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Witt K, McGill K, Leckning B, Hill NTM, Davies BM, Robinson J, Carter G. Global prevalence of psychosocial assessment following hospital-treated self-harm: systematic review and meta-analysis. BJPsych Open 2024; 10:e29. [PMID: 38205598 PMCID: PMC10790226 DOI: 10.1192/bjo.2023.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/04/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Hospital-treated self-harm is common, costly and associated with repeated self-harm and suicide. Providing a comprehensive psychosocial assessment following self-harm is recommended by professional bodies and may improve outcomes. AIMS To review the provision of psychosocial assessments after hospital-presenting self-harm and the extent to which macro-level factors indicative of service provision explain variability in these estimates. METHOD We searched five electronic databases to 3 January 2023 for studies reporting data on the proportion of patients and/or events that were provided a psychosocial assessment. Pooled weighted prevalence estimates were calculated with the random-effects model. Random-effects meta-regression was used to investigate between-study variability. RESULTS 119 publications (69 unique samples) were included. Across ages, two-thirds of patients had a psychosocial assessment (0.67, 95% CI 0.58-0.76). The proportion was higher for young people and older adults (0.75, 95% CI 0.36-0.99 and 0.83, 95% CI 0.48-1.00, respectively) compared with adults (0.64, 95% CI 0.54-0.73). For events, around half of all presentations had these assessments across the age range. No macro-level factor explained between-study heterogeneity. CONCLUSIONS There is room for improvement in the universal provision of psychosocial assessments for self-harm. This represents a missed opportunity to review and tailor aftercare supports for those at risk. Given the marked unexplained heterogeneity between studies, the person- and system-level factors that influence provision of psychosocial assessments after self-harm should be studied further.
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Affiliation(s)
- Katrina Witt
- Centre for Youth Mental Health, The University of Melbourne, Australia; and Orygen, Parkville, Australia
| | - Katie McGill
- School of Medicine and Public Health, The University of Newcastle, Australia; and Hunter New England Local Health District, Waratah, Australia
| | - Bernard Leckning
- Menzies School of Health Research, Charles Darwin University, Australia
| | - Nicole T. M. Hill
- School of Population and Global Health, The University of Western Australia, Australia; and Telethon Kids Institute, Nedlands, Australia
| | | | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Australia; and Orygen, Parkville, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Australia
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Waller J, Gowans P, Lord S, McGill K. Impact of Stoma Baseplate Convexity on Tension and Compression Around the Stoma Site: A Finite Element Analysis. Cureus 2024; 16:e52112. [PMID: 38213939 PMCID: PMC10783598 DOI: 10.7759/cureus.52112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
For patients living with intestinal or urinary stomas, skin barriers play an essential role in protecting the peristomal skin and preventing peristomal complications. Convex baseplates press into the peristomal skin and are suitable for retracted stomas that do not protrude, peristomal skin with creases, folds, or dips, and stomas where frequent leaking can occur with flat pouching systems. However, there is a lack of data on the magnitude and location of tension applied to the abdomen by convex baseplates. We evaluated the impact of a range of convex baseplates applied to a simulated stoma site. A comparative finite element analysis investigation was conducted to evaluate the impact of eight different convex stoma system baseplates applied to an idealised flat abdomen, representing skin, subcutaneous tissue, and musculature layers. The baseplates considered had varying convexity with depths of 3.5 mm and 7 mm and internal structural diameters between ~30 mm and ~60 mm. The convex product range provided tension in the skin (maximum principal strain) and compression through the fat layer (minimum principal strain). Large differences in the locations and magnitudes of skin tension and fat layer compression were seen between the baseplates under analysis, with both the depth and diameter of convexity influencing the strain experienced across the abdominal topography. The results generated highlight the importance of having an appropriate range of convexity products available and selecting an appropriate option for use based on the stoma type and condition of the peristomal skin.
