1
|
Barton E, Verduri A, Carter B, Hughes J, Hewitt J, Maskell NA. The association between frailty and survival in patients with pleural disease: a retrospective cohort study. BMC Pulm Med 2024; 24:180. [PMID: 38627673 PMCID: PMC11020337 DOI: 10.1186/s12890-024-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease. METHODS In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI ≥ 0.4) or not frail (mFI ≤ 0.2). RESULTS 676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161-1595). A positive association was found between 12-month mortality and frailty (aHR = 1.72, 95% CI 1.02-2.76, p = 0.025) and age ≥ 80 (aHR = 1.80, 95% CI 1.24-2.62, p = 0.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR = 4.36, 95% CI 2.17-8.77, p < 0.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR = 10.40, 95% CI 6.01-18.01, p < 0.0001). CONCLUSION This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients' frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management. TRIAL REGISTRATION This study is registered with the Health Research Authority (REC reference 08/H0102/11) and the NIHR Portfolio (Study ID 8960).
Collapse
Affiliation(s)
- Eleanor Barton
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
| | - A Verduri
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Policlinico Modena, Italy
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - J Hughes
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - J Hewitt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - N A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
2
|
Bierlich KC, Kane A, Hildebrand L, Bird CN, Fernandez Ajo A, Stewart JD, Hewitt J, Hildebrand I, Sumich J, Torres LG. Downsized: gray whales using an alternative foraging ground have smaller morphology. Biol Lett 2023; 19:20230043. [PMID: 37554011 PMCID: PMC10410206 DOI: 10.1098/rsbl.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
Describing individual morphology and growth is key for identifying ecological niches and monitoring the health and fitness of populations. Eastern North Pacific ((ENP), approximately 16 650 individuals) gray whales primarily feed in the Arctic/sub-Arctic regions, while a small subgroup called the Pacific Coast Feeding Group (PCFG, approximately 212 individuals) instead feeds between northern California, USA and British Columbia, Canada. Evidence suggests PCFG whales have lower body condition than ENP whales. Here we investigate morphological differences (length, skull, and fluke span) and compare length-at-age growth curves between ENP and PCFG whales. We use ENP gray whale length-at-age data comprised of strandings, whaling, and aerial photogrammetry (1926-1997) for comparison to data from PCFG whales collected through non-invasive techniques (2016-2022) to estimate age (photo identification) and length (drone-based photogrammetry). We use Bayesian methods to incorporate uncertainty associated with morphological measurements (manual and photogrammetric) and age estimates. We find that while PCFG and ENP whales have similar growth rates, PCFG whales reach smaller asymptotic lengths. Additionally, PCFG whales have relatively smaller skulls and flukes than ENP whales. These findings represent a striking example of morphological adaptation that may facilitate PCFG whales accessing a foraging niche distinct from the Arctic foraging grounds of the broader ENP population.
Collapse
Affiliation(s)
- K. C. Bierlich
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| | - A. Kane
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| | - L. Hildebrand
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| | - C. N. Bird
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| | - A. Fernandez Ajo
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| | - J. D. Stewart
- Ocean Ecology Lab, Marine Mammal Institute, Department of Fisheries, Wildlife and Conservation Sciences, Oregon State University, Corvallis, Oregon, USA
| | - J. Hewitt
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - I. Hildebrand
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| | - J. Sumich
- Marine Mammal Institute, Department of Fisheries, Wildlife and Conservation Sciences, Oregon State University, Corvallis, Oregon, USA
| | - L. G. Torres
- Geospatial Ecology of Marine Megafauna Lab, Oregon State University, Corvallis, Oregon, USA
| |
Collapse
|
3
|
Alexander JD, Freis SM, Zellers SM, Corley R, Ledbetter A, Schneider RK, Phelan C, Subramonyam H, Frieser M, Rea-Sandin G, Stocker ME, Vernier H, Jiang M, Luo Y, Zhao Q, Rhea SA, Hewitt J, Luciana M, McGue M, Wilson S, Resnick P, Friedman NP, Vrieze SI. Evaluating longitudinal relationships between parental monitoring and substance use in a multi-year, intensive longitudinal study of 670 adolescent twins. Front Psychiatry 2023; 14:1149079. [PMID: 37252134 PMCID: PMC10213319 DOI: 10.3389/fpsyt.2023.1149079] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/04/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Parental monitoring is a key intervention target for adolescent substance use, however this practice is largely supported by causally uninformative cross-sectional or sparse-longitudinal observational research designs. Methods We therefore evaluated relationships between adolescent substance use (assessed weekly) and parental monitoring (assessed every two months) in 670 adolescent twins for two years. This allowed us to assess how individual-level parental monitoring and substance use trajectories were related and, via the twin design, to quantify genetic and environmental contributions to these relationships. Furthermore, we attempted to devise additional measures of parental monitoring by collecting quasi-continuous GPS locations and calculating a) time spent at home between midnight and 5am and b) time spent at school between 8am-3pm. Results ACE-decomposed latent growth models found alcohol and cannabis use increased with age while parental monitoring, time at home, and time at school decreased. Baseline alcohol and cannabis use were correlated (r = .65) and associated with baseline parental monitoring (r = -.24 to -.29) but not with baseline GPS measures (r = -.06 to -.16). Longitudinally, changes in substance use and parental monitoring were not significantly correlated. Geospatial measures were largely unrelated to parental monitoring, though changes in cannabis use and time at home were highly correlated (r = -.53 to -.90), with genetic correlations suggesting their relationship was substantially genetically mediated. Due to power constraints, ACE estimates and biometric correlations were imprecisely estimated. Most of the substance use and parental monitoring phenotypes were substantially heritable, but genetic correlations between them were not significantly different from 0. Discussion Overall, we found developmental changes in each phenotype, baseline correlations between substance use and parental monitoring, co-occurring changes and mutual genetic influences for time at home and cannabis use, and substantial genetic influences on many substance use and parental monitoring phenotypes. However, our geospatial variables were mostly unrelated to parental monitoring, suggesting they poorly measured this construct. Furthermore, though we did not detect evidence of genetic confounding, changes in parental monitoring and substance use were not significantly correlated, suggesting that, at least in community samples of mid-to-late adolescents, the two may not be causally related.
Collapse
Affiliation(s)
- Jordan D. Alexander
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Samantha M. Freis
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Stephanie M. Zellers
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Robin Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Amy Ledbetter
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Rachel K. Schneider
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Chanda Phelan
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Maia Frieser
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Gianna Rea-Sandin
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Michelle E. Stocker
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Helen Vernier
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Ming Jiang
- Department of Computer Science, University of Minnesota, Minneapolis, MN, United States
| | - Yan Luo
- Department of Computer Science, University of Minnesota, Minneapolis, MN, United States
| | - Qi Zhao
- Department of Computer Science, University of Minnesota, Minneapolis, MN, United States
| | - Sally Ann Rhea
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Monica Luciana
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Matt McGue
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Sylia Wilson
- Institute of Child Development, University of Minnesota, Minneapolis, MN, United States
| | - Paul Resnick
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Naomi P. Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Scott I. Vrieze
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
4
|
Wilson S, Fan CC, Hewitt J. ABCD Behavior Genetics: Twin, Family, and Genomic Studies Using the Adolescent Brain Cognitive Development (ABCD) Study Dataset. Behav Genet 2023; 53:155-158. [PMID: 37095243 PMCID: PMC10833231 DOI: 10.1007/s10519-023-10144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Sylia Wilson
- Institute of Child Development, University of Minnesota, Minneapolis, USA.
| | - Chun Chieh Fan
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Radiology, School of Medicine, University of California, San Diego, USA
| | - John Hewitt
- Institute for Behavioral Genetics, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA
| |
Collapse
|
5
|
Noll D, Green L, Asokan G, Barbaro A, Hewitt J, Ovenden C, Kanhere H, Trochsler M. Is YouTube™ a good source of information for patients to understand laparoscopic fundoplication? Ann R Coll Surg Engl 2023; 105:365-371. [PMID: 36374324 PMCID: PMC10066653 DOI: 10.1308/rcsann.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Gastro-oesophageal reflux disease affects 10-20% of the population, and laparoscopic fundoplication is one management option. As the most frequently accessed video-sharing website, YouTube has become a popular source of information for patients. This study conducted a cross-sectional analysis of the quality and demographics of patient education videos available on YouTube for laparoscopic fundoplication. METHODS Three searches were performed on YouTube using the phrases 'laparoscopic fundoplication', 'heartburn surgery' and 'reflux operation'. The Health on The Net (HON) code, DISCERN and Journal of the American Medical Association (JAMA) systems were used to score the first 75 results from each query. Information about each video was collected, including number of views, time since posting, number of comments and the author of the video. Relationships between these variables and video quality were investigated. RESULTS The median number of views was 3,793. The most common author category was videos produced by surgeons. Overall the quality was poor, mean HON score was 2.5/8, mean DISCERN score was 29.3/80 and mean JAMA score was 1.5/4. Surgeon-authored videos scored higher when scored using the HON and JAMA systems. Videos of longer duration scored higher using all three scoring systems. No other factors were found to be associated with video quality. CONCLUSION The quality of information in YouTube videos on laparoscopic fundoplication is unreliable. Doctors should be aware of this and caution their patients of YouTube's limitations. Further research is needed to develop validated scoring systems for evaluating the quality of patient education videos.
Collapse
Affiliation(s)
- D Noll
- The University of Adelaide, Australia
| | - L Green
- The University of Adelaide, Australia
| | - G Asokan
- The University of Adelaide, Australia
| | - A Barbaro
- The University of Adelaide, Australia
| | - J Hewitt
- The University of Adelaide, Australia
| | - C Ovenden
- The University of Adelaide, Australia
| | | | | |
Collapse
|
6
|
Mohan C, Entezami P, John S, Hewitt J, Sylevych V, Psirides A. Comparison of the Aotearoa New Zealand Early Warning Score and National Early Warning Score to predict adverse inpatient events in a vital sign dataset. Anaesthesia 2023. [PMID: 36991498 DOI: 10.1111/anae.16007] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Abstract
Aotearoa New Zealand uses a single early warning score (EWS) across all public and private hospitals to detect adult inpatient physiological deterioration. This combines the aggregate weighted scoring of the UK National Early Warning Score with single parameter activation from Australian medical emergency team systems. We conducted a retrospective analysis of a large vital sign dataset to validate the predictive performance of the New Zealand EWS in discriminating between patients at risk of serious adverse events and compared this with the UK EWS. We also compared predictive performance for patients admitted under medical vs. surgical specialties. A total of 1,738,787 aggregate scores (13,910,296 individual vital signs) were obtained from 102,394 hospital admissions to six hospitals within the Canterbury District Health Board of New Zealand's South Island. Predictive performance of each scoring system was determined using area under the receiver operating characteristic curve. Analysis showed that the New Zealand EWS is equivalent to the UK EWS in predicting patients at risk of serious adverse events (cardiac arrest, death and/or unanticipated ICU admission). Area under the receiver operating characteristic curve for both EWSs for any adverse outcome was 0.874 (95%CI 0.871-0.878) and 0.874 (95%CI 0.870-0.877), respectively. Both EWSs showed superior predictive value for cardiac arrest and/or death in patients admitted under surgical rather than medical specialties. Our study is the first validation of the New Zealand EWS in predicting serious adverse events in a broad dataset and supports previous work showing the UK EWS has superior predictive performance in surgical rather than medical patients.
