syed Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - William McKellin
- Department of Anthropology, University of British Columbia, Vancouver, BC, Canada.
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
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Kwan C, Gitimoghaddam M, Collet JP. Effects of Social Isolation and Loneliness in Children with Neurodevelopmental Disabilities: A Scoping Review. Brain Sci 2020; 10:E786. [PMID: 33126519 PMCID: PMC7693393 DOI: 10.3390/brainsci10110786] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 12/28/2022] Open
Abstract
Loneliness and social isolation have negative consequences on physical and mental health in both adult and pediatric populations. Children with neurodevelopmental disabilities (NDD) are often excluded and experience more loneliness than their typically developing peers. This scoping review aims to identify the type of studies conducted in children with NDD to determine the effects of loneliness and/or social isolation. Three electronic databases (Ovid MEDLINE, EMBASE, PsychINFO) were searched from inception until 5 February 2019. Two independent reviewers screened the citations for inclusion and extracted data from the included articles. Quantitative (i.e., frequency analysis) and qualitative analyses (i.e., content analysis) were completed. From our search, 5768 citations were screened, 29 were read in full, and 12 were included. Ten were case-control comparisons with cross-sectional assessment of various outcomes, which limited inference. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and learning disorder were the most commonly studied NDD. This review showed that loneliness among children with NDD was associated with negative consequences on mental health, behaviour, and psychosocial/emotional development, with a likely long-term impact in adulthood. Lack of research in this area suggests that loneliness is not yet considered a problem in children with NDD. More studies are warranted using prospective designs and a larger sample size with a focus on the dynamic aspect of loneliness development.
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Affiliation(s)
- Celia Kwan
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (C.K.); (M.G.)
| | - Mojgan Gitimoghaddam
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (C.K.); (M.G.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (C.K.); (M.G.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
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10
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Fazeli MS, Pourrahmat MM, Massah G, Lee K, Lavoie PM, Fazeli M, Esser A, Collet JP. The Effect of Massage on the Cardiac Autonomic Nervous System and Markers of Inflammation in Night Shift Workers: a Pilot Randomized Crossover Trial. Int J Ther Massage Bodywork 2020; 13:6-17. [PMID: 32922577 PMCID: PMC7454237] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Shift work is a necessary part of many industries; however, it can have detrimental effects on health over time. PURPOSE This study investigated the effect of a massage intervention on the cardiac autonomic activity and blood inflammatory markers of healthy medical residents working night shifts. SETTING This trial was conducted at British Columbia Children's and Women's Hospital between February 2014 and June 2016. PARTICIPANTS Included participants were generally healthy medical residents and were working rotating night shifts on a regular basis. RESEARCH DESIGN This was a randomized, controlled, crossover, open-label trial (NCT02247089). INTERVENTIONS Participants received either a 30-min massage intervention or reading control after consecutive periods of night shift. MAIN OUTCOME MEASURES The primary outcome was high frequency, a proxy for the cardiac parasympathetic activity, measured via heart rate variability. Secondary outcomes included other heart rate variability measures, blood markers of inflammation, and blood pressure. RESULTS Twelve participants were recruited (nine female) with median age of 28 years. There was no significant difference between the massage intervention and the reading control for the primary outcome, (median relative change between pre- and postmassage [interquartile range]: 62% [-1 to 150], pre- and postreading: 14% [-10 to 51], p = .16). Similarly, there was no difference with respect to blood inflammatory markers and blood pressure. Median high frequency significantly increased between pre- and postmassage (185 vs. 358 ms2, p = .04). CONCLUSION This pilot study found no statistically significant difference between the massage intervention and the reading control; however, we did observe a significant increase in median high frequency from before massage to after massage, indicative of increased parasympathetic activity. This study may help inform planning of larger trials evaluating massage interventions on the activity of the autonomic nervous system and managing shift work stress.
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Affiliation(s)
- Mir Sohail Fazeli
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Evidinno Outcomes Research Inc., Vancouver, Canada
| | - Mir-Masoud Pourrahmat
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Evidinno Outcomes Research Inc., Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Golshan Massah
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kelsey Lee
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Pascal M. Lavoie
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Mirfarhang Fazeli
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Alison Esser
- Vancouver College of Massage Therapy, Vancouver, Canada
| | - Jean-Paul Collet
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada,Beijing Tiantan Hospital, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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11
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Zhao M, Guan L, Collet JP, Wang Y. Relationship between ischemic stroke locations, etiology subtypes, neurological outcomes, and autonomic cardiac function. Neurol Res 2020; 42:630-639. [PMID: 32701421 DOI: 10.1080/01616412.2020.1782103] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Post-stroke autonomic nervous dysfunction measured with heart rate variability (HRV) is correlated with the traditional risk factors and poor outcome. This study aimed to investigate the association between HRV and infarct locations, etiology subtypes, and neurological functional outcomes in patients with acute ischemic stroke (AIS). METHODS In this prospective observational study, 186 consecutive patients were assigned to four major stroke severity categories based on the National Institutes of Health Stroke Scale score (NIHSS) and the modified Rankin Scale score (mRS): mild (NIHSS 0-4) stroke, moderate (NIHSS 5-14) stroke, 'favorable' (mRS 0-2) group, and 'unfavorable' (mRS 3-5) group. HRV time domain parameters were applied to evaluate the autonomic function of patients within 1 week after admission. All patients were classified into different etiology subtypes based on the TOAST (modified Trial of ORG 10172 in Acute Stroke Treatment) classification. The association of HRV with stroke location, etiology subtypes, neurological outcome was explored for all participants. Univariate and multivariate analyses were applied to explore the prediction value of HRV. RESULTS 160 participants had large artery atherosclerotic infarction (LAA), 61 had right internal carotid artery system infarction (R-ICA), and 61 had vertebrobasilar artery system infarction (VB). Root-mean-square of differences (RMSSD) of adjacent RR intervals and the proportion calculated by dividing the interbeat interval differences >50 ms (pNN50) in patients of VB group was significantly lower than those of patients in R-ICA group (P < 0.01). HRV parameters in the LAA group was significantly lower than non-LAA group (P < 0.01). At discharge, significant lower HRV presented in the unfavorable group and moderate group (P < 0.05). After logistic univariate and multivariate analysis, lower SDNN (OR = 1.019; 95% CI = 1.003-1.035; p= 0.021) was independently associated with unfavorable mRS and higher NIHSS at discharge (OR = 1.013; 95%CI = 1.003-1.024; p= 0.015). Only SDNN showed predictive value for mRS≥3 (OR = 1.012; 95%CI = 1.002-1.022; p= 0.016) at 1 year. CONCLUSIONS HRV measured after admission is related to the AIS infarction basin, TOAST subtypes, and neurological outcomes at discharge suggesting a possible role for HRV in evaluating AIS and identifying high-risk patients.
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Affiliation(s)
- Mengxi Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Ling Guan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Neurological Diseases , Beijing, China
| | - Jean-Paul Collet
- Department of Medicine, BC Children's Hospital Research Institute, University of British Columbia , Vancouver, Canada.,Advanced Innovation Center for Human Brain Protection, Capital Medical University , Beijing, China
| | - Yilong Wang
- Advanced Innovation Center for Human Brain Protection, Capital Medical University , Beijing, China.,Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
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12
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Fazeli MS, Pourrahmat MM, Collet JP, Afshar K. The effects of antimuscarinic agents on the activity of the cardiac autonomic nervous system in children with functional overactive bladder. J Pediatr Urol 2019; 15:642.e1-642.e6. [PMID: 31526515 DOI: 10.1016/j.jpurol.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Functional overactive bladder disorder is one of the most prevalent presentations of bladder and bowel dysfunction in children, and it is associated with lower overall cardiac autonomic and parasympathetic activity. Antimuscarinics are the most frequently used pharmacological agents for treatment of children with functional overactive bladder disorder; however, there is a gap in the literature in describing the effect of antimuscarinics on the autonomic profile of this population. OBJECTIVE The aim of the study was to assess the cardiac parasympathetic activity before and after 12 weeks of oxybutynin treatment in children with overactive bladder. METHODS This was a single-institution prospective cohort study. Cardiac autonomic activity was assessed during storage and voiding phases of the bladder function via spectral analysis of heart rate variability and impedance cardiography. The primary outcome measure was high frequency, a proxy for parasympathetic nervous system activity. Parameters of uroflow study, severity of symptoms, and quality of life outcomes were also assessed. RESULTS Ten children (7 females) diagnosed with overactive bladder with a median age of 10 years (range = 6-14) were followed up for a median treatment duration of 11.8 weeks (range = 6-19.4). After treatment, there was a significant reduction in high frequency during the storage phase (median change = -24.17%, p = 0.047). No change was observed in the other outcome measures except for the overall Symptom Score for Dysfunctional Elimination Syndrome after treatment (5-point decrease, p = 0.034) (Summary Table). DISCUSSION The findings of the present follow-up study suggest that the use of oxybutynin in children with overactive bladder is associated with a significant reduction in the activity of the parasympathetic nervous system. The clinical implications of this finding are important because similar autonomic profiles (as markers of chronic stress) have been shown to be associated with increased inflammation and are found in major chronic diseases. The authors caution making a clinical connection between the heart rate variability profile of the patients in this study and patients with chronic diseases because oxybutynin is usually not administered as long-term treatment for overactive bladder. CONCLUSION Use of oxybutynin was associated with reduction in cardiac parasympathetic activity of children with functional overactive bladder. Further investigation into the role of the autonomic nervous system as a treatment target in the management of these children is warranted.