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Affiliation(s)
| | | | | | - Katie McGill
- Engineering, Kinneir Dufort Design Ltd., Bristol, GBR
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3
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Witt K, McGill K, Leckning B, Hill NT, Davies BM, Robinson J, Carter G. Global prevalence of psychiatric in- and out-patient treatment following hospital-presenting self-harm: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102295. [PMID: 37965430 PMCID: PMC10641155 DOI: 10.1016/j.eclinm.2023.102295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Hospital-treated self-harm is common, costly, and strongly associated with suicide. Whilst effective psychosocial interventions exist, little is known about what key factors might modify the clinical decision to refer an individual to psychiatric in- and/or out-patient treatment following an episode of hospital-treated self-harm. Methods We searched five electronic databases (CENTRAL, CDSR, MEDLINE, Embase, and PsycINFO) until 3 January 2023 for studies reporting data on either the proportion of patients and/or events that receive a referral and/or discharge to psychiatric in- and/or outpatient treatment after an episode of hospital-treated self-harm. Pooled weighted prevalence estimates were calculated using the random effects model with the Freedman-Tukey double arcsine adjustment in R, version 4.0.5. We also investigated whether several study-level and macro-level factors explained variability for these outcomes using random-effects meta-regression. The protocol of this review was pre-registered with PROSPERO (CRD42021261531). Findings 189 publications, representing 131 unique studies, which reported data on 243,953 individual participants who had engaged in a total of 174,359 episodes of self-harm were included. Samples were drawn from 44 different countries. According to World Bank classifications, most (83.7%) samples were from high income countries. Across the age range, one-quarter of persons were referred for inpatient psychiatric care and, of these, around one-fifth received treatment. Just over one-third were referred to outpatient psychiatric care, whilst around half of those referred received at least one treatment session across the age range. Event rate estimates were generally of a lower magnitude. Subgroup analyses found that older adults (mean sample age: ≥60 years) may be less likely than young people (mean sample age: ≤25 years) and adults (mean sample age: >25 years to <60 years) to be referred for outpatient psychiatric care following self-harm. More recent studies were associated with a small increase in the proportion of presentations (events) that were referred to, and received, psychiatric outpatient treatment. No macro-level factor explained between-study heterogeneity. Interpretation There is considerable scope for improvement in the allocation and provision of both in- and out-patient psychiatric care following hospital-presenting self-harm, particularly considering that the period after discharge from general hospitals represents the peak risk period for repeat self-harm and suicide. Given the marked between-study heterogeneity, the basis for allocation of aftercare treatment is therefore not yet known and should be further studied. Funding There was no specific funding for this review.
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Affiliation(s)
- Katrina Witt
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Katie McGill
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Local Health District, Waratah, New South Wales, Australia
| | - Bernard Leckning
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Nicole T.M. Hill
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | | | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
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Licht‐Mayer S, Campbell GR, Mehta AR, McGill K, Symonds A, Al‐Azki S, Pryce G, Zandee S, Zhao C, Kipp M, Smith KJ, Baker D, Altmann D, Anderton SM, Kap YS, Laman JD, 't Hart BA, Rodriguez M, Franklin RJM, Chandran S, Lassmann H, Trapp BD, Mahad DJ. Axonal response of mitochondria to demyelination and complex IV activity within demyelinated axons in experimental models of multiple sclerosis. Neuropathol Appl Neurobiol 2023; 49:e12851. [PMID: 36181265 PMCID: PMC10092519 DOI: 10.1111/nan.12851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/14/2021] [Revised: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022]
Abstract
AIMS Axonal injury in multiple sclerosis (MS) and experimental models is most frequently detected in acutely demyelinating lesions. We recently reported a compensatory neuronal response, where mitochondria move to the acutely demyelinated axon and increase the mitochondrial content following lysolecithin-induced demyelination. We termed this homeostatic phenomenon, which is also evident in MS, the axonal response of mitochondria to demyelination (ARMD). The aim of this study is to determine whether ARMD is consistently evident in experimental demyelination and how its perturbation relates to axonal injury. METHODS In the present study, we assessed axonal mitochondrial content as well as axonal mitochondrial respiratory chain complex IV activity (cytochrome c oxidase or COX) of axons and related these to axonal injury in nine different experimental disease models. We used immunofluorescent histochemistry as well as sequential COX histochemistry followed by immunofluorescent labelling of mitochondria and axons. RESULTS We found ARMD a consistent and robust phenomenon in all experimental disease models. The increase in mitochondrial content within demyelinated axons, however, was not always accompanied by a proportionate increase in complex IV activity, particularly in highly inflammatory models such as experimental autoimmune encephalomyelitis (EAE). Axonal complex IV activity inversely correlated with the extent of axonal injury in experimental disease models. CONCLUSIONS Our findings indicate that ARMD is a consistent and prominent feature and emphasise the importance of complex IV activity in the context of ARMD, especially in autoimmune inflammatory demyelination, paving the way for the development of novel neuroprotective therapies.