Collapse
Affiliation(s)
- C Mohan
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - P Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - S John
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - J Hewitt
- Quality and Patient Safety, Christchurch Hospital, Christchurch, New Zealand
| | - V Sylevych
- Decision Support Unit, Christchurch Hospital, Christchurch, New Zealand
| | - A Psirides
- Department of Intensive Care, Wellington Regional Hospital, Wellington, New Zealand
| |
Collapse
|
7
|
Humphry N, Jones M, Goodison S, Carter B, Hewitt J. The Effect of Sarcopenia on Postoperative Outcomes Following Emergency Laparotomy: A Systematic Review and Meta-Analysis. J Frailty Aging 2023; 12:305-310. [PMID: 38008981 DOI: 10.14283/jfa.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Emergency laparotomy procedures have high rates of postoperative mortality and morbidity in older patient. Sarcopenia is associated with poor postoperative outcomes in elective surgeries and there is growing evidence for its use as a risk predictor in the emergency setting. The study aimed to evaluate the effect of sarcopenia on postoperative mortality and morbidity following emergency laparotomy. Five electronic databases were systematically searched (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science) from conception until the 14th February 2022. All prospective cohort studies were included. Risk of bias was assessed with the Newcastle-Ottawa score. Pooled meta-analyses were estimated using the Mantel-Haenszel and inverse-generic variance method for mortality and morbidity outcomes. Eleven retrospective cohort studies were included, of which ten were included in the meta-analysis comprising of 3492 patients (1027 sarcopenic, 2465 non-sarcopenic). The study level incidence of sarcopenia ranged from 24.6 to 50.3% with a median rate of 25.1%. Sarcopenia was associated with increased 30-day mortality (OR 2.36, 95% CI, 1.66, 3.37, I2 = 43%), 90-day mortality (OR 2.51, 95% CI, 1.79, 3.52, I2 = 0%), and length of hospital stay (in days) (MD 1.18, 95% CI, 0.42, 1.94, I2 = 0%, P=0.002), but not incidence of postoperative major complications (OR 1.49, 95% CI, 0.86, 2.56, I2 = 70%, P = 0.15). Sarcopenia predicts poor outcomes following emergency laparotomy. We suggest assessment of sarcopenia should be incorporated into acute surgical assessment to identify high risk patients and inform clinical decision-making prior to an emergency laparotomy.
Collapse
Affiliation(s)
- N Humphry
- Dr Nia Humphry, School of Medicine, Cardiff University, United Kingdom, , Telephone number: +447815913222
| | | | | | | | | |
Collapse
|
8
|
Neumann A, Nolte IM, Pappa I, Ahluwalia TS, Pettersson E, Rodriguez A, Whitehouse A, van Beijsterveldt CEM, Benyamin B, Hammerschlag AR, Helmer Q, Karhunen V, Krapohl E, Lu Y, van der Most PJ, Palviainen T, St Pourcain B, Seppälä I, Suarez A, Vilor-Tejedor N, Tiesler CMT, Wang C, Wills A, Zhou A, Alemany S, Bisgaard H, Bønnelykke K, Davies GE, Hakulinen C, Henders AK, Hyppönen E, Stokholm J, Bartels M, Hottenga JJ, Heinrich J, Hewitt J, Keltikangas-Järvinen L, Korhonen T, Kaprio J, Lahti J, Lahti-Pulkkinen M, Lehtimäki T, Middeldorp CM, Najman JM, Pennell C, Power C, Oldehinkel AJ, Plomin R, Räikkönen K, Raitakari OT, Rimfeld K, Sass L, Snieder H, Standl M, Sunyer J, Williams GM, Bakermans-Kranenburg MJ, Boomsma DI, van IJzendoorn MH, Hartman CA, Tiemeier H. A genome-wide association study of total child psychiatric problems scores. PLoS One 2022; 17:e0273116. [PMID: 35994476 PMCID: PMC9394806 DOI: 10.1371/journal.pone.0273116] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Substantial genetic correlations have been reported across psychiatric disorders and numerous cross-disorder genetic variants have been detected. To identify the genetic variants underlying general psychopathology in childhood, we performed a genome-wide association study using a total psychiatric problem score. We analyzed 6,844,199 common SNPs in 38,418 school-aged children from 20 population-based cohorts participating in the EAGLE consortium. The SNP heritability of total psychiatric problems was 5.4% (SE = 0.01) and two loci reached genome-wide significance: rs10767094 and rs202005905. We also observed an association of SBF2, a gene associated with neuroticism in previous GWAS, with total psychiatric problems. The genetic effects underlying the total score were shared with common psychiatric disorders only (attention-deficit/hyperactivity disorder, anxiety, depression, insomnia) (rG > 0.49), but not with autism or the less common adult disorders (schizophrenia, bipolar disorder, or eating disorders) (rG < 0.01). Importantly, the total psychiatric problem score also showed at least a moderate genetic correlation with intelligence, educational attainment, wellbeing, smoking, and body fat (rG > 0.29). The results suggest that many common genetic variants are associated with childhood psychiatric symptoms and related phenotypes in general instead of with specific symptoms. Further research is needed to establish causality and pleiotropic mechanisms between related traits.
Collapse
Affiliation(s)
- Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Irene Pappa
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tarunveer S. Ahluwalia
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Andrew Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - Beben Benyamin
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Anke R. Hammerschlag
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Quinta Helmer
- Netherlands Twin Register, Dept Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ville Karhunen
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Eva Krapohl
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter J. van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teemu Palviainen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Beate St Pourcain
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherland
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center—Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Suarez
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Natalia Vilor-Tejedor
- Center for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- BarcelonaBeta Brain Research Center (BBRC)–Pasqual Maragall Foundation, Barcelona, Spain
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carla M. T. Tiesler
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- LMU–Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Munich, Germany
| | - Carol Wang
- School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda Wills
- Division of Substance Dependence, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States of America
| | - Ang Zhou
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Silvia Alemany
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gareth E. Davies
- Avera Institute for Human Genetics, Sioux Falls, South Dakota, United States of America
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anjali K. Henders
- Institute of Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Elina Hyppönen
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Meike Bartels
- Netherlands Twin Register, Dept Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jouke-Jan Hottenga
- Netherlands Twin Register, Dept Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Joachim Heinrich
- LMU–Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Munich, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States of America
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States of America
| | | | - Tellervo Korhonen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center—Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Christel M. Middeldorp
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Jackob M. Najman
- Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Craig Pennell
- School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Chris Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Albertine J. Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion Regulation (IPCE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert Plomin
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Kaili Rimfeld
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lærke Sass
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie Standl
- LMU–Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Munich, Germany
| | - Jordi Sunyer
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Gail M. Williams
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | | | - Dorret I. Boomsma
- Netherlands Twin Register, Dept Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Catharina A. Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| |
Collapse
|
9
|
Verduri A, Hewitt J, Carter B, Tonelli R, Clini E, Beghè B. Prevalence of asthma and COPD in a cohort of patients at the follow up after COVID-19 pneumonia. Pulmonology 2022; 29:247-249. [PMID: 35798643 PMCID: PMC9186410 DOI: 10.1016/j.pulmoe.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- A Verduri
- Department of Surgical and Medical Sciences (SMECHIMAI), University of Modena and Reggio Emilia, and Respiratory Unit, University Hospital of Modena Policlinico, Modena, I
| | - J Hewitt
- Division of Population Medicine, Cardiff University, Wales, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, England, UK
| | - R Tonelli
- Clinical and Experimental Medicine PhD School, University of Modena and Reggio, Modena, I
| | - E Clini
- Department of Surgical and Medical Sciences (SMECHIMAI), University of Modena and Reggio Emilia, and Respiratory Unit, University Hospital of Modena Policlinico, Modena, I.
| | - B Beghè
- Department of Surgical and Medical Sciences (SMECHIMAI), University of Modena and Reggio Emilia, and Respiratory Unit, University Hospital of Modena Policlinico, Modena, I
| |
Collapse
|
10
|
Ip HF, van der Laan CM, Krapohl EML, Brikell I, Sánchez-Mora C, Nolte IM, St Pourcain B, Bolhuis K, Palviainen T, Zafarmand H, Colodro-Conde L, Gordon S, Zayats T, Aliev F, Jiang C, Wang CA, Saunders G, Karhunen V, Hammerschlag AR, Adkins DE, Border R, Peterson RE, Prinz JA, Thiering E, Seppälä I, Vilor-Tejedor N, Ahluwalia TS, Day FR, Hottenga JJ, Allegrini AG, Rimfeld K, Chen Q, Lu Y, Martin J, Soler Artigas M, Rovira P, Bosch R, Español G, Ramos Quiroga JA, Neumann A, Ensink J, Grasby K, Morosoli JJ, Tong X, Marrington S, Middeldorp C, Scott JG, Vinkhuyzen A, Shabalin AA, Corley R, Evans LM, Sugden K, Alemany S, Sass L, Vinding R, Ruth K, Tyrrell J, Davies GE, Ehli EA, Hagenbeek FA, De Zeeuw E, Van Beijsterveldt TCEM, Larsson H, Snieder H, Verhulst FC, Amin N, Whipp AM, Korhonen T, Vuoksimaa E, Rose RJ, Uitterlinden AG, Heath AC, Madden P, Haavik J, Harris JR, Helgeland Ø, Johansson S, Knudsen GPS, Njolstad PR, Lu Q, Rodriguez A, Henders AK, Mamun A, Najman JM, Brown S, Hopfer C, Krauter K, Reynolds C, Smolen A, Stallings M, Wadsworth S, Wall TL, Silberg JL, Miller A, Keltikangas-Järvinen L, Hakulinen C, Pulkki-Råback L, Havdahl A, Magnus P, Raitakari OT, Perry JRB, Llop S, Lopez-Espinosa MJ, Bønnelykke K, Bisgaard H, Sunyer J, Lehtimäki T, Arseneault L, Standl M, Heinrich J, Boden J, Pearson J, Horwood LJ, Kennedy M, Poulton R, Eaves LJ, Maes HH, Hewitt J, Copeland WE, Costello EJ, Williams GM, Wray N, Järvelin MR, McGue M, Iacono W, Caspi A, Moffitt TE, Whitehouse A, Pennell CE, Klump KL, Burt SA, Dick DM, Reichborn-Kjennerud T, Martin NG, Medland SE, Vrijkotte T, Kaprio J, Tiemeier H, Davey Smith G, Hartman CA, Oldehinkel AJ, Casas M, Ribasés M, Lichtenstein P, Lundström S, Plomin R, Bartels M, Nivard MG, Boomsma DI. Genetic association study of childhood aggression across raters, instruments, and age. Transl Psychiatry 2021; 11:413. [PMID: 34330890 PMCID: PMC8324785 DOI: 10.1038/s41398-021-01480-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 04/11/2021] [Accepted: 05/20/2021] [Indexed: 01/15/2023] Open
Abstract
Childhood aggressive behavior (AGG) has a substantial heritability of around 50%. Here we present a genome-wide association meta-analysis (GWAMA) of childhood AGG, in which all phenotype measures across childhood ages from multiple assessors were included. We analyzed phenotype assessments for a total of 328 935 observations from 87 485 children aged between 1.5 and 18 years, while accounting for sample overlap. We also meta-analyzed within subsets of the data, i.e., within rater, instrument and age. SNP-heritability for the overall meta-analysis (AGGoverall) was 3.31% (SE = 0.0038). We found no genome-wide significant SNPs for AGGoverall. The gene-based analysis returned three significant genes: ST3GAL3 (P = 1.6E-06), PCDH7 (P = 2.0E-06), and IPO13 (P = 2.5E-06). All three genes have previously been associated with educational traits. Polygenic scores based on our GWAMA significantly predicted aggression in a holdout sample of children (variance explained = 0.44%) and in retrospectively assessed childhood aggression (variance explained = 0.20%). Genetic correlations (rg) among rater-specific assessment of AGG ranged from rg = 0.46 between self- and teacher-assessment to rg = 0.81 between mother- and teacher-assessment. We obtained moderate-to-strong rgs with selected phenotypes from multiple domains, but hardly with any of the classical biomarkers thought to be associated with AGG. Significant genetic correlations were observed with most psychiatric and psychological traits (range [Formula: see text]: 0.19-1.00), except for obsessive-compulsive disorder. Aggression had a negative genetic correlation (rg = ~-0.5) with cognitive traits and age at first birth. Aggression was strongly genetically correlated with smoking phenotypes (range [Formula: see text]: 0.46-0.60). The genetic correlations between aggression and psychiatric disorders were weaker for teacher-reported AGG than for mother- and self-reported AGG. The current GWAMA of childhood aggression provides a powerful tool to interrogate the rater-specific genetic etiology of AGG.