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Affiliation(s)
- Mir Sohail Fazeli
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Evidinno Outcomes Research Inc, Vancouver, Canada
| | - Mir-Masoud Pourrahmat
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jean-Paul Collet
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Beijing Tiantan Hospital, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Kourosh Afshar
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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13
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Lattuca B, Bouziri N, Portal JJ, Zhou J, Zeitouni M, Kerneis M, Guedeney P, Legrand L, Hammoudi N, Isnard R, Pousset F, Collet JP, Vicaut E, Montalescot G, Silvain J. P6454Antithrombotic therapy and cardiovascular events in patients with left ventricular thrombus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left Ventricular Thrombus (LVT) is associated with a high risk of thromboembolic complications such as stroke. Contemporary data are lacking on the management, prognosis and treatment of LVT, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs).
Purpose
To study the time and predictive factors associated with thrombus regression on treatment and its association with survival, embolic and bleeding complications.
Methods
From January 2011 to January 2018, a computerized case sensitive search of LVT was performed on 90 065 consecutive echocardiogram reports. All patients with a confirmed LVT were included in this analysis after imaging review by two independent experts. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. Major adverse cardiac events (MACE), defined as the composite of death, ischemic stroke or transient ischemic attack (TIA), myocardial infarction (MI) or embolic peripheral artery occlusion were analyzed as well as major bleeding events (BARC ≥3) and the predictive factors and impact of LVT regression.
Results
We identified 174 patients with a suspected LVT of whom 159 had confirmed LVT on two different cardiac imaging exams. Ischemic cardiomyopathy was the main cause of LVT (n=125, 78.6%) including 56 (35.2%) patients with an acute ST segment elevation MI. The mean left ventricular ejection fraction was 31.9±12.5% with predominant (98.1%) apical location of the LVT.
Anticoagulation therapy was achieved with vitamin K antagonists, NOACs and parenteral heparins in 48.7%, 22.8% and 27.8% of patients, respectively. Concomitant antiplatelet therapy was prescribed in 67.9% of patients. Total LVT regression was reached in two third of patients (62.3%, n=99) within a median time of 103 [32–392] days. Independent predictors of total LVT regression were an ischemic cardiomyopathy (HR: 0.36 [0.19–0.70], p=0.002), a larger baseline thrombus area (HR=0.66 [0.45–0.96], p<0.031) and a prolonged anticoagulation therapy over 3 months (HR=0.11 [0.05–0.22], p<0.0001).
During a median follow-up of 632 [187–1126] days, MACE occurred in 59 (37.1%) patients with a 18.9% rate of mortality and 13.2% of major bleeding. Patients with a total LVT regression had a non-significant lower rate of MACE as compared with patients without total LVT regression (35.4% vs. 40.0%; HR=0.71 [0.42–1.21]; p=0.20), and a significant lower rate of mortality (15.2% vs. 25.0%; HR=0.48 [0.23–0.98]; p=0.039).
Occurence of mortality (A) and MACE (B)
Conclusions
The prognosis of LVT remains severe with a high risk of major cardiovascular event and mortality. Total LVT regression, mostly reached in 3 months, can be obtained with both vitamin K antagonists and NOACs and is associated with a better prognosis.
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Affiliation(s)
- B Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - N Bouziri
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J J Portal
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital (APHP), Paris, France
| | - J Zhou
- Information system department, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - M Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - M Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - P Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - L Legrand
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - N Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - R Isnard
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - F Pousset
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J P Collet
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - E Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital (APHP), Paris, France
| | - G Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
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14
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Guedeney P, Sorrentino S, Giustino G, Chapelle C, Claessen B, Ollier E, Laporte S, Camaj A, Kalkman DN, Vogel B, De Rosa S, Indolfi C, Collet JP, Mehran R, Montalescot G. P5367Indirect comparison of the safety and efficacy of alirocumab and evolocumab: from a comprehensive meta-analysis of 30 randomized controlled trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/14/2022] Open
Abstract
Abstract
Background
Alirocumab and evolocumab, two proprotein convertase subtilisin–kexin type 9 inhibitors, have both been associated with improved outcomes in patients with atherosclerotic cardiovascular disease in addition to standard lipid-lowering therapies. However, their comparative safety and efficacy profiles are unknown.
Purpose
To compare the safety and efficacy of alirocumab versus evolocumab.
Methods
We conducted a systematic review and network meta-analysis of placebo-controlled randomized trials available up to November 2018 evaluating the safety and efficacy of alirocumab and evolocumab. We estimated risk ratio and 95% confidence intervals using fixed effect model in a frequentist pairwise and network metanalytic approach. The primary safety endpoints were any adverse events leading to treatment-discontinuation, injection site reaction, systemic allergic reaction, neurocognitive events, ophthalmologic events and new-onset of diabetes mellitus (DM) or worsening of pre-existing DM. The primary efficacy endpoints were all-cause and cardiovascular (CV) death, myocardial infarction (MI) and stroke. This study was registered in PROSPERO (CRD42018090768).
Results
A total of 30 trials, enrolling 59,026 patients were included in this analysis, of whom 13,607 received alirocumab and 17,931 received evolocumab. Mean weighted follow-up time was 2.5 years, with an exposure time of 144,907 patients-years. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. There were no significant differences between alirocumab and evolocumab in terms of safety endpoints, except for injection site reaction with a 27% increased risk of injection site reaction with alirocumab compared to evolocumab (Figure). Compared with evolocumab, alirocumab was associated with a reduction of all-cause death but not CV death. There were no significant differences in MI or stroke between alirocumab and evolocumab.
Conclusion
Alirocumab and evolocumab share a similar safety profile. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to heterogeneity of the studied populations between the two drugs.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - S Sorrentino
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - G Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - C Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - B Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - E Ollier
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - S Laporte
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - A Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - D N Kalkman
- University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, Netherlands (The)
| | - B Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - S De Rosa
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
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15
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Guedeney P, Huchet F, Manigold F, Rouanet S, Vicaut E, Balagny P, Leprince P, Lebreton G, Letocart V, Barthelemy O, Montalescot G, Guerin P, Collet JP. P3855Incidence, risk factors and impact of readmission for heart failure after successful transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Incidence and correlates of readmission for heart failure in all-comers, after successful transcatheter aortic valve replacement (TAVR) remain unclear.
Objective
We sought to evaluate the incidence, risk factors and clinical impact of readmission for HF after successful TAVR in an unselected patient population.
Methods
All patients who underwent successful TAVR in two high-volume French tertiary centers from February 2010 to December 2016 were prospectively included and followed-up for one year. Cox multivariate model was used to assess risk factors of readmission for heart failure, evaluated a time-updated covariate and mortality.
Results
A total of 1139 patients (mean age 82.4±7.7 years, 52.2% male) were included. Readmission for heart failure occurred in 99 (8.7%) patients. Risk factors of readmission for HF were chronic pulmonary disease (adjHR 1.8; 95% CI [1.2–2.8], p=0.008), chronic kidney disease (adjHR 1.7; 95% CI [1.1–2.6], p=0.01), diabetes mellitus (adjHR 1.7; 95% CI [1.1–2.5], p=0.01), prior atrial fibrillation (adjHR 1.6; 95% CI [1.1–2.4], p=0.02) and post-TAVR left ventricular ejection fraction (LVEF) ≤35% (adjHR 2.1 95% CI 1.2–3.7, p=0.009). Readmission for HF was strongly associated with mortality (Figure) along with increased STS score (adjHR 1.07 95% CI 1.03–1.12, p=0.002), prior atrial fibrillation (adjHR 2.13 95% CI 1.53–2.96, p<0.001) and shock during the index hospitalization (adjHR 2.68 95% CI 1.48–4.87, p=0.001).
Figure 1
Conclusion
Readmission for heart failure occurs in one out of ten patients after successful TAVR and is strong risk factor of mortality. Comorbidities and post-TAVR LVEF≤35% are the main correlates of readmission for heart failure.