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Affiliation(s)
- Simon Licht‐Mayer
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | | | - Arpan R. Mehta
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- UK Dementia Research InstituteUniversity of EdinburghEdinburghUK
| | - Katie McGill
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Alex Symonds
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Sarah Al‐Azki
- Blizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Gareth Pryce
- Blizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Stephanie Zandee
- Centre for Inflammation ResearchUniversity of EdinburghEdinburghUK
| | - Chao Zhao
- Wellcome Trust‐MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical CentreUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUK
| | - Markus Kipp
- Institute of AnatomyRostock University Medical CenterRostockGermany
| | - Kenneth J. Smith
- Department of Neuroinflammation, The UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - David Baker
- Blizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Daniel Altmann
- Faculty of Medicine, Department of MedicineHammersmith CampusLondonUK
| | | | - Yolanda S. Kap
- Department of ImmunobiologyBiomedical Primate Research CentreRijswijkThe Netherlands
| | - Jon D. Laman
- Department of ImmunobiologyBiomedical Primate Research CentreRijswijkThe Netherlands
- Department Pathology and Medical Biology and MS Center Noord Nederland (MSCNN)University Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Bert A. 't Hart
- Department of ImmunobiologyBiomedical Primate Research CentreRijswijkThe Netherlands
- Department Pathology and Medical Biology and MS Center Noord Nederland (MSCNN)University Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department Anatomy and NeuroscienceAmsterdam University Medical Center (VUMC)AmsterdamNetherlands
| | - Moses Rodriguez
- Department of Neurology and ImmunologyMayo College of Medicine and ScienceRochesterMinnesotaUSA
| | - Robin J. M. Franklin
- Wellcome Trust‐MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical CentreUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUK
| | - Siddharthan Chandran
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- UK Dementia Research InstituteUniversity of EdinburghEdinburghUK
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain ResearchMedical University ViennaViennaAustria
| | - Bruce D. Trapp
- Department of NeuroscienceLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Don J. Mahad
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
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Dani A, Balachandran S, McGill K, Whyte I, Carter G. Prevalence of Depression and Predictors of Discharge to a Psychiatric Hospital in Young People with Hospital-Treated Deliberate Self-Poisoning at an Australian Sentinel Unit. Int J Environ Res Public Health 2022; 19:15753. [PMID: 36497828 PMCID: PMC9737120 DOI: 10.3390/ijerph192315753] [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] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Hospital treated deliberate self-poisoning is common in young people. Internationally, estimates of rates of depression in this population are very wide (14.6% to 88%). The aims of this study were to determine the prevalence of depression and the independent predictors of referral for psychiatric hospitalisation in young people (aged 16 to 25 years) following an index episode of hospital treated deliberate self-poisoning. METHOD A retrospective cohort study design (n = 1410), with data drawn from a population-based clinical case register. Unadjusted and adjusted estimates of predictors of referral for psychiatric admission (after-care) used logistic regression models. RESULTS Prevalence of any depression diagnosis was 35.5% (n = 500); and 25.4% (n = 358) were referred for a psychiatric admission. The adjusted estimates for predictors of psychiatric inpatient referral were: high suicidal level (OR 118.21: CI 95% 63.23-220.99), low/moderate suicidal level (14.27: 9.38-21.72), any depression (2.88: 1.97-4.22), any psychosis (4.06; 1.15-14.36), older age (1.12: 1.04-1.21), and number of support people (0.88: 0.78-0.98). CONCLUSION Depression was diagnosed in more than a third and was an independent predictor of psychiatric inpatient referral, so service providers need to account for this level of need in the provision of assessment and after-care services. Evidence-based guidelines for psychiatric inpatient after-care for deliberate self-poisoning and/or depression in young people are limited. Our explanatory model included suicidal level, depression, psychosis, older age, and available support persons, suggesting that the treating clinicians were making these discharge decisions for admission in keeping with those limited guidelines, although the balance of benefits and harms of psychiatric hospitalisation are not established. Future research examining patient experiences, effectiveness of psychiatric hospitalisation, and alternatives to hospitalisation is warranted.
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Affiliation(s)
- Anitha Dani
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Srilaxmi Balachandran
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Katie McGill
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Research Evaluation and Dissemination (MH-READ), Hunter New England Mental Health Service, Newcastle, NSW 2298, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
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McGill K, Salem A, Hanstock TL, Heard TR, Garvey L, Leckning B, Whyte I, Page A, Carter G. Indigeneity and Likelihood of Discharge to Psychiatric Hospital in an Australian Deliberate Self-Poisoning Hospital-Treated Cohort. Int J Environ Res Public Health 2022; 19:12238. [PMID: 36231541 PMCID: PMC9566708 DOI: 10.3390/ijerph191912238] [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] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003-2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge; Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40-0.87) at the univariate level, with little change after sequential adjustment; and AOR 0.34 (0.21-0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation.