Collapse
Affiliation(s)
- Hill F Ip
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Camiel M van der Laan
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Eva M L Krapohl
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cristina Sánchez-Mora
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Beate St Pourcain
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Koen Bolhuis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Teemu Palviainen
- Institute for Molecular Medicine FIMM, HiLife, University of Helsinki, Helsinki, Finland
| | - Hadi Zafarmand
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Scott Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Tetyana Zayats
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Fazil Aliev
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Faculty of Business, Karabuk University, Karabuk, Turkey
| | - Chang Jiang
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Carol A Wang
- Faculty of Medicine and Health, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Gretchen Saunders
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Ville Karhunen
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Anke R Hammerschlag
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Daniel E Adkins
- Department of Sociology, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Richard Border
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Applied Mathematics, University of Colorado Boulder, Boulder, CO, USA
| | - Roseann E Peterson
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph A Prinz
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Division of Metabolic Diseases and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Natàlia Vilor-Tejedor
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Barcelona Beta Brain Research Center, Pasqual Maragall Foundation (FPM), Barcelona, Spain
| | - Tarunveer S Ahluwalia
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Felix R Day
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrea G Allegrini
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kaili Rimfeld
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Martin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - María Soler Artigas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Rovira
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Bosch
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Español
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep Antoni Ramos Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Judith Ensink
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
- De Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Katrina Grasby
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - José J Morosoli
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Xiaoran Tong
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Shelby Marrington
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Christel Middeldorp
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia
- Children's Health Queensland Hospital and Health Service, Child and Youth Mental Health Service, Brisbane, QLD, Australia
| | - James G Scott
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Metro North Mental Health, University of Queensland, St Lucia, QLD, Australia
- Queensland Centre for Mental Health Research, St Lucia, QLD, Australia
| | - Anna Vinkhuyzen
- Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD, Australia
| | - Andrey A Shabalin
- Department of Psychiatry, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robin Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Ecology and Evolutionary Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Luke M Evans
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Ecology and Evolutionary Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Karen Sugden
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience and Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - Silvia Alemany
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Lærke Sass
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Vinding
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kate Ruth
- Genetics of Complex Traits, Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter, UK
| | - Jess Tyrrell
- Genetics of Complex Traits, Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter, UK
| | | | - Erik A Ehli
- Avera Institute for Human Genetics, Sioux Falls, SD, USA
| | - Fiona A Hagenbeek
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eveline De Zeeuw
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Najaf Amin
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alyce M Whipp
- Institute for Molecular Medicine FIMM, HiLife, University of Helsinki, Helsinki, Finland
| | - Tellervo Korhonen
- Institute for Molecular Medicine FIMM, HiLife, University of Helsinki, Helsinki, Finland
| | - Eero Vuoksimaa
- Institute for Molecular Medicine FIMM, HiLife, University of Helsinki, Helsinki, Finland
| | - Richard J Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, The Netherlands
| | | | | | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jennifer R Harris
- Division of Health Data and Digitalisation, The Norwegian Institute of Public Health, Oslo, Norway
| | - Øyvind Helgeland
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalization, The Norwegian Institute of Public Health, Bergen, Norway
| | - Stefan Johansson
- Department of Biomedicine, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gun Peggy S Knudsen
- Division of Health Data and Digitalisation, The Norwegian Institute of Public Health, Oslo, Norway
| | | | - Qing Lu
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- School of Psychology, University of Lincoln, Lincolnshire, UK
| | - Anjali K Henders
- Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, University of Queensland, Long Pocket, QLD, Australia
| | - Jackob M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Sandy Brown
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Kenneth Krauter
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Chandra Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - Andrew Smolen
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Michael Stallings
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Sally Wadsworth
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Tamara L Wall
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Judy L Silberg
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human & Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Allison Miller
- Department of Pathology and Biomedical Science, and Carney Centre for Pharmacogenomics, University of Otago Christchurch, Christchurch Central City, New Zealand
| | | | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - John R B Perry
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Sabrina Llop
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Jose Lopez-Espinosa
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jordi Sunyer
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Louise Arseneault
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University of Munich Medical Center, Ludwig-Maximilians-Universität München, Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Joseph Boden
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, Christchurch Central City, New Zealand
| | - John Pearson
- Biostatistics and Computational Biology Unit, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch Central City, New Zealand
| | - L John Horwood
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, Christchurch Central City, New Zealand
| | - Martin Kennedy
- Department of Pathology and Biomedical Science, and Carney Centre for Pharmacogenomics, University of Otago Christchurch, Christchurch Central City, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Lindon J Eaves
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human & Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hermine H Maes
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human & Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - William E Copeland
- Department of Psychiatry, College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Naomi Wray
- Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD, Australia
- Queensland Brain Institute, Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD, Australia
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - William Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Avshalom Caspi
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience and Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Terrie E Moffitt
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience and Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Craig E Pennell
- Faculty of Medicine and Health, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - S Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Danielle M Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
- College Behavioral and Emotional Health Institute, Virginia Commonwealth University, Richmond, VA, USA
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Tanja Vrijkotte
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, HiLife, University of Helsinki, Helsinki, Finland
- Department of Public Health, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catharina A Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albertine J Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miquel Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Ribasés
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Robert Plomin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Meike Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Michel G Nivard
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Li Y, Thompson WK, Reuter C, Nillo R, Jernigan T, Dale A, Sugrue LP, Brown J, Dougherty RF, Rauschecker A, Rudie J, Barch DM, Calhoun V, Hagler D, Hatton S, Tanabe J, Marshall A, Sher KJ, Heeringa S, Hermosillo R, Banich MT, Squeglia L, Bjork J, Zucker R, Neale M, Herting M, Sheth C, Huber R, Reeves G, Hettema JM, Howlett KD, Cloak C, Baskin-Sommers A, Rapuano K, Gonzalez R, Karcher N, Laird A, Baker F, James R, Sowell E, Dick A, Hawes S, Sutherland M, Bagot K, Bodurka J, Breslin F, Morris A, Paulus M, Gray K, Hoffman E, Weiss S, Rajapakse N, Glantz M, Nagel B, Ewing SF, Goldstone A, Pfefferbaum A, Prouty D, Rosenberg M, Bookheimer S, Tapert S, Infante M, Jacobus J, Giedd J, Shilling P, Wade N, Uban K, Haist F, Heyser C, Palmer C, Kuperman J, Hewitt J, Cottler L, Isaiah A, Chang L, Edwards S, Ernst T, Heitzeg M, Puttler L, Sripada C, Iacono W, Luciana M, Clark D, Luna B, Schirda C, Foxe J, Freedman E, Mason M, McGlade E, Renshaw P, Yurgelun-Todd D, Albaugh M, Allgaier N, Chaarani B, Potter A, Ivanova M, Lisdahl K, Do E, Maes H, Bogdan R, Anokhin A, Dosenbach N, Glaser P, Heath A, Casey BJ, Gee D, Garavan HP, Dowling G, Brown S. Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children. JAMA Neurol 2021; 78:578-587. [PMID: 33749724 PMCID: PMC7985817 DOI: 10.1001/jamaneurol.2021.0306] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings. Objectives To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. Design, Setting, and Participants This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. Main Outcomes and Measures Percentage of children with IFs in each category and prevalence of specific IFs. Results A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2 = 0.260; 95% CI, 0.135-0.387). Conclusions and Relevance Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.
Collapse
Affiliation(s)
- Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Wesley K. Thompson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Chase Reuter
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Ryan Nillo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Terry Jernigan
- Center for Human Development, University of California, San Diego, La Jolla
| | - Anders Dale
- Center for Human Development, University of California, San Diego, La Jolla
| | - Leo P. Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Julian Brown
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robert F Dougherty
- Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, California
| | - Andreas Rauschecker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jeffrey Rudie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Psychiatry, Radiology, Washington University in St Louis, St Louis, Missouri
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Tech, Emory University, Atlanta
| | - Donald Hagler
- Department of Radiology, University of California, San Diego, La Jolla
| | - Sean Hatton
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora
| | - Andrew Marshall
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia
| | - Steven Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health Sciences University, Portland
| | - Marie T Banich
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado, Boulder
| | - Lindsay Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Robert Zucker
- Department of Psychiatry and Psychology, University of Michigan, Ann Arbor
| | - Michael Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Megan Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Rebeka Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland, Baltimore
| | - John M Hettema
- Department of Psychiatry, Texas A&M Health Science Center, Bryan
| | - Katia Delrahim Howlett
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Christine Cloak
- Department of Radiology and Nuclear Medicine, University of Maryland, Baltimore
| | | | - Kristina Rapuano
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Raul Gonzalez
- Department of Psychology, Florida International University, Miami
| | - Nicole Karcher
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Angela Laird
- Department of Physics, Florida International University, Miami
| | | | - Regina James
- Department of Clinical Research, 2M Research Services, Arlington, Virginia
| | - Elizabeth Sowell
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Anthony Dick
- Department of Psychology, Florida International University, Miami
| | - Samuel Hawes
- Department of Psychology, Florida International University, Miami
| | | | - Kara Bagot
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Amanda Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Kevin Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth Hoffman
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Susan Weiss
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Nishadi Rajapakse
- Department of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Meyer Glantz
- Department of Psychology, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Bonnie Nagel
- Department of Psychiatry, Oregon Health and Science University, Portland
| | | | | | | | | | - Monica Rosenberg
- Department of Psychology, University of Chicago, Chicago, Illinois
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles
| | - Susan Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Maria Infante
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Joanna Jacobus
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Jay Giedd
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Paul Shilling
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Natasha Wade
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Kristina Uban
- Department of Public Health, University of California, Irvine
| | - Frank Haist
- Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla
| | - Charles Heyser
- Center for Human Development, University of California, San Diego, La Jolla
| | - Clare Palmer
- Center for Human Development, University of California, San Diego, La Jolla
| | - Joshua Kuperman
- Department of Radiology, University of California, San Diego, La Jolla
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder
| | - Linda Cottler
- Department of Epidemiology, University of Florida, Gainesville
| | - Amal Isaiah
- Department of Otorhinolaryngology/Head and Neck Surgery and Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Linda Chang
- Departments of Radiology and Neurology, University of Maryland, Baltimore
| | - Sarah Edwards
- Department of Psychiatry, University of Maryland, Baltimore
| | - Thomas Ernst
- Department of Radiology, University of Maryland, Baltimore
| | - Mary Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Leon Puttler
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - William Iacono
- Department of Psychology, University of Minnesota, Minneapolis
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis
| | - Duncan Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Claudiu Schirda
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Foxe
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Edward Freedman
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Michael Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Perry Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | | | | | | | - Bader Chaarani
- Department of Psychiatry, University of Vermont, Burlington
| | | | - Masha Ivanova
- Department of Psychiatry, University of Vermont, Burlington
| | - Krista Lisdahl
- Department of Psychiatry, University of Vermont, Burlington
| | - Elizabeth Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
| | - Hermine Maes
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Andrey Anokhin
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Nico Dosenbach
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
| | - Paul Glaser
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Andrew Heath
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Betty J Casey
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Dylan Gee
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Hugh P Garavan
- Department of Psychiatry, University of Vermont, Burlington
| | - Gaya Dowling
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Sandra Brown
- Department of Psychiatry and Psychology, University of California, San Diego, La Jolla
| |
Collapse
|
12
|
Smith A, Hewitt J, Quinn TJ, Robling M. Patient-reported outcome measures (PROMs) use in post-stroke patient care and clinical practice: a realist synthesis protocol. Syst Rev 2021; 10:128. [PMID: 33910631 PMCID: PMC8082773 DOI: 10.1186/s13643-021-01682-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is growing interest in the use of routine patient-reported outcome measures (PROMs) to influence the care of individual patients with stroke. However, there are significant gaps in our understanding as to how PROMs influence post-stroke patient care and clinical practice. This is due to factors including the number of purported uses for PROMs and that PROMs are complex interventions, which attempt to stimulate varied actions or behaviours. Therefore, the objective of this realist synthesis is to offer theory-based explanations as to how PROMs influence post-stroke clinical practice and patient care. METHODS This is a protocol for a realist synthesis, which involves three distinct phases: theory building (phase 1), theory testing and refinement (phase 2) and synthesis (phase 3). Phase 1 will develop initial rough programme theories (IRPTs), through literature searches (from January 2000 onwards) of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and the grey literature. Only secondary sources will be included that contribute to the development of IRPTs. Only two IRPTs, prioritised by the stakeholder group, will be taken forward to be tested and refined during phase 2. Further novel searches will be employed in phase 2, utilising the same criteria as phase 1; however, phase 2 searches will not utilise grey literature searches, and only primary research studies that contribute to the refinement of programme theories under investigation will be included. Two independent reviewers will screen and select all returned results. The reviewers will code and annotate relevant sources, resulting in 'fragments' to be extracted and graded based on the richness of their contribution to explanation and causal insight. Further, these fragments will be organised into 'Context-Mechanism-Outcome' configurations. Phase 3 of the review will involve the synthesis of context-mechanism-outcome configurations to form middle-range theory-based explanations and developed logic models for stakeholders to understand how PROMs in post-stroke clinical practice and patient care work for whom, how and under what circumstances. DISCUSSION The resulting realist synthesis will provide guidance on the implementation of PROMs within routine post-stroke clinical practice and patient care and act as a touchstone for further testing and refinement of PROMs programmes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020138649 .