Acknowledgement/Funding
ACTION study group
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - F Huchet
- University Hospital of Nantes, Cardiology, Nantes, France
| | - F Manigold
- University Hospital of Nantes, Cardiology, Nantes, France
| | - S Rouanet
- StatEthic, Statistician unit, Levallois Perret, France
| | - E Vicaut
- Action study group, Unité de recherche Clinique, Hôpital Lariboisière, Paris, France
| | - P Balagny
- Hospital Pitie-Salpetriere, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Cardiac Surgery, Paris, France
| | - G Lebreton
- Hospital Pitie-Salpetriere, Cardiac Surgery, Paris, France
| | - V Letocart
- University Hospital of Nantes, Cardiology, Nantes, France
| | | | | | - P Guerin
- University Hospital of Nantes, Cardiology, Nantes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
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16
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Danchin N, Puymirat E, Ducrocq G, Henry P, Collet JP, Genee O, Joseph T, Belle L, Naccache N, Ferrieres J, Schiele F, Simon T. P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperglycemia is a well-known prognostic marker in patients with acute myocardial infarction (AMI), associated with higher mortality compared with normoglycemia. Whether the prognostic impact of glycemic status at the acute stage of AMI is similar in patients with chronic dysglycemia has not been extensively explored.
Aims and methods
Using data from the nationwide French FAST-MI cohorts (2005, 2010 and 2015), we analysed the association between glycemia at entry and 30-day death, according to HbA1c level. From the 13,130 patients included, 5,452 had both glycemia and HbA1c assessed at entry. Of those, 1173 (21.5%) had an HbA1c ≥7%.
Results
In patients with HbA1c <7%, LVEF was inversely correlated with glycemic levels (55±11% for glycemia <100, 52±11% for glycemia 100–140, 50±12% for glycemia 140–160 and 49±12% for glycemia >180 mg/dl); a graded association between admission glycemia and 30-day mortality was observed, ranging from 0.7% in normoglycemic patients to 6.3% in patients with admission glycemia >180 mg/dl. In contrast, in patients with HbA1c ≥7%, LVEF was not correlated with glycemia (<100 mg/dl: 49±14%, >180 mg/dl 49±12%), and mortality was the highest in patients with normoglycemia (9.2%) and the lowest in patients with glycemia between 140 and 180 mg/dl (3.1%) (Figure). In multivariate analyses adjusting for baseline characteristics and early management, normoglycemia was associated with a decreased risk of 30-day mortality in patients with HbA1c <7% (HR 0.27, 95% confidence interval 0.10–0.73, P=0.01), while it was associated with a two-fold increase in mortality in patients with HbA1c ≥7% (HR 2.49, 95% confidence interval 1.02–6.09, P=0.046).
Figure 1. 30-day death
Conclusion
In AMI patients with high HbA1c levels on admission, normoglycemia is associated with higher early mortality than hyperglycemia. In contrast, a graded correlation is observed between admission glycemia and early mortality in patients with HbA1c <7%. Management of glycemia at the acute stage of MI might require different measures according to the initial HbA1c level.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Henry
- Hospital Lariboisiere, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - O Genee
- Clinique de la Reine Blanche, Orleans, France
| | - T Joseph
- Centre Hospitalier, Quimper, France
| | - L Belle
- Hospital of Annecy, Annecy, France
| | - N Naccache
- French Society of Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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17
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Zeitouni M, Barthelemy O, Rouanet S, Guedeney P, Hauguel-Moreau M, Hage G, Overtchouk P, Brugier D, Vignolles N, Kerneis M, Silvain J, Collet JP, Vicaut E, Thiele H, Montalescot G. P961Investigator versus Core Lab evaluation of coronary blood flow in PCI of patients in cardiogenic shock: a substudy of the CULPRIT-SHOCK trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Thrombolysis In Myocardial Infarction (TIMI) flow is a prognostic factor which assessment is complex in life-threatening situations. Because TIMI flow evaluation by site investigator (SI) is subject to bias, independent Core-Laboratory (CL) adjudication is the reference standard in clinical trials.
Purpose
To evaluate the concordance between CL and SI in the evaluation of the culprit artery TIMI flow, and the associated prognosis in the CULPRIT-SHOCK trial.
Methods
All patients of the CULPRIT-SHOCK trial with CL adjudications were included in this analysis. CL adjudicators were blinded to patient's characteristics and outcomes: pre and post-PCI TIMI flows were solely evaluated on the basis of coronary angiograms. SI determined the TIMI flow before and immediately after PCI of the culprit lesion. The concordance was determined by Cohen's κ coefficient. A multivariate analysis was used to evaluate 1) factors of discordance 2) the association between each method of evaluation and the mortality at 30 days and 1 year.
Results
Among CULPRIT-SHOCK patients, 663 patients were eligible for this analysis. Of the 214 patients adjudicated TIMI flow 3 by CL before PCI, SI over-estimated the obstruction to TIMI flow 0–1-2 in 121 (56.5%). Of the 139 patients scored TIMI flow 0–1-2 by CL after PCI, SI over-graded their results to TIMI flow 3 in 79 (56.8%). Overall, the K coefficient of agreement was 0.44, 95% CI [0.36; 0.51] before PCI and 0.44, 95% CI [0.35; 0.53] after PCI. Mechanical circulatory support and culprit left main were the main factors of discordance of TIMI flow after PCI. The association between TIMI flow 0–1-2 after PCI and 30-days mortality was significant, whether adjudicated by SI or CL (figure). Post-PCI TIMI-flow 0–1-2 was associated to 1-year mortality only when evaluated by SI (figure).
Association between TIMI and mortality
Conclusions
In comparison to the independant CL evaluation, SI overestimated the severity of coronary slow flow before PCI, and the success of PCI in improving coronary flow. The level of agreement between CL and SI was moderate. While both evaluations predicted 30-days mortality, only SI scoring was associated to 1-year mortality.
Acknowledgement/Funding
European Union Seventh Framework Program, the German Heart Research Foundation, German Cardiac Society.
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Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Rouanet
- StatEthic, Statistician unit, Levallois-Perret, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Hauguel-Moreau
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - G Hage
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - P Overtchouk
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - N Vignolles
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Action Study Group, Unite de Recherche Clinique, Paris, France
| | - H Thiele
- Leipzig University Hospital, Heart center, Leipzig, Germany
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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18
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Procopi A, Procopi N, Collet JP, Barthelemy O, Leprince P, Choussat R, Isnard R. P5575Acute left ventricular mechanics changes after TAVR: the afterload concept revisited. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies have emphasized the prognostic value of mild left ventricular ejection fraction (LVEF) impairment in severe aortic stenosis. However, despite adaptive mechanisms to pressure overload, subtle impaired systolic function could be worsened by increased afterload and partly reversible immediately after its correction.
Objectives
The aim was to evaluate the short terms effects of transcatheter aortic valve replacement (TAVR) on LV systolic function assessed by global longitudinal strain (GLS). We hypothesized that abrupt decrease of LV afterload after TAVR could lead to immediate improvement of LV systolic function.
Methods
Patients referred to our Department for TAVR were included from January 2018 to July 2018 in this observational prospective single center study. Transthoracic echocardiography (TTE) was performed immediately before and 1–5 days after TAVR by the same operator and reviewed in a blind fashion.
Results
35 symptomatic patients with severe aortic stenosis referred for TAVR (age 84±5 y, 18 male, NYHA 2–3, orifice area 0.7±0.2 cm2, LVEF 66±13%, GLS −15.1±4.7%) were included. Only 9/35 (26%) had a LVEF ≤60%. Overall, no significant change in LVEF (65±14%; p=0.55) or GLS (−16.1±4.8%; p=0.11) occurred immediately after TAVR despite a dramatic decrease in transoartic mean pressure gradient (44±15 mm Hg versus 6±3 mmHg; p<0.0001). However in the subgroup of patients with LVEF ≤60%, a significant increase in GLS after TAVR was observed (−9.6±4.1% versus −12.1±3.3%; p=0.0039).
Improvement in GLS according to the LVEF
Conclusion
Following TAVR, an early improvement in LV systolic function assessed by GLS was observed only in patients with pre-existing mild LV systolic dysfunction. Further studies should evaluate whether this improvement is associated with better long term outcome.
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Affiliation(s)
- A Procopi
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - N Procopi
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - R Choussat
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - R Isnard
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
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19
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Guan L, Wang Y, Claydon VE, Mazowita G, Wang Y, Brant R, Collet JP. Autonomic Parameter and Stress Profile Predict Secondary Ischemic Events After Transient Ischemic Attack or Minor Stroke. Stroke 2019; 50:2007-2015. [PMID: 31238826 DOI: 10.1161/strokeaha.118.022844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Purpose- Traditional risk factors for ischemic stroke are body stressors that are related to autonomic autonomic system (ANS) dysfunction. The value of ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) to predict ischemic stroke after transient ischemic attack is compromised by the inclusion of a limited number of stressors. We aimed to assess whether markers of ANS function and stress could predict the occurrence of secondary ischemic events after transient ischemic attack or minor stroke. Methods- This is a prospective cohort study in which 201 patients were recruited within 48 hours after initial transient ischemic attack or minor stroke and followed for 90 days to assess the development of secondary ischemic events. ABCD2 score, heart rate variability (HRV) parameters as markers of ANS function, and psychological stress were assessed. Logistic regression and area under the curve (AUC) were used to assess the models' predictive ability. Results- Morning high frequency (HF) HRV power and changes in HF HRV from morning to afternoon (daytime HF changes) were the most useful HRV predictors for both ischemic events (AUC=0.61 and 0.70) and ischemic stroke (AUC=0.62 and 0.72). Compared with ABCD2 score, 2 HRV-based stress models showed higher predictive ability for ischemic events (AUC=0.82 versus 0.63, 0.76 versus 0.63; P<0.05) and ischemic stroke (AUC=0.87 versus 0.64, 0.82 versus 0.64; P<0.05). Conclusions- Assessing the effects of stress on the ANS may be an innovative way to stratify the risk of ischemic events after transient ischemic attack or minor stroke. New risk stratification by assessing the dynamic features of ANS dysfunction and stress may help identify high-risk sub-populations that may benefit from added management.
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Affiliation(s)
- Ling Guan
- From the Department of Medicine (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, China (Yongjun Wang, Yilong Wang)
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Canada (V.E.C.)
| | - Garey Mazowita
- Department of Family Practice (G.M.), University of British Columbia, Vancouver, Canada.,Department of Family and Community Medicine, Providence Healthcare, Canada (G.M.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, China (Yongjun Wang, Yilong Wang)
| | - Rollin Brant
- Department of Statistics (R.B.), University of British Columbia, Vancouver, Canada
| | - Jean-Paul Collet
- From the Department of Medicine (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada.,Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, China (J.-P.C.)
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20
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Godier A, Garrigue D, Lasne D, Fontana P, Bonhomme F, Collet JP, de Maistre E, Ickx B, Gruel Y, Mazighi M, Nguyen P, Vincentelli A, Albaladejo P, Lecompte T. Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med 2019; 38:289-302. [DOI: 10.1016/j.accpm.2018.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022]
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21
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Kazi AM, Ahsan N, Khan A, Jamal S, Kalimuddin H, Ghulamhussain N, Wajidali Z, Muqeet A, Zaidi F, Subzlani M, McKellin W, Ali A, Collet JP. Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial. JMIR Res Protoc 2019; 8:e12851. [PMID: 31148544 PMCID: PMC6658276 DOI: 10.2196/12851] [Citation(s) in RCA: 10] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/14/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)-based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call-based messages and interventions to improve routine immunization (RI) coverage. OBJECTIVE The primary objective of this study is to evaluate whether automated mobile phone-based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. METHODS This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family's vaccination experience and related factors. RESULTS All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. CONCLUSIONS The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone-based communication to improve RI coverage and timelines. Moreover, information regarding families' perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. TRIAL REGISTRATION ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12851.
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Affiliation(s)
- Abdul Momin Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Nazia Ahsan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ayub Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saima Jamal
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hussain Kalimuddin
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Zabin Wajidali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abdul Muqeet
- Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan
| | - Fabiha Zaidi
- Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan
| | - Meraj Subzlani
- Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan
| | - William McKellin
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Beijing Tiantan Hospital and Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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22
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Pound CM, Robinson J, Giglia L, Rodd C, Sharma A, Chafe R, Collet JP, Ulanova M, McGavock J. Scholarly training objectives and requirements for paediatric residents in Canada. Paediatr Child Health 2019; 24:76-80. [PMID: 30996596 DOI: 10.1093/pch/pxy070] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the absence of national standards for scholarly requirements, paediatric resident training varies significantly across Canadian programs. This variability may contribute to significant differences in trainee experiences and productivity. A panel of coordinators of paediatric resident research programs from across Canada met in 2014, to share experiences and identify barriers to successful resident scholarly activity. A survey of all programs was completed in 2015. A scoping review and series of meetings led to the development of a proposed list of expectations, timelines for successful completion and consequences for not completing a scholarly project. We propose a harmonized list of scholarly competencies and activities for paediatric residents in Canada to accomplish before completing their training. We also propose that programs implement standardized timelines and consequences in the event that a resident does not meet their program's scholarly expectations.
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Affiliation(s)
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Celia Rodd
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Atul Sharma
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Roger Chafe
- Pediatrics Faculty of Medicine Memorial University, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland and Labrador
| | - Jean-Paul Collet
- Medical Sciences Division, Faculty of Medicine, Northern Ontario School of Medicine, Lakehead University, Thunderbay, Ontario
| | - Marina Ulanova
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Jonathan McGavock
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
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23
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Masucci L, Schreiber RA, Kaczorowski J, Collet JP, Bryan S. Universal screening of newborns for biliary atresia: Cost-effectiveness of alternative strategies. J Med Screen 2019; 26:113-119. [DOI: 10.1177/0969141319832039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Biliary atresia, a rare newborn liver disease, is the most common cause of liver-related death in children and the main indication for paediatric liver transplantation. Early detection and surgical intervention with a Kasai portoenterostomy offers the best chance for long-term patient survival. We conducted a cost-effectiveness analysis to compare no universal screening with screening using either a home-based infant stool colour card with passive card distribution strategy, or conjugated bilirubin testing. Methods A Markov model was developed, with structure, costs, and probabilities informed by the literature and clinical expert opinion, to simulate a newborn cohort over a 10-year time horizon. Health benefits were expressed as life-years gained. This analysis was conducted from the perspective of the Canadian publicly funded health care system (all costs in Canadian dollars). Both deterministic and probabilistic analyses were conducted. Results Screening using a home-based colour card with passive card distribution was a cost-effective option. For a population of 392,902 annual births in Canada, this strategy cost approximately $192,000 more than no universal screening but led to eight life-years gained (incremental cost-effectiveness ratio (ICER) = $24,065 per life-year gained). Screening using conjugated bilirubin testing versus the colour card cost $2,369,199 more and led to five more life-years gained (ICER= $473,840 per life year gained), and so was not cost-effective. Conclusions A home-based screening program using infant stool colour cards with a passive distribution strategy could be highly cost-effective when administered at a low unit cost and with a reasonable screening performance.
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Affiliation(s)
- Lisa Masucci
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Richard A Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Canada
| | - JP Collet
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
- Child and Family Research Institute, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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24
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Gitimoghaddam M, McKellin WH, Miller AR, Weiss JA, Majnemer A, Mâsse LC, Brant R, Symington V, Wishart RL, Collet JP. Gymnastic-Based Movement Therapy for Children With Neurodevelopmental Disabilities: Results From a Pilot Feasibility Study. Front Pediatr 2019; 7:186. [PMID: 31139605 PMCID: PMC6527593 DOI: 10.3389/fped.2019.00186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Developmental and behavioral issues often limit the participation of children with neurodevelopmental disabilities (NDD) in community-based activities with their peers, which decreases opportunities for their social learning and development. Parents of children with NDD seek out programs that address physical and psychosocial development. Several studies already support the positive effects for the child to attend physical activity programs (PAPs). However, these studies are highly prone to biases and Hawthorne effect. In the planning stage of a large prospective study to assess the effectiveness of PAPs we reviewed the records of children who participated in a gymnastic-based program, the Empowering Steps Movement Therapy (ESMT). Besides generating useful data for developing the prospective study we thought these data reflect the rate of changes in context of normal practice in a naturalistic environment; therefore protected from Hawthorne effect and other biases. Design: This is a historical cohort: the files of 67 children with NDD were examined across a 2-year period (Jan 2011 to Jan 2013). As part of standard practice, the ESMT therapists document changes in motor function every 6 months, using the ESMT's proprietary motor scale. Parents also completed a parental questionnaire in June 2011 regarding their perceptions of changes in their child's physical and psychosocial function, as well as family functioning since their child started the program. Results: Linear Mixed Effects Model clearly identified three groups according to changes in motor function: the ones with rapid changes (mostly functional children with autism spectrum disorder: n = 13), the ones with moderate changes (different types of NDD diagnoses: n = 41) and the ones that did not change or even decreased motor skills over the follow-up (children with complex diseases or uncontrolled epilepsy despite treatment: n = 13). Parental questionnaires (n = 39) reported improvement in most of the children's physical and psychosocial abilities; they also indicated improvement in some of the family parameters. There was no association between the changes in children's motor functions and parents' responses to the questionnaire. Conclusion: Despite limitations due to the retrospective nature of the study, the absence of a control group and the absence of validated measurement tools, the observed positive effects of attending movement therapy center on motor performance and psychosocial development confirm in a naturalistic environment what has been shown in context of clinical trials or quasi-experimental studies. These results are not conclusive. They warrant further, rigorous investigation using validated instruments, independent assessors, and control groups.