Collapse
Affiliation(s)
- A Smith
- Division of Population Medicine, Cardiff University, Cardiff, UK.
| | - J Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - T J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
| |
Collapse
|
13
|
Vilches-Moraga A, Price A, Braude P, Pearce L, Short R, Verduri A, Stechman M, Collins JT, Mitchell E, Einarsson AG, Moug SJ, Quinn TJ, Stubbs B, McCarthy K, Myint PK, Hewitt J, Carter B. Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study. BMC Med 2020; 18:408. [PMID: 33334341 PMCID: PMC7746415 DOI: 10.1186/s12916-020-01856-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. METHODS Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. RESULTS Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56). CONCLUSIONS Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.
Collapse
Affiliation(s)
- A Vilches-Moraga
- Faculty of Medical and Human Services, University of Manchester, Manchester, England
- Salford Royal Hospital Foundation Trust, Salford, England
| | - A Price
- Salford Royal Hospital Foundation Trust, Salford, England
| | - P Braude
- North Bristol NHS Trust, Bristol, England
| | - L Pearce
- Faculty of Medical and Human Services, University of Manchester, Manchester, England
- Salford Royal Hospital Foundation Trust, Salford, England
| | - R Short
- Department of Biostatistics and Health Informatics, King's College London, London, England
| | - A Verduri
- University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - M Stechman
- University Hospital of Wales, Cardiff University, Cardiff, Wales
| | - J T Collins
- Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Newport, Wales
| | - E Mitchell
- North Bristol NHS Trust, Bristol, England
| | | | - S J Moug
- Royal Alexandra Hospital, Paisley, Scotland
| | - T J Quinn
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - K McCarthy
- North Bristol NHS Trust, Bristol, England
| | - P K Myint
- University of Aberdeen, Aberdeen, Scotland
| | - J Hewitt
- Aneurin Bevan Health Board, Cardiff University, Cardiff, Wales
| | - B Carter
- Department of Biostatistics and Health Informatics, King's College London, London, England.
| |
Collapse
|
14
|
Sanyaolu L, Scholz AFM, Mayo I, Coode-Bate J, Oldroyd C, Carter B, Quinn T, Hewitt J. Risk factors for incident delirium among urological patients: a systematic review and meta-analysis with GRADE summary of findings. BMC Urol 2020; 20:169. [PMID: 33109133 PMCID: PMC7590461 DOI: 10.1186/s12894-020-00743-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Post-operative delirium is an important, yet under-researched complication of surgery. Patients undergoing urological surgery may be at especially high risk of POD, as they are often older, and interventions can be associated with conditions that trigger delirium. The main aim of this systematic review was to evaluate the available evidence for risk factors in this patient group. Methods Five databases were searched (MEDLINE, Web of Science, EMBASE, CINAHL and PsychInfo) between January 1987 and June 2019. The Newcastle–Ottawa Scale was used to assess for risk of bias. Pooled odds ratio or mean difference (MD) for individual risk factors were estimated using the Mantel–Haenzel and inverse variance methods. Results Seven articles met the inclusion criteria, giving a total population of 1937. The incidence of POD ranged from 5 to 29%. Three studies were deemed low risk of bias and four at a high risk of bias. Nine risk factors were suitable for meta-analysis, with age (MD 4.314 95% CI 1.597, 7.032 p = 0.002) and the clock drawing test (MD − 2.443 95% CI − 3.029, − 1.857 p < 0.001) having a statistically significant association with POD in pooled analyses. Conclusion Delirium is common in urological patients. This review has identified a lack of studies in this surgical population, with wide heterogeneity and high risk of bias. It also highlights a number of potential risk factors for post-operative delirium, of which some are modifiable. However, the strength of evidence is weak at present and so future research should focus on assessing comparable risk factors in this patient group in order to inform future clinical practice. Review registration The review protocol was prospectively registered with the PROSPERO database (reference CRD42017054613)
Collapse
Affiliation(s)
- L Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK.
| | - A F M Scholz
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - I Mayo
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - C Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Cochrane Skin Group, School of Medicine, The University of Nottingham, Nottingham, UK
| | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
15
|
McCarthy K, Myint PK, Moug S, Pearce L, Braude P, Vilches-Moraga A, Hewitt J, Carter B. Resumption of elective colorectal surgery during COVID-19 and risk of death. Colorectal Dis 2020; 22:1026-1027. [PMID: 32726872 DOI: 10.1111/codi.15282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- K McCarthy
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Moug
- General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - L Pearce
- General Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - P Braude
- Geriatric Medicine, North Bristol NHS Trust, Bristol, UK
| | - A Vilches-Moraga
- Ageing and Complex Medicine Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Hewitt
- Geriatric Medicine, Cardiff University, Cardiff, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, King's College London, London, UK
| | | |
Collapse
|
16
|
Carter B, Collins JT, Barlow-Pay F, Rickard F, Bruce E, Verduri A, Quinn TJ, Mitchell E, Price A, Vilches-Moraga A, Stechman MJ, Short R, Einarsson A, Braude P, Moug S, Myint PK, Hewitt J, Pearce L, McCarthy K. Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople). J Hosp Infect 2020; 106:376-384. [PMID: 32702463 PMCID: PMC7372282 DOI: 10.1016/j.jhin.2020.07.013] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
Background Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. Aim To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection. Methods The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities. Findings The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51–0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47–1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37–0.66). Conclusion The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.
Collapse
Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J T Collins
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Cardiff, UK
| | | | - F Rickard
- North Bristol NHS Trust, Bristol, UK
| | - E Bruce
- Institute of Applied Health Sciences, University of Aberdeen, UK
| | - A Verduri
- Hospital of Modena Policlinico, Modena, Italy
| | - T J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - E Mitchell
- Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK
| | - A Price
- Salford Royal NHS Trust, Salford, UK
| | - A Vilches-Moraga
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - M J Stechman
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - R Short
- Forensic & Neurodevelopmental Sciences, King's College London, London, UK
| | | | - P Braude
- Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK
| | - S Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Hewitt
- Aneurin Bevan University Health Board, Cardiff, UK; Cardiff University, Cardiff, UK.
| | - L Pearce
- Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - K McCarthy
- Department of Surgery, North Bristol NHS Trust, Bristol, UK
| | | |
Collapse
|
17
|
Winiger E, Hewitt J. 0930 Prenatal Cannabis Use and Sleep Outcomes in Children 9-10 Years of Age in the Adolescence Brain Cognitive Development Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The fetal brain is densely populated with CB1 receptors that increase in number throughout gestation and might be involved in sleep processes since they are found in many brain areas related to the regulation of the sleep-wake cycle. THC binds to CB1 receptors, possibly altering neurodevelopment and fetal cortical circuitry in the womb. Studies have found prenatal cannabis use is associated with early sleep factors from as early as few days after birth to 3 years of age, yet no studies have examined associations in later childhood.
Methods
We used data from the Adolescent Brain Cognitive Development (ABCD) study to determine whether maternal reports of cannabis use while pregnant were associated with child sleep outcomes (The Sleep Disturbance Scale for Children) among 11,875 children ages 9-10. Regression analyses accounted for the nested nature of families (twin and non-twin sibling) and were estimated controlling for potential covariates including daily tobacco and weekly alcohol use during pregnancy, mother’s education, combined household income, parental marital status, child sex, and child age.
Results
Amongst mothers in our sample, 6% endorsed using cannabis while pregnant. Prenatal cannabis use was associated with lower sleep duration, disorders of initiating and maintaining sleep, disorders of arousal, sleep wake disorders, disorders of excessive somnolence, and a summed sleep score (all b >0.09 and p < 0.04) but not with sleep latency, sleep breathing disorders, and sleep hyperhidrosis (all b <0.08 and p >0.09).
Conclusion
Prenatal cannabis use was associated with increased childhood sleep deficits including shorter sleep duration and higher endorsements of sleep disorder symptoms. This is the first report of prenatal cannabis use being associated with sleep in childhood as late as 9-10 years of age. Although causality is not established, the results suggest potential long-term effects of prenatal cannabis use on sleep and the need for abstinence from cannabis use while pregnant.
Support
T32 DA017637. The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025 (https:// abcdstudy.org/federal-partners.html).
Collapse
Affiliation(s)
- E Winiger
- Institute for Behavioral Genetics, Boulder, CO
| | - J Hewitt
- Institute for Behavioral Genetics, Boulder, CO
| |
Collapse
|
18
|
Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P, Maitra I, Pearce L, Moug SJ, Ross B, Oleksiewicz J, Fearnhead N, Jump C, Boyle J, Shaw A, Barker J, Hughes J, Randall J, Tonga I, Kynaston J, Boal M, Eardley N, Kane E, Reader H, Mahapatra SR, Garner-Jones M, Tan JJ, Mohamed S, George R, Whiteman E, Malik K, Smart CJ, Bogdan M, Chaudhury MP, Sharma V, Subar D, Patel P, Chok SM, Lim E, Adhiyaman V, Davies G, Ross E, Maitra R, Steele CW, Roxburgh C, Griffiths S, Blencowe NS, Kirkham EN, Abraham JS, Griffiths K, Abdulaal Y, Iqbal MR, Tarazi M, Hill J, Khan A, Farrell I, Conn G, Patel J, Reddy H, Sarveswaran J, Arunachalam L, Malik A, Ponchietti L, Pawelec K, Goh YM, Vitish-Sharma P, Saad A, Smyth E, Crees A, Merker L, Bashir N, Williams G, Hayes J, Walters K, Harries R, Singh R, Henderson NA, Polignano FM, Knight B, Alder L, Kenchington A, Goh YL, Dicurzio I, Griffiths E, Alani A, Knight K, MacGoey P, Ng GS, Mackenzie N, Maitra I, Moug S, Ong K, McGrath D, Gammeri E, Lafaurie G, Faulkner G, Di Benedetto G, McGovern J, Subramanian B, Narang SK, Nowers J, Smart NJ, Daniels IR, Varcada M, Gala T, Cornish J, Barber Z, O'Neill S, McGregor R, Robertson AG, Paterson-Brown S, Raymond T, Thaha MA, English WJ, Forde CT, Paine H, Morawala A, Date R, Casey P, Bolton T, Gleaves X, Fasuyi J, Durakovic S, Dunstan M, Allen S, Riga A, Epstein J, Pearce L, Gaines E, Howe A, Choonara H, Dewi F, Bennett J, King E, McCarthy K, Taylor G, Harris D, Nageswaran H, Stimpson A, Siddiqui K, Lim LI, Ray C, Smith L, McColl G, Rahman M, Kler A, Sharma A, Parmar K, Patel N, Crofts P, Baldari C, Thomas R, Stechman M, Aldridge R, O'Kelly J, Wilson G, Gallegos N, Kalaiselvan R, Rajaganeshan R, Mackenzie A, Naik P, Singh K, Gandraspulli H, Wilson J, Hancorn K, Khawaja A, Nicholas F, Marks T, Abbott C, Chandler S. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br J Surg 2020; 107:218-226. [DOI: 10.1002/bjs.11392] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/20/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.
Methods
The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.
Results
A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.
Conclusion
Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.
Collapse
Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Law
- Department of Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - K L Parmar
- Manchester Cancer Research Centre, Manchester, NorthWest Deanery, UK
| | - J M Boyle
- Royal College of Surgeons of England, London, UK
| | - P Casey
- Health Education North West, Manchester, NorthWest Deanery, UK
| | - I Maitra
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - L Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Humphry N, Wilson T, Cox M, Hewitt J. 96SARCOPENIA, FRAILTY AND NUTRITIONAL STATUS OF COLORECTAL CANCER SURGICAL PATIENTS AND URINARY BIOMARKERS: STUDY PROTOCOL. Age Ageing 2019. [DOI: 10.1093/ageing/afz063.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Humphry
- Cardiff and Vale University Health Board
| | | | | | | |
Collapse
|
20
|
Gilpin R, Foreman T, Hewitt J. 107PATIENT RELATED OUTCOME MEASURES IN STROKE. Age Ageing 2019. [DOI: 10.1093/ageing/afz065.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell I, Pearce L, Moug SJ. 98FRAILTY IN OLDER PATIENTS UNDERGOING EMERGENCY LAPAROTOMY: FURTHER RESULTS FROM THE ELF STUDY (EMERGENCY LAPAROTOMY AND FRAILTY). Age Ageing 2019. [DOI: 10.1093/ageing/afz063.07] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - S J Moug
- Royal Alexandra Hospital, Paisley
| |
Collapse
|
22
|
Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV, Tay HS, McCormack C, Stechman MJ, Moug SJ, Myint PK. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019; 48:388-394. [PMID: 30778528 DOI: 10.1093/ageing/afy217] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages. METHODS a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period. RESULTS the cohort included 2,279 patients (median age 54 years [IQR 36-72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40's to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61-2.01) supporting a linear dose-response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days. CONCLUSIONS worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.
Collapse
Affiliation(s)
- J Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - K McCarthy
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
| | - L Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - J Law
- Department of General Surgery, Blackpool Victoria Infirmary, Blackpool, UK
| | - F V Wilson
- Department of Geriatric Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - H S Tay
- Department of Geriatric Medicine Aberdeen Royal Infirmary, Aberdeen, UK
| | - C McCormack
- Department of Geriatric Medicine Aberdeen Royal Infirmary, Aberdeen, UK
| | - M J Stechman
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - S J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK
| | - P K Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Research, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
23
|
Elbashir H, Dafalla Y, Elkhalifa S, Hewitt J, Cottage R, Garcez T, Patel M. 010. QUALITY IMPROVEMENT PROJECT: IMPLEMENTING NEW ‘ANCA SAMPLE’ PATHWAY. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez057.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Yosra Dafalla
- Manchester NHS Foundation Trust Manchester, United Kingdom
| | | | - John Hewitt
- Manchester NHS Foundation Trust Manchester, United Kingdom
| | | | - Tomaz Garcez
- Manchester NHS Foundation Trust Manchester, United Kingdom
| | - Mumtaz Patel
- Manchester University Hospitals Manchester, United Kingdom
| |
Collapse
|
24
|
Tay HS, Ablett A, Evans LA, Browning A, Goeteyn J, Owen S, Myint PK, Hewitt J. 77OLDER PEOPLE SURGICAL OUTCOMES COLLABORATION: ACADEMIC TRAINING AND DEVELOPMENT. Age Ageing 2019. [DOI: 10.1093/ageing/afy198.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H S Tay
- Nottingham University Hospital NHS Trust
| | | | | | | | | | - S Owen
- University Hospital of Wales
| | | | | | | |
Collapse
|
25
|
Ablett AD, McCarthy K, Carter B, Pearce L, Stechman M, Moug S, Ceelen W, Hewitt J, Myint PK. A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multi-center study. Int J Surg 2018; 60:236-244. [PMID: 30481611 DOI: 10.1016/j.ijsu.2018.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. METHODS This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu). The effect of having hypoalbuminemia (defined as albumin ≤3.5 g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed. RESULTS The cohort consisted of 1406 older patients with median (IQR) age of 76 (70-83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03-1.70); p = 0.03), 30-day mortality (4.23 (2.22-8.08); p < 0.001), 90-day mortality (3.36 (2.14-5.28); p < 0.001) (primary outcome), and increased hospital length of stay, irrespective of whether a patient received emergency surgical intervention. Every point increase in MALE score was associated with higher odds of mortality, with a MALE score of 4 being associated with 30-day mortality (adjusted OR(95% CI) = 33.38 (3.86-288.7); p = 0.001) and 90-day mortality (11.37 (3.85-33.59); p < 0.001) compared to the reference category of those with MALE score 0. CONCLUSIONS The easy to use and practical MALE risk score calculated at point of care identifies older adults at a greater risk of poor outcomes, thereby allowing clinicians to prioritize patients who may benefit from early comprehensive geriatric assessment in the emergency general surgical setting.
Collapse
Affiliation(s)
- A D Ablett
- Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom
| | - K McCarthy
- Department of General Surgery, King's College London, United Kingdom
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, United Kingdom
| | - L Pearce
- Department of General Surgery, Manchester Royal Infirmary, United Kingdom
| | - M Stechman
- Department of General Surgery, University Hospital of Wales, United Kingdom
| | - S Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, United Kingdom
| | - W Ceelen
- Department of GI Surgery, University Hospital, Ghent, Belgium
| | - J Hewitt
- Department of Population Medicine, Cardiff University, United Kingdom
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom.
| |
Collapse
|
26
|
Ablett AD, Browning A, Quan V, Tay HS, McCormack C, Carter B, Hewitt J, Myint PK. 67ANTI-CHOLINERGIC BURDEN AND PATIENT RELATED CLINICAL OUTCOMES IN AN EMERGENCY GENERAL SURGICAL SETTING. Age Ageing 2018. [DOI: 10.1093/ageing/afy120.01] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Aartsen M, Ackermann M, Adams J, Aguilar JA, Ahlers M, Ahrens M, Al Samarai I, Altmann D, Andeen K, Anderson T, Ansseau I, Anton G, Argüelles C, Auffenberg J, Axani S, Bagherpour H, Bai X, Barron J, Barwick S, Baum V, Bay R, Beatty J, Becker KH, Tjus J, BenZvi S, Berley D, Bernardini E, Besson D, Binder G, Bindig D, Blaufuss E, Blot S, Bohm C, Boerner M, Bos F, Boeser S, Botner O, Bourbeau E, Bourbeau J, Bradascio F, Braun J, Brenzke M, Bretz HP, Bron S, Brostean-Kaiser J, Burgman A, Busse R, Carver T, Cheng E, Chirkin D, Christov A, Clark K, Classen L, Coenders S, Collin G, Conrad J, Coppin P, Correa P, Cowen D, Cross R, Dave P, Day M, de Andre JPAM, De Clercq C, Delaunay J, Dembinski H, DeRidder S, Desiati P, de Vries K, DeWasseige G, DeWith M, DeYoung T, Díaz-Vélez JC, Di Lorenzo V, Dujmovic H, Dumm J, Dunkman M, Dvorak E, Eberhardt B, Ehrhardt T, Eichmann B, Eller P, Evenson P, Fahey S, Fazely A, Felde J, Filimonov K, Finley C, Flis S, Franckowiak A, Friedman E, Fritz A, Gaisser T, Gallagher J, Gerhardt L, Ghorbani K, Glauch T, Gluesenkamp T, Goldschmidt A, Gonzalez J, Grant D, Griffith Z, Haack C, Hallgren A, Halzen F, Hanson K, Hebecker D, Heereman D, Helbing K, Hellauer R, Hickford S, Hignight J, Hill G, Hoffman K, Hoffmann R, Hoinka T, Hokanson-Fasig B, Hoshina K, Huang F, Huber M, Hultqvist K, Huennefeld M, Hussain R, In S, Iovine N, Ishihara A, Jacobi E, Japaridze G, Jeong M, Jero K, Jones B, Kalaczynski P, Kang W, Kappes A, Kappesser D, Karg T, Karle A, Katz U, Kauer M, Keivani A, Kelley J, Kheirandish A, Kim J, Kim M, Kintscher T, Kiryluk J, Kittler T, Klein S, Koirala R, Kolanoski H, Koepke L, Kopper C, Kopper S, Koschinsky JP, Koskinen J, Kowalski M, Krings K, Kroll M, Krueckl G, Kunwar S, Kurahashi Neilson N, Kuwabara T, Kyriacou A, Labare M, Lanfranchi J, Larson M, Lauber F, Leonard K, Lesiak-Bzdak M, Leuermann M, Liu Q, Lozano Mariscal CJ, Lu L, Luenemann J, Luszczak W, Madsen J, Maggi G, Mahn K, Mancina S, Maruyama R, Mase K, Maunu R, Meagher K, Medici M, Meier M, Menne T, Merino G, Meures T, Miarecki S, Micallef J, Momente G, Montaruli T, Moore R, Morse R, Moulai M, Nahnhauer R, Nakarmi P, Naumann U, Neer G, Niederhausen H, Nowicki S, Nygren D, Pollmann A, Olivas A, Murchadha AÓ, O'Sullivan E, Palczewski T, Pandya H, Pankova D, Peiffer P, Pepper J, de los Heros C, Pieloth D, Pinat E, Plum M, Price B, Przybylski G, Raab C, Raedel L, Rameez M, Rauch L, Rawlins K, Rea IC, Reimann R, Relethford B, Relich M, Resconi E, Rhode W, Richman M, Robertson S, Rongen M, Rott C, Ruhe T, Ryckbosch D, Rysewyk D, Safa I, Saelzer T, Sanchez S, Sandrock A, Sandroos J, Santander M, Sarkar S, Sarkar S, Satalecka K, Schlunder P, Schmidt T, Schneider A, Schoenen S, Schoneberg S, Schumacher L, Sclanfani S, Seckel D, Seunarine S, Soedingrekso J, Soldin D, Song M, Spiczak G, Spiering C, Stachurska J, Stamatikos M, Stanev