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Affiliation(s)
- Mojgan Gitimoghaddam
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - William H McKellin
- Department of Anthropology, University of British Columbia, Vancouver, BC, Canada
| | - Anton R Miller
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Sunny Hill Health Centre for Children, Vancouver, BC, Canada
| | | | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Louise C Mâsse
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rollin Brant
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | | | - Robert L Wishart
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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25
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Majnemer A, O'Donnell M, Ogourtsova T, Kasaai B, Ballantyne M, Cohen E, Collet JP, Dewan T, Elsabbagh M, Hanlon-Dearman A, Filliter JH, Lach L, McElroy T, McGrath P, McKellin W, Miller A, Patel H, Rempel G, Shevell M, Wittmeier K. BRIGHT Coaching: A Randomized Controlled Trial on the Effectiveness of a Developmental Coach System to Empower Families of Children With Emerging Developmental Delay. Front Pediatr 2019; 7:332. [PMID: 31440489 PMCID: PMC6694748 DOI: 10.3389/fped.2019.00332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022] Open
Abstract
Background: In preschool-aged children with, or at elevated risk for, developmental disabilities, challenges and needs arise from vulnerabilities linked to critical and newly emerging cognitive, speech, motor, behavioral, and social skills. For families, this can be a stressful period as they witness the gradual unfolding of their child's differences and await to receive care. Nationally and internationally, service delivery models during this critical period are not standardized nor are they nimble or sufficient enough, leading to long wait times, service gaps and duplications. Given these struggles, there is a need to examine whether "health coaching", a structured educational program that is deliverable by different and more accessible means, can be effective in empowering families, by delivering information, providing social supports, and decreasing the demands on the overwhelmed health and developmental services. The primary objective is to evaluate the feasibility and the effectiveness of a coaching intervention (in comparison to usual and locally available care), for parents of children with emerging developmental delays. Method/Design: A multi-centered pragmatic randomized controlled trial design will be used. Families will be recruited from a representative sample of those awaiting publicly-funded regional child health services for children with developmental delays in four Canadian provinces. The target sample size is 392 families with children aged 1.5 to 4.5 years at recruitment date. Families will be randomly assigned to receive either the BRIGHT Coaching intervention (coach supported, hardcopy and online self-managed educational resources: 14 sessions, 2 sessions every 4 weeks for 6-9 months) or usual care that is locally available. In addition to the feasibility and acceptability measures, outcomes related to family empowerment, parental satisfaction and efficacy with caregiver competency will be evaluated at baseline, post-treatment (8 months), and follow-up (12 months). Discussion: This manuscript presents the background information, design, description of the interventions and of the protocol for the randomized controlled trial on the effectiveness of BRIGHT Coaching intervention for families of children with emerging developmental delays. Trial Registration: ClinicalTrials.gov, U.S. National Library of Medicine, National Institutes of Health #NCT03880383, 03/15/2019. Retrospectively registered.
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Affiliation(s)
- Annette Majnemer
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Maureen O'Donnell
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Child-Health BC, Vancouver, BC, Canada
| | - Tatiana Ogourtsova
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bahar Kasaai
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | | | - Eyal Cohen
- Hospital for Sick Children, Toronto, ON, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Mayada Elsabbagh
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Jillian Helen Filliter
- IWK Health Centre, Halifax, NS, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lucyna Lach
- McGill University Health Centre, Montreal, QC, Canada
| | - Theresa McElroy
- Child-Health BC, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - William McKellin
- Rare Disease Foundation, Vancouver, BC, Canada.,Department of Anthropology, University of British Columbia, Vancouver, BC, Canada
| | - Anton Miller
- Child and Family Research Institute, Vancouver, BC, Canada
| | - Hema Patel
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Gina Rempel
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Winnipeg, Winnipeg, MB, Canada
| | - Michael Shevell
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Kristy Wittmeier
- University of Manitoba, Winnipeg, MB, Canada.,Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Zeitouni M, Collet JP, Hulot JS, Silvain J, Kerneis M, Lattuca B, Barthelemy O, Lavie-Badie Y, Esteve JB, Payot L, Brugier D, Galier S, Diallo A, Vicaut E, Montalescot G. P4207The natural history of premature coronary artery disease over 20 years: the AFIJI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J S Hulot
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - B Lattuca
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse, France
| | - J B Esteve
- Protestant Infirmary of Lyon, Cardiology, Caluire et Cuire, France
| | - L Payot
- Centre Hospitalier, Cardiology, Saint-Brieuc, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Galier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - A Diallo
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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27
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Lattuca B, Cayla G, Cuisset T, Silvain J, Bellemain-Appaix A, Beygui F, Varenne O, Sabouret P, Boueri Z, Motreff P, Bonnet JL, Diallo A, Collet JP, Vicaut E, Montalescot G. 5916Platelet function testing predicts bleeding complications in elderly patients admitted for an acute coronary syndrome: insights from the ANTARCTIC trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Cayla
- University Hospital of Nimes, Cardiology, Nimes, France
| | - T Cuisset
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | | | - F Beygui
- Hospital Cote de Nacre, Cardiology, Caen, France
| | - O Varenne
- Hospital Cochin, Cardiology, Paris, France
| | - P Sabouret
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - Z Boueri
- Hospital of Bastia, Cardiology, Bastia, France
| | - P Motreff
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - J L Bonnet
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - A Diallo
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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Guan L, Metzger DL, Lavoie PM, Collet JP. Glucose control and autonomic response during acute stress in youth with type 1 diabetes: A pilot study. Pediatr Diabetes 2018; 19:1020-1024. [PMID: 29654713 DOI: 10.1111/pedi.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a chronic source of metabolic and neuropsychological stress, which may eventually lead to autonomic neuropathy and other complications related to micro- and macro-vasculopathies. We aimed to investigate the relationship between T1D chronic stress and autonomic response to acute stress testing that was expected being affected by chronic stress. METHODS Twenty youths with confirmed diagnosis of T1D were assessed. Chronic stress assessment included hemoglobin A1c (HbA1c) ≥7.5%, psychological stress assessed by perceived stress scale (PSS), hypoglycemic events, and proinflammatory cytokines. The acute stress testing used standardized stress video games. Autonomic response to acute stress was assessed by the amplitude and direction of changes in heart rate variability. Analyses determined correlations between changes in parasympathetic nervous system during stress testing and chronic diabetes stressors. RESULTS A strong correlation was found between the amplitude of high frequency (HF) changes and HbA1c values (ρ = 0.74, P < .001). Youths with HbA1c ≥7.5% showed a larger amplitude of HF changes during acute stress (49% vs 16%, P < .001) and a higher PSS score (22.5 vs 19.0, P = .003), compared to those with HbA1c <7.5%. Additionally, among youths with HbA1c ≥7.5%, those with positive changes in HF had a lower level of IL-8 than those with negative changes (5.40 vs 7.85 pg/mL, P = .009). CONCLUSIONS Study findings support the need for better understanding the health effects of stress-related autonomic dysfunction in youth with T1D.