T, Stasik A, Stein R, Stettner J, Steuer A, Stezelberger T, Stokstad R, Stoessl A, Strotjohann NL, Stuttard T, Sullivan G, Sutherland M, Taboada I, Tatar J, Tenholt F, Ter-Antonyan S, Terliuk A, Tilav S, Toale P, Tobin M, Toennis C, Toscano S, Tosi D, Tselengidou M, Tung C, Turcati A, Turley C, Ty B, Unger L, Usner M, Van Driessche W, Van Eijk D, van Eijndhoven N, Vandenbroucke J, Vanheule S, van Santen J, Vogel E, Vraeghe M, Walck C, Wallace A, Wallraff M, Wandler F, Wandkowsky N, Waza A, Weaver C, Weiss M, Wendt C, Werthebach J, Westerhoff S, Whelan B, Whitehorn N, Wiebe K, Wiebusch C, Wille L, Williams D, Wills L, Wolf M, Wood J, Wood T, Woschnagg K, Xu D, Xu X, Xu Y, Yanez JP, Yodh G, Yoshida S, Yuan T, Abdollahi S, Ajello M, Angioni R, Baldini L, Ballet J, Barbiellini G, Bastieri D, Bechtol K, Bellazzini R, Berenji B, Bissaldi E, Blandford R, Bonino R, Bottacini E, Bregeon J, Bruel P, Büehler R, Burnett T, Burns E, Buson S, Cameron R, Caputo R, Caraveo PA, Cavazzuti E, Charles E, Chen S, Cheung T, Chiang J, Chiaro G, Ciprini S, Cohen-Tanugi J, Conrad J, Costantin D, Cutini S, D'Ammando F, de Palma F, Digel S, Di Lalla N, Di Mauro M, Di Venere L, Domínguez A, Favuzzi C, Franckowiak A, Fukazawa Y, Funk S, Fusco P, Gargano F, Gasparrini D, Giglietto N, Giomi M, Giommi P, Giordano F, Giroletti M, Glanzman T, Green D, Grenier I, Grondin MH, Guiriec S, Harding A, Hayashida M, Hays L, Hewitt J, Horan D, Jóhannesson G, Kadler M, Kensei S, Kocevski D, Krauss F, Kreter M, Kuss M, La Mura G, Larsson S, Latronico L, Lemoine-Goumard M, Li J, Longo F, Loparco F, Lovellette M, Lubrano P, Magill J, Maldera S, Malyshev D, Manfreda A, Mazziotta MN, McEnery J, Meyer M, Michelson P, Mizuno T, Monzani ME, Morselli A, Moskalenko I, Negro M, Nuss E, Ojha R, Omodei N, Orienti M, Orlando E, Palatiello M, Paliya V, Perkins J, Persic M, Pesce-Rollins M, Piron F, Porter T, Principe G, Rainò S, Rando R, Rani B, Razzano M, Razzaque S, Reimer A, Reimer O, Renault-Tinacci N, Ritz S, Rochester L, Parkinson PS, Sgrò C, Siskind EJ, Spandre G, Spinelli P, Suson D, Tajima H, Takahashi M, Tanaka Y, Thayer J, Thompson DJ, Tibaldo L, Torres DF, Torresi E, Tosti G, Troja E, Valverde JV, Vianello G, Vogel M, Wood K, Wood M, Zaharijas G, Ahnen ML, Ansoldi S, Antonelli LA, Arcaro C, Baack D, Babić A, Banerjee B, Bangale P, Barres de Almeida U, Barrio JA, González JB, Bednarek W, Bernardini E, Berti A, Bhattacharyya W, Biland A, Blanch O, Bonnoli G, Carosi R, Carosi A, Ceribella G, Chatterjee A, Colak SM, Colin P, Colombo E, Contreras JL, Cortina J, Covino S, Cumani P, Da Vela P, Dazzi F, De Angelis A, De Lotto B, Delfino M, Delgado J, Di Pierro F, Domínguez A, Dominis Prester D, Dorner D, Doro M, Einecke S, Elsaesser D, Fallah Ramazani V, Fernández-Barral A, Fidalgo D, Foffano L, Pfrang K, Fonseca MV, Font L, Fruck C, Galindo D, Gallozzi S, García López RJ, Garczarczyk M, Gaug M, Giammaria P, Godinović N, Gora D, Guberman D, Hadasch D, Hahn A, Hassan T, Hayashida M, Herrera J, Hose J, Hrupec D, Inoue S, Ishio K, Konno Y, Kubo H, Kushida J, Lelas D, Lindfors E, Lombardi S, Longo F, López M, Maggio C, Majumdar P, Makariev M, Maneva G, Manganaro M, Mannheim K, Maraschi L, Mariotti M, Martínez M, Masuda S, Mazin D, Minev M, Miranda JM, Mirzoyan R, Moralejo A, Moreno V, Moretti E, Nagayoshi T, Neustroev V, Niedzwiecki A, Nievas Rosillo M, Nigro C, Nilsson K, Ninci D, Nishijima K, Noda K, Nogués L, Paiano S, Palacio J, Paneque D, Paoletti R, Paredes JM, Pedaletti G, Peresano M, Persic M, Prada Moroni PG, Prandini E, Puljak I, Rodriguez J, Reichardt I, Rhode W, Ribó M, Rico J, Righi C, Rugliancich A, Saito T, Satalecka K, Schweizer T, Sitarek J, Šnidarić I, Sobczynska D, Stamerra A, Strzys M, Surić T, Takahashi M, Tavecchio F, Temnikov P, Terzić T, Teshima M, Torres-Albà N, Treves A, Tsujimoto S, Vanzo G, Vazquez Acosta M, Vovk I, Ward JE, Will M, Zarić D, Franceschini A, Lucarelli F, Tavani M, Piano G, Donnarumma I, Pittori C, Verrecchia F, Barbiellini G, Bulgarelli A, Caraveo P, Cattaneo PW, Colafrancesco S, Costa E, Di Cocco G, Ferrari A, Gianotti F, Giuliani A, Lipari P, Mereghetti S, Morselli A, Pacciani L, Paoletti F, Parmiggiani N, Pellizzoni A, Picozza P, Pilia M, Rappoldi A, Trois A, Vercellone S, Vittorini V, Albert A, Alfaro R, Álvarez C, Arceo R, Arteaga Velázquez JC, Avila Rojas DO, Ayala Solares HA, Becerril AD, Belmont-Moreno E, Bernal A, Caballero Mora KS, Capistrán Rojas T, Carramiñana A, Casanova S, Castillo Maldonado MA, Cotti U, Cotzomi J, Coutiño de León S, De León Acuña CL, De la Fuente E, Hernandez RD, Dichiara S, Dingus B, DuVernois M, Díaz Velez JC, Ellsworth R, Engel K, Fiorino DW, Fleischhack H, Fraija NI, García González JA, Garfias F, González MM, Muñoz AG, Goodman JA, Hampel-Arias Z, Harding JP, Cadena SH, Hona B, Hueyotl-Zahuantitla F, Hui M, Hüntemeyer P, Iriarte A, Jardin-Blicq A, Joshi V, Kaufmann S, Kunde GJ, Lara A, Lauer R, Lee W, Lennarz D, Vargas HL, Linnemann J, Longinotti AL, Luis-Raya G, Luna-García R, Malone K, Marinelli SS, Martinez O, Martinez Castellanos I, Martínez Huerta H, Martínez Castro J, Matthews J, Miranda-Romagnoli P, Moreno Barbosa E, Mostafa M, Nayerhoda A, Nellen L, Newbold M, Nisa MU, Noriega-Papaqui R, Pelayo R, Pretz J, Pérez Pérez EG, Ren Z, Rho CD, Rivière C, González DR, Rosenberg M, Ruiz-Velasco E, Ruiz-Velasco E, Greus FS, Sandoval A, Schneider M, Schoorlemmer H, Sinnis G, Smith AJ, Springer W, Surajbali P, Tibolla O, Tollefson K, Torres I, Villaseñor L, Weisgarber T, Werner F, Yapici T, Yodh G, Zepeda A, Zhou H, Álvarez Romero JDD, Abdalla H, Angüner EO, Armand C, Backes M, Becherini Y, Berge D, Böttcher M, Boisson C, Bolmont J, Bonnefoy S, Bordas P, Brun F, Büchele M, Bulik T, Caroff S, Carosi A, Casanova S, Cerruti M, Chakraborty N, Chandra S, Chen A, Colafrancesco S, Davids ID, Deil C, Devin J, Djannati-Ataï A, Egberts K, Emery G, Eschbach S, Fiasson A, Fontaine G, Funk S, Füßling M, Gallant YA, Gaté F, Giavitto G, Glawion D, Glicenstein JF, Gottschall D, Grondin MH, Haupt M, Henri G, Hinton JA, Hoischen C, Holch TL, Huber D, Jamrozy M, Jankowsky D, Jankowsky F, Jouvin L, Jung-Richardt I, Kerszberg D, Khélifi B, King J, Klepser S, Kluźniak W, Komin N, Kraus M, Lefaucheur J, Lemière A, Lemoine-Goumard M, Lenain JP, Leser E, Lohse T, López-Coto R, Lorentz M, Lypova I, Marandon V, Martí-Devesa GG, Maurin G, Mitchell A, Moderski R, Mohamed M, Mohrmann L, Moulin E, Murach T, de Naurois M, Niederwanger F, Niemiec J, Oakes L, O'Brien P, Ohm S, Ostrowski M, Oya I, Panter M, Parsons RD, Perennes C, Piel Q, Pita S, Poireau V, Noel AP, Prokoph H, Pühlhofer G, Quirrenbach A, Raab S, Rauth R, Renaud M, Rieger F, Rinchiuso L, Romoli C, Rowell G, Rudak B, Sanchez DA, Sasaki M, Schlickeiser R, Schüssler F, Schulz A, Schwanke U, Seglar-Arroyo M, Shafi N, Simoni R, Sol H, Stegmann C, Steppa C, Tavernier T, Taylor AM, Tiziani D, Trichard C, Tsirou M, van Eldik C, van Rensburg C, van Soelen B, Veh J, Vincent P, Voisin F, Wagner SJ, Wagner RM, Wierzcholska A, Zanin R, Zdziarski AA, Zech A, Ziegler A, Zorn J, Zywucka N, Savchenko V, Ferrigno C, Bazzano A, Diehl R, Kuulkers E, Laurent P, Mereghetti S, Natalucci L, Panessa F, Rodi J, Ubertini P, Morokuma T, Ohta K, Tanaka YT, Mori H, Yamanaka M, Kawabata KS, Utsumi Y, Nakaoka T, Kawabata M, Nagashima H, Yoshida M, Matsuoka Y, Itoh R, Keel W, Copperwheat C, Steele I, Cenko SB, Evans P, Fox D, Kennea J, Marshall F, Osborne J, Tohuvavohu A, Turley C, Cowen D, DeLaunay J, Keivani A, Santander M, Abeysekara A, Archer A, Benbow W, Bird R, Brill A, Brose R, Buchovecky M, Buckley J, Bugaev V, Christiansen J, Connolly M, Cui W, Daniel M, Errando M, Falcone A, Feng Q, Finley J, Fortson L, Furniss A, Gueta O, Hütten M, Hervet O, Hughes G, Humensky T, Johnson C, Kaaret P, Kar P, Kelley-Hoskins N, Kertzman M, Kieda D, Krause M, Krennrich F, Kumar S, Lang M, Lin T, Maier G, McArthur S, Moriarty P, Mukherjee R, Nieto D, O'Brien S, Ong R, Otte A, Park N, Petrashyk A, Pohl M, Popkow A, Pueschel E, Quinn J, Ragan K, Reynolds P, Richards G, Roache E, Rulten C, Sadeh I, Santander M, Scott S, Sembroski G, Shahinyan K, Sushch I, Trépanier S, Tyler J, Vassiliev V, Wakely S, Weinstein A, Wells R, Wilcox P, Wilhelm A, Williams D, Zitzer B, Tetarenko A, Kimball A, Miller-Jones J, Sivakoff G. Multimessenger observations of a flaring blazar coincident with high-energy neutrino IceCube-170922A. Science 2018; 361:science.aat1378. [DOI: 10.1126/science.aat1378] [Citation(s) in RCA: 451] [Impact Index Per Article: 75.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/08/2018] [Indexed: 11/02/2022]
Abstract
Previous detections of individual astrophysical sources of neutrinos are limited to the Sun and the supernova 1987A, whereas the origins of the diffuse flux of high-energy cosmic neutrinos remain unidentified. On 22 September 2017, we detected a high-energy neutrino, IceCube-170922A, with an energy of ~290 tera–electron volts. Its arrival direction was consistent with the location of a known γ-ray blazar, TXS 0506+056, observed to be in a flaring state. An extensive multiwavelength campaign followed, ranging from radio frequencies to γ-rays. These observations characterize the variability and energetics of the blazar and include the detection of TXS 0506+056 in very-high-energy γ-rays. This observation of a neutrino in spatial coincidence with a γ-ray–emitting blazar during an active phase suggests that blazars may be a source of high-energy neutrinos.
Collapse
|
28
|
Smart R, Carter B, McGovern J, Luckman S, Connelly A, Hewitt J, Quasim T, Moug S. Frailty Exists in Younger Adults Admitted as Surgical Emergency Leading to Adverse Outcomes. J Frailty Aging 2018; 6:219-223. [PMID: 29165541 DOI: 10.14283/jfa.2017.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty is prevalent in the older adult population (≥65 years of age) and results in adverse outcomes in the emergency general surgical population. OBJECTIVE To determine whether frailty exists in the younger adult emergency surgical population (<65 years) and what influence frailty may have on patient related outcomes. DESIGN Prospective observational cohort study. SETTING Emergency general surgical admissions. PARTICIPANTS All patients ≥40 years divided into 2 groups: younger adults (40-64.9 years) and older adult comparative group (≥65). MEASUREMENTS Over a 6-month time frame the following data was collected: demographics; Scottish Index of Multiple Deprivation (SIMD); blood markers; multi-morbidities, polypharmacy and cognition. Frailty was assessed by completion of the Canadian Study of Health and Ageing (CSHA). Each patient was followed up for 90 days to allow determination of length of stay, re-admission and mortality. RESULTS 82 young adults were included and the prevalence of frailty was 16% (versus older adults 38%; p=0.001) and associated with: multi-morbidity; poly-pharmacy; cognitive impairment; and deprivation. Frailty in older adults was only significantly associated with increasing age. CONCLUSIONS This novel study has found that frailty exists in 16% of younger adults admitted to emergency general surgical units, potentially leading to adverse short and long-term outcomes. Strategies need to be developed that identify and treat frailty in this vulnerable younger adult population.
Collapse
Affiliation(s)
- R Smart
- Susan J Moug,Consultant Surgeon and Honorary Senior Clinical Lecturer; Department of Surgery, Royal Alexandra Hospital; Paisley, United Kingdom, PA2 9PN, +441413146965.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Weaver N, Coffey M, Hewitt J. Concepts, models and measurement of continuity of care in mental health services: A systematic appraisal of the literature. J Psychiatr Ment Health Nurs 2017; 24:431-450. [PMID: 28319308 DOI: 10.1111/jpm.12387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Care continuity is considered to be a cornerstone of modern mental health care. As community mental health services have become increasingly fragmented and complex, the crucial criterion for best quality care has become the degree to which treatment delivered by separate services and professionals is continuous and well coordinated. However, clarification of the key elements of continuity has proved challenging and a consensus has not been reached. Recent research has shown significant levels of variation in the quality of care coordination across England and Wales, with potentially detrimental consequences for individuals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Studies on care continuity identified in this review are grouped into three categories: studies defining concepts of care continuity, studies providing models of continuity and studies describing development of questionnaires about care continuity. There are many similarities and parallels between concepts of continuity described in the studies under review. Therefore, there is potential for developing a consensus on the nature of care continuity as a multidimensional concept. The priority placed upon the patient's experience of care continuity is identified as a major focus in these studies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A consensus on the nature of care continuity would benefit both theory and practice in mental health nursing. It would provide a firmer foundation for new research seeking to improve continuity for people using services, and enable mental health nurses working as care coordinators to have a better understanding of the elements of their role that are most effective. ABSTRACT Introduction The increased complexity of community mental health services, and associated fragmentation of traditional dividing lines between services, has underscored the centrality of care continuity and coordination in modern mental health care. However, clarification of the key features of the care continuity concept has proved difficult and a consensus has not been reached. Aim/Question This review draws together and critically examines latest evidence concerning concepts, models and scales based on a multidimensional understanding of care continuity. Method Databases ASSIA, PubMed, MEDLINE and Cochrane were searched for papers dating from January 2005 to July 2016, of which 21 articles met the inclusion criteria. These were subjected to quality appraisal based on CASP and COSMIN checklists. Studies were grouped into three thematic categories describing concepts, models and scales of care continuity. Results/Discussion Synthesis indicated correspondence between independent, multidimensional models of care continuity, providing greater clarity regarding the essential features of the concept. Association, although not causation, between care continuity factors and health outcomes is supported by current evidence. Implications for practice Clarification of care continuity in mental health services may enable nurses working as care coordinators to develop a better understanding of key elements of their role, and provide guidance for future service development.
Collapse
Affiliation(s)
- N Weaver
- Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - M Coffey
- Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Hewitt
- Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University, Swansea, UK
| |
Collapse
|
30
|
Ablett A, Goeteyn J, Evans L, Law J, Owen S, Hewitt J, Myint PK. 34HYPOALBUMINAEMIA PREDICTS IMPORTANT CLINICAL OUTCOMES IN OLDER UNSELECTED ACUTE SURGICAL ADMISSIONS: AN INTERNATIONAL MULTICENTRE STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx110.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - J Law
- Manchester Royal Infirmary
| | | | | | | | | |
Collapse
|
31
|
Evans L, Goeteyn J, Carter B, Greig M, Tay H, McCormack C, Ceelen W, Pearce L, McCarthy K, Myint P, Moug S, Stechman M, Hewitt J. Preoperative kidney function linked to mortality and readmission outcomes at Day 90 and 30 in older emergency surgical patients. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
32
|
Tay HS, Wood AD, Hewitt J, Pearce L, Moug SJ, McCarthy K, Stechman MJ, Myint PK. 39DO OLDER SURGICAL PATIENTS WHO UNDERGO EMERGENCY OPERATION HAVE HIGHER MORTALITY AND LONGER LENGTH OF HOSPITALISATION COMPARED TO THOSE MANAGED CONSERVATIVELY? Age Ageing 2017. [DOI: 10.1093/ageing/afx055.39] [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: 11/14/2022] Open
|
33
|
Moug SJ, Stechman M, McCarthy K, Pearce L, Myint PK, Hewitt J. Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient. Ann R Coll Surg Engl 2016; 98:165-9. [PMID: 26890834 DOI: 10.1308/rcsann.2016.0087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. METHODS This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. RESULTS Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. CONCLUSIONS Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.
Collapse
Affiliation(s)
- S J Moug
- Royal Alexandra Hospital , Paisley , UK
| | - M Stechman
- University Hospital of Wales , Cardiff , UK
| | | | | | - P K Myint
- University of Aberdeen; Aberdeen Royal Infirmary , UK
| | - J Hewitt
- University Hospital Llandough , Cardiff , UK.,on behalf of The Older Persons Surgical Outcomes Collaboration (OPSOC)
| | | |
Collapse
|
34
|
Abstract
Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. Conclusions The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.
Collapse
Affiliation(s)
- L Pearce
- Manchester Royal Infirmary , Manchester , UK
| | - J Bunni
- Cheltenham General Hospital , Cheltenham , UK
| | | | - J Hewitt
- Cardiff University , Cardiff , UK
| |
Collapse
|
35
|
Robson R, Lacey AS, Luzio SD, Van Woerden H, Heaven ML, Wani M, Halcox JPJ, Castilla-Guerra L, Dawson J, Hewitt J. HbA1c measurement and relationship to incident stroke. Diabet Med 2016; 33:459-62. [PMID: 26683404 PMCID: PMC5066734 DOI: 10.1111/dme.13057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Abstract
AIMS To determine the proportion of people with diabetes who have HbA1c measured, what proportion achieve an HbA1c level of < 58 mmol/mol (7.5%), the frequency of testing and if there was any change in HbA1c level in the year before and the year after an incident stroke. METHODS This study used the Secure Anonymised Information Linkage (SAIL) databank, which stores hospital data for the whole of Wales and ~ 65% of Welsh general practice records, to identify cases of stroke in patients with diabetes between 2000 and 2010. These were matched against patients with diabetes but without stroke disease. We assessed the frequency of HbA1c testing and change in HbA1c in the first year after stroke. Estimation was made of the proportion of patients achieving an HbA1c measurement ≤ 58 mmol/mol (7.5%). RESULTS There were 1741 patients with diabetes and stroke. Of these, 1173 (67.4%) had their HbA1c checked before their stroke and 1137 (65.3%) after their stroke. In the control group of 16 838 patients with diabetes but no stroke, 8413 (49.9%) and 9288 (55.1%) had their HbA1c checked before and after the case-matched stroke date, respectively. In patients with diabetes and stroke, HbA1c fell from 61-56 mmol/mol (7.7-7.3%) after their stroke (P < 0.001). Before the study, 55.0% of patients with stroke had an HbA1c ≥ 58 mmol/mol compared with 65.2% of control patients, these figures were 62.5% and 65.3% after the stroke. CONCLUSIONS The frequency of diabetes testing was higher in patients who had experienced a stroke before and after their incident stroke compared with control patients but did not increase after their stroke. Glucose control improved significantly in the year after a stroke.
Collapse
Affiliation(s)
- R Robson
- Department of Geriatric Medicine, North Middlesex NHS Trust, London, UK
| | - A S Lacey
- College of Medicine, Swansea University, Swansea, UK
| | - S D Luzio
- College of Medicine, Swansea University, Swansea, UK
| | - H Van Woerden
- Department of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - M L Heaven
- College of Medicine, Swansea University, Swansea, UK
| | - M Wani
- Department of Geriatric Medicine, Morriston Hospital Swansea, Swansea, UK
| | - J P J Halcox
- College of Medicine, Swansea University, Swansea, UK
| | - L Castilla-Guerra
- Department of Internal Medicine, Hospital de la Merced, University of Seville, Spain
| | - J Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J Hewitt
- Department of Primary Care and Public Health, Cardiff University, Cardiff, UK
| |
Collapse
|
36
|
Abstract
PURPOSE The UK Biobank is a large-scale biomedical resource, containing sociodemographic and medical information, including data on a previous diagnosis of stroke or transient ischaemic attack (TIA). We described these participants and their medication usage. PARTICIPANTS We identified participants who either self-reported or were identified from a nurse-led interview, having suffered a stroke or a TIA and compared them against participants without stroke ort TIA. We assessed their risk factor burden (sex, age, deprivation, waist to hip ratio (WHR), hypertension, smoking, alcohol intake, diabetes, physical exercise and oral contraception use (oral contraceptive pill, OCP)) and medication usage. FINDINGS TO DATE We studied 502,650 people (54.41% women), 6669 (1.23%) participants self-reported a stroke. The nurse-led interview identified 7669 (1.53%) people with stroke and 1781 (0.35%) with TIA. Hypertension, smoking, higher WHR, lower alcohol consumption and diabetes were all more common in people with cerebrovascular disease (p<0.0001 for each). Women with cerebrovascular disease were less likely to have taken the OCP (p=0.0002). People with cerebrovascular disease did more exercise (p=0.03). Antithrombotic medication was taken by 81% of people with stroke (both self-report and nurse-led responders) and 89% with TIA. For self-reported stroke, 63% were taking antithrombotic and cholesterol medications, 54% taking antithrombotic and antihypertensive medications and 46% taking all 3. For the nurse-led interview and TIA, these figures were 65%, 54% and 46%, and 70%, 53% and 45%, respectively. FUTURE PLANS The UK Biobank provides a large, generalisable and contemporary data source in a young population. The characterisation of the UK Biobank cohort with cerebrovascular disease will form the basis for ongoing research using this data source.
Collapse
Affiliation(s)
- J Hewitt
- Department of Geriatric Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M Walters
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - J Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
37
|
|
38
|
Castilla-Guerra L, Fernández-Moreno MC, Hewitt J. Treatment of hyperglycaemia in patients with acute stroke. Rev Clin Esp 2016; 216:92-8. [PMID: 26189890 DOI: 10.1016/j.rce.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/06/2015] [Revised: 06/03/2015] [Accepted: 06/14/2015] [Indexed: 01/14/2023]
Abstract
The proportion of diabetic patients who are hospitalised for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycaemia in the first hours of the stroke. Although hyperglycaemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycaemia during the acute phase of the stroke. Ultimately, patients who have presented with stroke should be screened for diabetes.