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Affiliation(s)
- Ling Guan
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Daniel L Metzger
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Division of Pediatric Endocrinology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Lattuca B, Silvain J, Zeitouni M, Guerin M, Kerneis M, Guedeney P, Collet JP, Lesnik P, Montalescot G. P2708Impact of heterozygous familial hypercholesterolemia on mortality in ST-segment elevation myocardial infarction patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Guerin
- ICAN - Institute of CardioMetabolism and Nutrition, Pitie Salpêtrière Hospital, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - P Lesnik
- ICAN - Institute of CardioMetabolism and Nutrition, Pitie Salpêtrière Hospital, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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30
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Guedeney P, Huchet F, Overtchouk P, Rouanet S, Vicaut E, Manigold T, Letocart V, Balagny P, Leprince P, De Decker L, Lebreton G, Barthelemy O, Montalescot G, Guerin P, Collet JP. P3423Impact of oral anticoagulation on clinical outcomes and hemodynamic parameters after successful transcatheter aortic valve replacement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - F Huchet
- University Hospital of Nantes Nord Laennec, Nantes, France
| | | | | | - E Vicaut
- Lariboisiere hospital, Clinical research unit - ACTION study group, Paris, France
| | - T Manigold
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - V Letocart
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - P Balagny
- Hospital Pitie-Salpetriere, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Paris, France
| | - L De Decker
- University Hospital of Nantes, Nantes, France
| | - G Lebreton
- Hospital Pitie-Salpetriere, Paris, France
| | | | | | - P Guerin
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
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31
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Lattuca B, Cayla G, Silvain J, Cuisset T, Leclercq F, Manzo-Silberman S, Saint-Etienne C, Delarche N, El Mahmoud R, Carrie D, Souteyrand G, Diallo A, Collet JP, Vicaut E, Montalescot G. P2245Impact and predictive factors of bleeding complications in elderly patients admitted for an acute coronary syndrome: insights from the ANTARCTIC trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Cayla
- University Hospital of Nimes, Cardiology, Nimes, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - T Cuisset
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - F Leclercq
- Hospital Regional University of Montpellier, Montpellier, France
| | | | | | - N Delarche
- Hospital Center of Pau, Cardiology, Pau, France
| | - R El Mahmoud
- University Hospital Ambroise Pare, Cardiology, Boulogne-Billancourt, France
| | - D Carrie
- University Hospital of Toulouse, Cardiology, Toulouse, France
| | - G Souteyrand
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - A Diallo
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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32
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Lattuca B, Yan Y, Kerneis M, Cuisset T, Silvain J, Range G, Elhadad S, Pouillot C, Leclercq F, Manzo-Silberman S, Bellemain-Appaix A, Vicaut E, Cayla G, Collet JP, Montalescot G. P1722Platelet function monitoring for the prediction of clinical outcomes: a pooled analysis of the randomized ARCTIC and ANTARCTIC trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - Y Yan
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - T Cuisset
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Range
- Hospital Louis Pasteur of Chartres, Cardiology, Chartres, France
| | - S Elhadad
- Hospital of Lagny Marne la Vallée, Cardiology, Jossigny, France
| | - C Pouillot
- Clinic Sainte Clotilde, Cardiology, Saint Denis de la Réunion, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | | | | | - E Vicaut
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - G Cayla
- University Hospital of Nimes, Cardiology, Nimes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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33
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Collet JP, Zeitouni M, Hulot JS, Silvain J, Barthelemy O, Kerneis M, Lattuca B, Lavie-Badie Y, Payot L, Esteve JB, Brugier D, Galier S, Diallo A, Vicaut E, Montalescot G. P6233Intima-Media thickness to better risk-stratify patients with premature coronary artery disease: an analysis from the AFUI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J S Hulot
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - B Lattuca
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse, France
| | - L Payot
- Centre Hospitalier, Cardiology, Saint-Brieuc, France
| | - J B Esteve
- Protestant Infirmary of Lyon, Cardiology, Caluire et Cuire, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Galier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - A Diallo
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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Cayla G, Cuisset T, Lattuca B, Silvain J, Leclercq F, Manzo Silberman S, Pouillot C, Carrie D, Beygui F, Vicaut E, Range G, Henry P, Van Belle E, Collet JP, Montalescot G. 5914De-escalation versus escalation of antiplatelet therapy in elderly ACS patients: insight from the ANTARCTIC trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Cayla
- CHU Nimes, ACTION Study Group, Cardiology, Nimes, France
| | - T Cuisset
- AP-HM - Hospital La Timone, Marseille, France
| | - B Lattuca
- University Hospital of Nimes, Cardiology, Nimes, France
| | - J Silvain
- AP-HP Hospital Pitie-Salpetriere ACTION Study Group, Cardiology, Paris, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | | | - C Pouillot
- Clinique Sainte Clotilde, Cardiology, Sainte Clotilde, France
| | - D Carrie
- University Hospital of Toulouse, Cardiology, Toulouse, France
| | - F Beygui
- University Hospital of Caen, Cardiology, Caen, France
| | - E Vicaut
- Hospital Lariboisiere, Recherche Clinique, Paris, France
| | - G Range
- Hospital Louis Pasteur of Chartres, Cardiology, Chartres, France
| | - P Henry
- Hospital Lariboisiere, Cardiology, Paris, France
| | - E Van Belle
- Hospital Regional University of Lille - Cardiological Hospital, Lille, France
| | - J P Collet
- AP-HP Hospital Pitie-Salpetriere ACTION Study Group, Cardiology, Paris, France
| | - G Montalescot
- AP-HP Hospital Pitie-Salpetriere ACTION Study Group, Cardiology, Paris, France
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35
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Zeitouni M, Collet JP, Silvain J, Hulot JS, Kerneis M, Lavie-Badie Y, Barthelemy O, Payot L, Esteve JB, Lattuca B, Galier S, Brugier D, Diallo A, Vicaut E, Montalescot G. P5400Professional status and long-term prognosis of premature coronary artery disease: the AFIJI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J S Hulot
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - L Payot
- Centre Hospitalier, Cardiology, Saint-Brieuc, France
| | - J B Esteve
- Protestant Infirmary of Lyon, Cardiology, Caluire et Cuire, France
| | - B Lattuca
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Galier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - A Diallo
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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Overtchouk P, Guedeney P, Montalescot G, Verhoye JP, Koning R, Lefevre TL, Van Belle E, Eltchaninoff H, Gilard M, Leprince P, Iung B, Barthelemy O, Silvain J, Le Breton H, Collet JP. 1213Post-TAVR antithrombotic treatment and one-year survival: insights from the FRANCE TAVI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | | | - J P Verhoye
- University Hospital of Rennes, Rennes, France
| | - R Koning
- Clinic Saint-Hilaire, Rouen, France
| | - T L Lefevre
- Institut Hospitalier Jacques Cartier, Massy, France
| | | | | | - M Gilard
- University Hospital of Brest, Brest, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Paris, France
| | - B Iung
- Hospital Bichat-Claude Bernard, Paris, France
| | | | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | - H Le Breton
- University Hospital of Rennes, Rennes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
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Kazi AM, Ali M, Zubair K, Kalimuddin H, Kazi AN, Iqbal SP, Collet JP, Ali SA. Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial. JMIR Public Health Surveill 2018. [PMID: 29514773 PMCID: PMC5863012 DOI: 10.2196/publichealth.7026] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant. Conclusions Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc)
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Affiliation(s)
- Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Murtaza Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khurram Zubair
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hussain Kalimuddin
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abdul Nafey Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Syed Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Guan L, Collet JP, Mazowita G, Claydon VE. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability. Front Neurol 2018; 9:90. [PMID: 29556209 PMCID: PMC5844932 DOI: 10.3389/fneur.2018.00090] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.
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Affiliation(s)
- Ling Guan
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Garey Mazowita
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada.,Department of Family and Community Medicine, Providence Healthcare, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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Woolfson J, Schreiber R, Butler A, MacFarlane J, Kaczorowski J, Masucci L, Bryan S, Collet JP. BILIARY ATRESIA HOME SCREENING PROGRAM IN BRITISH COLUMBIA: EVALUATION OF FIRST TWO YEARS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Hursh BE, Fazeli MS, Wang S, Marchant EA, Woo P, Elango R, Lavoie PM, Chanoine JP, Collet JP. Cardiac Autonomic Function at Baseline and under Stress and Its Relationship to Circulatory Markers of Inflammation in Obese Compared to Nonobese Children: A Pilot Study. Horm Res Paediatr 2017; 85:339-46. [PMID: 27105080 DOI: 10.1159/000445685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The autonomic nervous system (ANS) provides neurogenic control of inflammatory reactions. ANS changes in obesity may result in inflammation. This study sought to gain insight into cardiac autonomic dysfunction and inflammation in childhood obesity, and to gather pilot data on the potential relationship between altered ANS and inflammation. METHODS Fifteen obese children and adolescents without metabolic complications and 15 nonobese controls underwent heart rate variability and impedance cardiography testing during rest, mental stress, and physical stress. Inflammatory cytokines and immune reactivity were measured. RESULTS There was no statistically significant difference between groups in cardiac ANS testing at rest or in response to stress. Median high-sensitivity C-reactive protein (hsCRP) was higher in the obese group [obese 2.6 mg/l (IQR 1.6-11.9); nonobese 0.3 mg/l (IQR 0.2-0.7); p < 0.001]. Interleukin-6 and tumour necrosis factor-α were similar between groups. Immune reactivity testing (in vitro Toll-like receptor stimulation) revealed a strong, but comparable, inflammatory response in both groups. CONCLUSIONS Obese children and adolescents without metabolic complications did not have cardiac ANS dysfunction. While hsCRP was elevated, systemic cytokines were not raised. Compared to prior studies, which often focused on children with obesity and its complications, it is encouraging that obese children without metabolic complications may not yet have autonomic dysfunction.