Collapse
Affiliation(s)
- L Castilla-Guerra
- Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, España.
| | - M C Fernández-Moreno
- Servicio de Neurología, Hospital de Valme, Universidad de Sevilla, Sevilla, España
| | - J Hewitt
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, WCAT Lead - Geriatric & Stroke Medicine, Cardiff, Reino Unido
| |
Collapse
|
39
|
Rivers K, Johansen A, Smith F, Hewitt J. Development of an Evidence-Based Checklist to Evaluate Dehydration in Older Patients Admitted to a Bahamian Hospital. ACTA ACUST UNITED AC 2016. [DOI: 10.15761/gimci.1000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
40
|
Scholz AFM, Oldroyd C, McCarthy K, Quinn TJ, Hewitt J. Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. Br J Surg 2015; 103:e21-8. [PMID: 26676760 DOI: 10.1002/bjs.10062] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/02/2015] [Accepted: 10/26/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Postoperative delirium (POD) is common after surgery. As age is a known risk factor, the increased ageing of the population undergoing surgery emphasizes the importance of the subject. Knowledge of other potential risk factors in older patients with surgical gastrointestinal diseases is lacking. The aim here was to collate and synthesize the published literature on risk factors for delirium in this group. METHODS Five databases were searched (MEDLINE, Web of Science, Embase, CINAHL(®) and PSYCinfo(®) ) between January 1987 and November 2014. The Newcastle-Ottawa Scale was used to rate study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. RESULTS Eleven studies met the inclusion criteria; they provided a total of 1427 patients (318 with delirium and 1109 without), and predominantly included patients undergoing elective colorectal surgery. The incidence of POD ranged from 8·2 to 54·4 per cent. A total of 95 risk factors were investigated, illustrating wide heterogeneity in study design. Seven statistically significant risk factors were identified in pooled analysis: old age, American Society of Anesthesiologists (ASA) physical status grade at least III, body mass index, lower serum level of albumin, intraoperative hypotension, perioperative blood transfusion and history of alcohol excess. Patients with POD had a significantly increased duration of hospital stay and a higher mortality rate compared with those without delirium. CONCLUSION Delirium is common in older patients undergoing gastrointestinal surgery. Several risk factors were consistently associated with POD.
Collapse
Affiliation(s)
- A F M Scholz
- Institute of Primary Care and Public Health, Cardiff University, University Hospital, Llandough, Cardiff
| | - C Oldroyd
- Institute of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, Glasgow
| | - K McCarthy
- Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK
| | - T J Quinn
- Institute of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, Glasgow
| | - J Hewitt
- Institute of Primary Care and Public Health, Cardiff University, University Hospital, Llandough, Cardiff
| |
Collapse
|
41
|
Moug SJ, McCarthy K, Coode-Bate J, Stechman MJ, Hewitt J. Laparoscopic versus open surgery for colorectal cancer in the older person: A systematic review. Ann Med Surg (Lond) 2015; 4:311-8. [PMID: 26468376 PMCID: PMC4572399 DOI: 10.1016/j.amsu.2015.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 04/08/2015] [Revised: 06/25/2015] [Accepted: 08/06/2015] [Indexed: 12/12/2022] Open
Abstract
Background Laparoscopic surgery is being increasingly offered to the older person. Objective To systematically review the literature regarding laparoscopic colorectal cancer surgery in older people and compare to younger adult populations. Study selection We included randomized controlled trials that compared open to laparoscopic colorectal cancer surgery. Older people were defined as being 65 years and above. Outcome measures Overall survival and post-operative morbidity and mortality. Secondary endpoints were length of hospital stay, wound recurrence, disease-free survival and conversion rate. Results Seven trials included older people, average age of approximately 70 years. Two reported data specific to older patients (over 70 years): The ALCCaS study reported reduced length of stay and short-term complication rates in the laparoscopic group when compared to open surgery (8 versus 10 days, and 36.7% versus 50.6% respectively) and the CLASICC study reported equivalent 5 year survival between arms and a reduction of 2 days length of stay following laparoscopic surgery in older people. In trials which considered data on older and younger participants all five trials reported comparable overall survival and showed comparable or reduced complication rates; two demonstrated significantly shorter length of stay following laparoscopic surgery compared to open surgery. Conclusion Large numbers of older people have been included in well-conducted, multi-centre, randomized controlled trials for laparoscopic and open colorectal cancer surgery. This systematic review suggests that age itself should not be a factor when considering the best surgical option for older patients. Seven well conducted randomised controlled trials of open versus laparoscopic colorectal cancer surgery have included older people. Age alone should not be a barrier to laparoscopic colorectal cancer surgery. The effect of comorbidity in older people undergoing laparoscopic surgery is less clear and warrants further study.
Collapse
Affiliation(s)
- S J Moug
- General Surgery, Royal Alexandra Hospital, Paisley, Glasgow, United Kingdom
| | - K McCarthy
- General Surgery, Southmead Hospital, Bristol, United Kingdom
| | - J Coode-Bate
- Urology, Norfolk and Norwich Hospital, Norwich, United Kingdom
| | - M J Stechman
- General Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - J Hewitt
- Department of Academic Geriatric Medicine, Cardiff University, United Kingdom
| |
Collapse
|
42
|
de Graaf M, van Beek J, Vennema H, Podkolzin AT, Hewitt J, Bucardo F, Templeton K, Mans J, Nordgren J, Reuter G, Lynch M, Rasmussen LD, Iritani N, Chan MC, Martella V, Ambert-Balay K, Vinjé J, White PA, Koopmans MP. Emergence of a novel GII.17 norovirus – End of the GII.4 era? ACTA ACUST UNITED AC 2015; 20. [PMID: 26159308 DOI: 10.2807/1560-7917.es2015.20.26.21178] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In the winter of 2014/15 a novel GII.P17-GII.17 norovirus strain (GII.17 Kawasaki 2014) emerged, as a major cause of gastroenteritis outbreaks in China and Japan. Since their emergence these novel GII.P17-GII.17 viruses have replaced the previously dominant GII.4 genotype Sydney 2012 variant in some areas in Asia but were only detected in a limited number of cases on other continents. This perspective provides an overview of the available information on GII.17 viruses in order to gain insight in the viral and host characteristics of this norovirus genotype. We further discuss the emergence of this novel GII.P17-GII.17 norovirus in context of current knowledge on the epidemiology of noroviruses. It remains to be seen if the currently dominant norovirus strain GII.4 Sydney 2012 will be replaced in other parts of the world. Nevertheless, the public health community and surveillance systems need to be prepared in case of a potential increase of norovirus activity in the next seasons caused by this novel GII.P17-GII.17 norovirus.
Collapse
Affiliation(s)
- M de Graaf
- Erasmus MC, Department of Viroscience, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Affiliation(s)
- L Yeo
- Department of Dermatology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
| | - E Husain
- Department of Pathology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | - J Hewitt
- Department of Dermatology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| |
Collapse
|
44
|
|
45
|
Williams M, Chakrabarti M, Benson E, Black A, Tarrant M, Moug S, Stechman, M, McCarthy K, Hewitt J. 51 * THE PREVALENCE OF COGNITIVE IMPAIRMENT MEASURED USING THE MONTREAL COGNITIVE ASSESSMENT METHOD (MOCA) IN AN OLDER ACUTE GENERAL SURGICAL POPULATION. Age Ageing 2014. [DOI: 10.1093/ageing/afu128.1] [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: 11/13/2022] Open
|
46
|
Hewitt J, Chou EMH, Brown LA, Smith VC, Yong SL, Wadsworth LD, Wu JK, Macgillivray RTA. Molecular characterization of a 4,409,480 bp deletion of the human X chromosome in a patient with haemophilia B. Haemophilia 2014; 20:e230-4. [PMID: 24589221 DOI: 10.1111/hae.12395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- J Hewitt
- Department of Biochemistry & Molecular Biology, University of British Columbia, Vancouver, BC, Canada; Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Hartman C, Hopfer C, Corley R, Hewitt J, Stallings M. Using Cloninger's temperament scales to predict substance-related behaviors in adolescents: a prospective longitudinal study. Am J Addict 2013; 22:246-51. [PMID: 23617866 DOI: 10.1111/j.1521-0391.2012.12010.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/17/2012] [Accepted: 02/24/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We tested one of Cloninger's temperament theories - that high novelty seeking (NS), along with low harm avoidance (HA), reward dependence (RD), and persistence (PE), predicts early-onset substance problems. METHODS In a community-based sample of 777 adolescents examined at two time points (mean age 13 and 18, respectively), we examined whether Cloninger's four temperament dimensions at wave 1 predicted five substance-related outcomes at wave 2: age of initiation for cigarettes, alcohol, and illicit drugs, number of substance classes tried, and total number of DSM-IV substance use disorder (SUD) symptoms. RESULTS Cloninger's predicted temperament pattern did significantly predict the number of SUD symptoms at wave 2. For initiation of cigarettes/illicit drugs and number of substance classes tried, HA/NS/PE fit the pattern, but RD did not. For onset of alcohol, only NS and PE fit Cloninger's prediction. Results for NS and PE were most consistent. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Overall, this study provides evidence that Cloninger's theory may hold true for predicting problem use more than for predicting "use" or experimentation. In addition, youth with high novelty seeking and low persistence may find substances especially reinforcing, and identifying these youth and intervening before initiation has occurred may reduce the risk of future substance-related problems.
Collapse
|
48
|
Harris KM, Halpern CT, Hussey J, Whitsel EA, Killeya-Jones L, Tabor J, Elder G, Hewitt J, Shanahan M, Williams R, Siegler I, Smolen A. Social, behavioral, and genetic linkages from adolescence into adulthood. Am J Public Health 2013; 103 Suppl 1:S25-32. [PMID: 23927505 DOI: 10.2105/ajph.2012.301181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The influence of genetic factors on health and behavior is conditioned by social, cultural, institutional, and physical environments in which individuals live, work, and play. We encourage studies supporting multilevel integrative approaches to understanding these contributions to health, and describe the Add Health study as an exemplar. Add Health is a large sample of US adolescents in grades 7 to 12 in 1994-1995 followed into adulthood with 4 in-home interviews and biomarker collections, including DNA. In addition to sampling multiple environments and measuring diverse social and health behavior, Add Health features a fully articulated behavioral genetic sample (3000 pairs) and ongoing genotyping of 12,000 archived samples. We illustrate approaches to understanding health through investigation of the interplay among biological, psychosocial, and physical, contextual, or cultural experiences.
Collapse
Affiliation(s)
- Kathleen Mullan Harris
- Kathleen Mullan Harris is with the Department of Sociology, Carolina Population Center, and Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill. Carolyn Tucker Halpern and Jon Hussey are with the Department of Maternal and Child Health, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill. Eric A. Whitsel is with the Departments of Epidemiology, Gillings School of Global Public Health, and Medicine, School of Medicine, University of North Carolina at Chapel Hill. Ley Killeya-Jones and Joyce Tabor are with the Carolina Population Center, University of North Carolina at Chapel Hill. Glen Elder is with the Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill. John Hewitt is with the Department of Psychology and the Institute for Behavioral Genetics, University of Colorado at Boulder. Michael Shanahan is with the Department of Sociology and Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill. Redford Williams and Ilene Siegler are with Duke University Medical Center, Durham, NC. Andrew Smolen is with the Institute for Behavioral Genetics, University of Colorado at Boulder
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Hewitt J, Bosworth A. PARE0019 National rheumatoid arthritis society scottish campaigns network. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
Hewitt J, Bosworth A. PARE0018 The impact of rheumatoid arthritis co-morbidities: recommendations for action. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|