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Affiliation(s)
- Brenden E Hursh
- Endocrinology and Diabetes Unit, BC Children's Hospital, The University of British Columbia, Vancouver, B.C., Canada
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Mosavianpour M, Sarmast HH, Kissoon N, Collet JP. Theoretical domains framework to assess barriers to change for planning health care quality interventions: a systematic literature review. J Multidiscip Healthc 2016; 9:303-10. [PMID: 27499628 PMCID: PMC4959766 DOI: 10.2147/jmdh.s107796] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Theoretical domains framework (TDF) provides an integrative model for assessing barriers to behavioral changes in order to suggest interventions for improvement in behavior and ultimately outcomes. However, there are other tools that are used to assess barriers. OBJECTIVE The objective of this study is to determine the degree of concordance between domains and constructs identified in two versions of the TDF including original (2005) and refined version (2012) and independent studies of other tools. METHODS We searched six databases for articles that studied barriers to health-related behavior changes of health care professionals or the general public. We reviewed quantitative papers published in English which included their questionnaires in the article. A table including the TDF domains of both original and refined versions and related constructs was developed to serve as a reference to describe the barriers assessed in the independent studies; descriptive statistics were used to express the results. RESULTS Out of 552 papers retrieved, 50 were eligible to review. The barrier domains explored in these articles belonged to two to eleven domains of the refined TDF. Eighteen articles (36%) used constructs outside of the refined version. The spectrum of barrier constructs of the original TDF was broader and could meet the domains studied in 48 studies (96%). Barriers in domains of "environmental context and resources", "beliefs about consequences", and "social influences" were the most frequently explored in 42 (84%), 37 (74%), and 33 (66%) of the 50 articles, respectively. CONCLUSION Both refined and original TDFs cataloged barriers measured by the other studies that did not use TDF as their framework. However, the original version of TDF explored a broader spectrum of barriers than the refined version. From this perspective, the original version of the TDF seems to be a more comprehensive tool for assessing barriers in practice.
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Affiliation(s)
- Mirkaber Mosavianpour
- Department of Pediatrics, Faculty of Medicine, University of British Columbia; British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
| | - Hamideh Helen Sarmast
- British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
| | - Niranjan Kissoon
- Department of Pediatrics, Faculty of Medicine, University of British Columbia; British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia; British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
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Fazeli MS, Collet JP, MacNeily AE, Afshar K. Cardiac Autonomic Nervous System Activity in Children with Bladder and Bowel Dysfunction. J Urol 2016; 195:1245-9. [PMID: 26926551 DOI: 10.1016/j.juro.2015.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Bladder and bowel dysfunction is a common reason for referral to pediatric urology. The role of the autonomic nervous system in the pathogenesis of bladder and bowel dysfunction has not been well investigated. We compared autonomic nervous system activity in children with bladder and bowel dysfunction to that in healthy controls. We hypothesized that children with dysfunction have a different autonomic profile as measured by parameters from spectral analysis of heart rate variability and impedance cardiography. MATERIALS AND METHODS We recruited 40 children, including 25 girls, with a median age of 10 years (range 5 to 18) in whom bladder and bowel dysfunction was clinically diagnosed by a validated questionnaire and 19 healthy controls, including 9 girls, with a median age of 8 years (range 5 to 16). Cardiac autonomic activity was assessed at baseline and during voiding. The primary outcome measures were the main parameters of heart rate variability, including total power and high frequency, as well as pre-ejection period and heart rate. RESULTS Comparison of outcomes at baseline showed significantly lower total power and high frequency heart rate variability in bladder and bowel dysfunction cases (p = 0.001 and 0.002, respectively). Children with dysfunction also showed a significantly smaller decrease in sympathetic nervous system activity during voiding (p = 0.05). CONCLUSIONS Our results demonstrate that compared to healthy controls children with bladder and bowel dysfunction show a different cardiac autonomic profile at rest and in response to voiding. This difference may be used in future studies to further clarify the pathophysiology of bladder and bowel dysfunction, and introduce novel treatment targets to manage the condition.
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Affiliation(s)
- Mir Sohail Fazeli
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Andrew E MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada.
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Ware MA, Wang T, Shapiro S, Collet JP, Boulanger A, Esdaile JM, Gordon A, Lynch M, Moulin DE, O'Connell C. Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). The Journal of Pain 2015; 16:1233-1242. [DOI: 10.1016/j.jpain.2015.07.014] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 07/18/2015] [Accepted: 07/28/2015] [Indexed: 02/07/2023]
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Fazeli MS, Pourrahmat MM, Liu M, Guan L, Collet JP. The Effect of Head Massage on the Regulation of the Cardiac Autonomic Nervous System: A Pilot Randomized Crossover Trial. J Altern Complement Med 2015; 22:75-80. [PMID: 26562003 DOI: 10.1089/acm.2015.0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the effect of a single 10-minute session of Chinese head massage on the activity of the cardiac autonomic nervous system via measurement of heart rate variability (HRV). DESIGN In this pilot randomized crossover trial, each participant received both head massage and the control intervention in a randomized fashion. SETTINGS/LOCATION The study was conducted at Children's & Women's Health Centre of British Columbia between June and November 2014. PARTICIPANTS Ten otherwise healthy adults (6 men and 4 women) were enrolled in this study. INTERVENTIONS The intervention comprised 10 minutes of head massage therapy (HMT) in a seated position compared with a control intervention of sitting quietly on the same chair with eyes closed for an equal amount of time (no HMT). OUTCOME MEASURES The primary outcome measures were the main parameters of HRV, including total power (TP), high frequency (HF), HF as a normalized unit, pre-ejection period, and heart rate (HR). RESULTS A single short session (10 minutes) of head massage demonstrated an increase in TP continuing up to 20 minutes after massage and reaching statistical significance at 10 minutes after massage (relative change from baseline, 66% for HMT versus -6.6% for no HMT; p = 0.017). The effect on HF also peaked up to 10 minutes after massage (59.4% for HMT versus 4% for no HMT; p = 0.139). Receiving head massage also decreased HR by more than three-fold compared to the control intervention. CONCLUSION This study shows the potential benefits of head massage by modulating the cardiac autonomic nervous system through an increase in the total variability and a shift toward higher parasympathetic nervous system activity. Randomized controlled trials with larger sample size and multiple sessions of massage are needed to substantiate these findings.
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Affiliation(s)
- Mir Sohail Fazeli
- 1 Department of Pediatrics, University of British Columbia , Vancouver, British Columbia, Canada .,2 Child and Family Research Institute , Vancouver, British Columbia, Canada
| | - Mir-Masoud Pourrahmat
- 1 Department of Pediatrics, University of British Columbia , Vancouver, British Columbia, Canada .,2 Child and Family Research Institute , Vancouver, British Columbia, Canada
| | - Mailan Liu
- 1 Department of Pediatrics, University of British Columbia , Vancouver, British Columbia, Canada .,2 Child and Family Research Institute , Vancouver, British Columbia, Canada .,3 Chengdu University of Traditional Chinese Medicine , Sichuan, China
| | - Ling Guan
- 1 Department of Pediatrics, University of British Columbia , Vancouver, British Columbia, Canada .,2 Child and Family Research Institute , Vancouver, British Columbia, Canada
| | - Jean-Paul Collet
- 1 Department of Pediatrics, University of British Columbia , Vancouver, British Columbia, Canada .,2 Child and Family Research Institute , Vancouver, British Columbia, Canada
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Amed S, Naylor PJ, Pinkney S, Shea S, Mâsse LC, Berg S, Collet JP, Wharf Higgins J. Creating a collective impact on childhood obesity: Lessons from the SCOPE initiative. Can J Public Health 2015; 106:e426-33. [PMID: 26680435 DOI: 10.17269/cjph.106.5114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/15/2015] [Accepted: 07/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We describe the processes used in SCOPE, a community-based participatory research (CBPR) initiative, to achieve multisectoral engagement and collective action to prevent childhood obesity. PARTICIPANTS SCOPE engages representatives from various sectors (local government, health, schools, recreation, local media, early childhood, community services) who influence the environments in which children live, learn and play. SETTING SCOPE has been implemented in three communities in British Columbia (BC). INTERVENTION SCOPE (www.live5210.ca) is a multi-setting, multi-component initiative designed to enhance a community's capacity to create and deliver localized solutions to promote healthy weights among children. SCOPE, in partnership with a local organization, engages multiple stakeholders who plan and implement actions framed by a common evidence-based health message ('Live 5-2-1-0'). SCOPE's central team in Vancouver, BC facilitates alignment with provincial initiatives, knowledge translation and exchange (KTE) within and across communities, and the collection, analysis and reporting of shared data. OUTCOMES Best practice processes that have emerged from SCOPE's experience align with the principles of CBPR and the five conditions of Collective Impact - a common agenda, mutually reinforcing action, continuous communication, a backbone organization and shared measurement. SCOPE has achieved sustainable practice change framed by a common agenda ('Live 5-2-1-0') leading to mutually reinforcing cross-sectoral action. CONCLUSION A multi-pronged community-led childhood obesity prevention initiative can be achieved using CBPR principles and attending to the conditions for achieving collective impact.
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Affiliation(s)
- Shazhan Amed
- University of British Columbia - Department of Paediatrics.
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McIntosh B, Daly A, Mâsse LC, Collet JP, Higgins JW, Naylor PJ, Amed S. Sustainable childhood obesity prevention through community engagement (SCOPE) program: evaluation of the implementation phase. Biochem Cell Biol 2015; 93:472-8. [PMID: 25974751 DOI: 10.1139/bcb-2014-0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Childhood obesity rates are steadily rising. Sustainable Childhood Obesity Prevention Through Community Engagement (SCOPE) is a community-based participatory action research (PAR) program aimed at preventing childhood obesity. This study aimed to describe community perspectives on, and elicit feedback about, SCOPE's first phase of implementation in two pilot cities in British Columbia, Canada. A case study was implemented using interviews and questionnaires to obtain feedback about SCOPE from two groups: SCOPE coordinators and stakeholders (i.e., individuals and organizations that were a member of the community and engaged with SCOPE coordinators). Participants were recruited via email and (or) by telephone. Coordinators completed a telephone interview. Stakeholders completed a questionnaire and (or) a telephone interview. Thematic analysis was conducted. Participants included 2 coordinators and 15 stakeholders. Participants similarly interpreted SCOPE as a program focused on raising awareness about childhood obesity prevention, while engaging multiple community sectors. Overall, participants valued the program's role in facilitating networking and partnership development, providing evidence-based resources, technical expertise, and contributing funding. Participants felt that SCOPE is sustainable. However, participants felt that barriers to achieving healthy weights among children included those related to the built environment, and social, behavioral, and economic obstacles. Perspectives on factors that facilitated and acted as barriers to SCOPE's first phase of implementation were obtained from the SCOPE communities and may be used to enhance the sustainability of SCOPE and its applicability to other BC communities.
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Affiliation(s)
- Bonnie McIntosh
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Amelia Daly
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Louise C Mâsse
- b University of British Columbia, School of Population and Public Health, F508-4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Jean-Paul Collet
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Joan Wharf Higgins
- c University of Victoria, School of Exercise Science, Physical and Health Education, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada
| | - Patti-Jean Naylor
- c University of Victoria, School of Exercise Science, Physical and Health Education, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada
| | - Shazhan Amed
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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Amed S, Nuernberger K, Reimer K, Krueger H, Aydede SK, Ayers D, Collet JP. Care delivery in youth with type 2 diabetes - are we meeting clinical practice guidelines? Pediatr Diabetes 2014; 15:477-83. [PMID: 24888460 DOI: 10.1111/pedi.12147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/14/2014] [Accepted: 03/26/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Studies indicate high rates of treatment failure and early onset diabetes-related complications in youth-onset type 2 diabetes (T2D). We aim to describe the quality of care provided to children and youth with T2D. METHODS This prospective cohort study used administrative datasets to describe individuals aged 10-24 yr diagnosed with T2D at <20 yr of age (488 individuals; 2111 person-years). The primary outcome was being 'at goal' for adherence to Canadian clinical practice guidelines (CPGs). This was defined as having either optimal [three diabetes-related physician visits/year, three hemoglobin A1C (A1C) tests/year, and all recommended screening tests for complications (i.e., retinopathy, nephropathy)] or good (two diabetes-related physician visits/year, two A1C tests/year, and at least two screening tests) adherence to CPGs. Descriptive statistics and logistic regression modeling were used. RESULTS Sixty eight percentage person-years had poor adherence to CPGs (<2 physician visits and A1c tests/year and no screening tests). Only 29% and 25% were at goal for adherence in the 15-19 and 20-24 yr age groups, respectively. There was a 52% decreased odds of being at goal for adherence 4 yr after diagnosis of T2D (p < 0.001). For every year increase in age at diagnosis, there was a 5% decreased odds of being at goal (p = 0.04). CONCLUSIONS Youth with T2D are not receiving high quality care, and older youth and young adults are particularly at risk. Future research is needed to understand the effectiveness of care in the context of poor adherence as well as patient, physician, and health system factors that might improve adherence.
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Affiliation(s)
- Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital, Vancouver, BC, Canada
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Fazeli MS, Lin Y, Nikoo N, Jaggumantri S, Collet JP, Afshar K. Biofeedback for nonneuropathic daytime voiding disorders in children: a systematic review and meta-analysis of randomized controlled trials. J Urol 2014; 193:274-9. [PMID: 25072179 DOI: 10.1016/j.juro.2014.07.097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Biofeedback has been used to treat children with symptoms of bladder dysfunction not responding to standard therapy alone. However, evidence of the effectiveness of biofeedback is scarce and is based on small studies. We conducted a systematic review of the literature to assess the effects of biofeedback as adjunctive therapy for symptoms of nonneuropathic voiding disorders in children up to age 18 years. MATERIALS AND METHODS We searched MEDLINE(®), Embase(®) and CENTRAL on the OvidSP(®) platform as well as conference proceedings for randomized trials presented at scientific conventions, symposia and workshops through August 13, 2013. Hand searches and review of reference lists of retrieved articles were also performed. RESULTS Five eligible studies were included in the systematic review, of which 4 (382 participants) were pooled in the meta-analysis based on available outcomes data. The overall proportion of cases with resolved incontinence at month 6 was similar in the biofeedback and control groups (OR 1.37 [95% CI 0.64 to 2.93], RD 0.07 [-0.09, 0.23]). There was also no significant difference in mean maximum urinary flow rate (mean difference 0.50 ml, range -0.56 to 1.55) or likelihood of urinary tract infection (OR 1.30 [95% CI 0.65 to 2.58]). CONCLUSIONS Current evidence does not support the effectiveness of biofeedback in the management of children with nonneuropathic voiding disorders. More high quality, randomized controlled trials are needed to better evaluate the effect of biofeedback.
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Affiliation(s)
- Mir Sohail Fazeli
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yiqun Lin
- School of Public and Population Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nooshin Nikoo
- School of Public and Population Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sravan Jaggumantri
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urology, University of British Columbia, Vancouver, British Columbia, Canada.
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Schreiber RA, Masucci L, Kaczorowski J, Collet JP, Lutley P, Espinosa V, Bryan S. Home-based screening for biliary atresia using infant stool colour cards: a large-scale prospective cohort study and cost-effectiveness analysis. J Med Screen 2014; 21:126-32. [PMID: 25009198 DOI: 10.1177/0969141314542115] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Biliary atresia (BA), a leading cause of paediatric liver failure and liver transplantation, manifests by three weeks of life as jaundice with acholic stools. Poor outcomes due to delayed diagnosis remain a problem worldwide. We evaluated and assessed the cost-effectiveness of methods of introducing a BA Infant Stool Colour Card (ISCC) screening programme in Canada. SETTING AND METHODS A prospective study at BC Women's Hospital recruited consecutive healthy newborns through six incrementally more intensive screening approaches. Under the baseline "passive" strategy, families received ISCCs at maternity, with instructions to monitor infant stool colour daily and return the ISCC by mail at age 30 days. Additional strategies were: ISCC mailed to family physician; reminder letters or telephone calls to families or physicians. Random telephone surveys of ISCC non-returners assessed total card utilization. Primary outcome was ISCC utilization rate expressed as a composite outcome of the ISCC return rate and non-returned ISCC use. Markov modelling was used to predict incremental costs and life years gained from screening (passive and reminder), compared with no screening, over a 10-year time horizon. RESULTS 6,187 families were enrolled. Card utilization rates in the passive screening strategy were estimated at 60-94%. For a Canadian population, the increase in cost for passive screening, compared with no screening, is $213,584 and the gain in life years is 9.7 ($22,000 per life-year gained). CONCLUSIONS A BA ISCC screening programme targeting families of newborns is feasible in Canada. Passive distribution of ISCC at maternity is potentially effective and highly cost-effective.
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Affiliation(s)
- Richard A Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition Department of Pediatrics, University of British Columbia, Vancouver, Canada Child and Family Research Institute, Vancouver, Canada
| | - Lisa Masucci
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Institute, BC, Canada
| | - Janusz Kaczorowski
- Dept of Family and Emergency Medicine, Université de Montréal and CRCHUM, Canada
| | - J P Collet
- Department of Pediatrics, University of British Columbia, Vancouver, Canada Child and Family Research Institute, Vancouver, Canada
| | - Pamela Lutley
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Institute, BC, Canada
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Sarmast H, Mosavianpour M, Collet JP, Kissoon N. TDF (Theoretical Domain Framework): how inclusive are TDF domains and constructs compared to other tools for assessing barriers to change? BMC Health Serv Res 2014. [PMCID: PMC4122970 DOI: 10.1186/1472-6963-14-s2-p81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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