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Affiliation(s)
- Katie McGill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Mental Health-Research, Evaluation and Dissemination (MH-READ), Hunter New England Local Health District, Newcastle, NSW 2298, Australia
| | - Amir Salem
- School of Psychological Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Tanya L. Hanstock
- School of Psychological Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Todd R. Heard
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Wiyillin Ta Child and Adolescent Mental Health Service, Hunter New England Local Health District, Newcastle, NSW 2300, Australia
| | - Leonie Garvey
- Aboriginal Health, Hunter New England Local Health District, Wallsend, NSW 2287, Australia
| | - Bernard Leckning
- Black Dog Institute, University of New South Wales, Sydney, NSW 1466, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
| | - Greg Carter
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
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McGill K, Bhullar N, Batterham PJ, Carrandi A, Wayland S, Maple M. Key issues, challenges, and preferred supports for those bereaved by suicide: Insights from postvention experts. Death Stud 2022; 47:624-629. [PMID: 35984768 DOI: 10.1080/07481187.2022.2112318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
For many, suicide bereavement is challenging. Postvention responses are few and evidence to inform them is lacking. Eighteen postvention experts completed an online survey regarding the key issues, challenges, and supports available to people bereaved by suicide. Participants were asked to identify the issues, then rank them in terms of importance at key times during the first 2 years after death, with navigating grief, managing relationships, and dealing with practical challenges identified. Access to information, practical assistance and non-judgmental support were most important early in the bereavement period. These findings provide a foundation for recommendations for postvention interventions.
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Affiliation(s)
- Katie McGill
- Faculty of Medicine and Health, University of New England, Armidale, Australia
- MH-READ, Hunter New England Local Health District, Newcastle, Australia
- Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, Australia
| | - Navjot Bhullar
- Faculty of Medicine and Health, University of New England, Armidale, Australia
- Discipline of Psychology, Edith Cowan University, Perth, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Alayna Carrandi
- Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Sarah Wayland
- Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Myfanwy Maple
- Faculty of Medicine and Health, University of New England, Armidale, Australia
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McGill K, Bhullar N, Pearce T, Batterham PJ, Wayland S, Maple M. Effectiveness of Brief Contact Interventions for Bereavement: A Systematic Review. Omega (Westport) 2022:302228221108289. [PMID: 35758167 DOI: 10.1177/00302228221108289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brief contact interventions are an efficient and cost-effective way of providing support to individuals. Whether they are an effective bereavement intervention is not clear. This systematic review included articles from 2014 to 2021.711 studies were identified, with 15 meeting inclusion criteria. The brief contact interventions included informational and emotional supports. Narrative synthesis identified that participants valued brief contact interventions, however some did not find them helpful. Exposure to a brief contact intervention was typically associated with improvements in wellbeing. Studies with comparison groups typically found significant but modest improvements in grief, depression symptoms and wellbeing associated with the intervention. However, one intervention was associated with significant deterioration of depression symptoms. Existing brief contact interventions for bereavement appear feasible, generally acceptable to the target population and are associated with improvements in wellbeing. Further development and evaluation to account for why improvements occur, and to identify any unintended impacts, is required.
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Affiliation(s)
- Katie McGill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Navjot Bhullar
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Tania Pearce
- School of Health, University of New England, Armidale, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Sarah Wayland
- School of Health, University of New England, Armidale, NSW, Australia
| | - Myfanwy Maple
- School of Health, University of New England, Armidale, NSW, Australia
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McGill K, Whyte IM, Sawyer L, Adams D, Delamothe K, Lewin TJ, Robinson J, Kay-Lambkin FJ, Carter GL. Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non-clinical after-care program for hospital-treated deliberate self-poisoning. Suicide Life Threat Behav 2022; 52:500-514. [PMID: 35122297 DOI: 10.1111/sltb.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/27/2021] [Accepted: 11/12/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Active contact and follow-up interventions have been shown to be effective in reducing repetition of hospital-treated self-harm. The Way Back Support Service (WBSS) is a new service funded by the Australian government to provide three months of non-clinical after-care following a hospital-treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self-poisoning (DSP) and psychiatric hospital admissions over a 12-month follow-up period for a population of DSP patients within the Hunter (Australia) region. METHODS A non-randomized, historical controlled (two periods) trial design with intention-to-treat analyses. Outcome data were drawn from hospital records. RESULTS There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re-admissions for DSP in the follow-up period. For psychiatric admissions, the intervention cohort had a non-significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts. CONCLUSION The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence-based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation.
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Affiliation(s)
- Katie McGill
- MH-READ, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ian M Whyte
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Lisa Sawyer
- Hunter Primary Care, Newcastle, New South Wales, Australia
| | - Danielle Adams
- Hunter Primary Care, Newcastle, New South Wales, Australia
| | | | - Terry J Lewin
- MH-READ, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jo Robinson
- Orygen, Parkvillle, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkvillle, Victoria, Australia
| | - Frances J Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gregory L Carter
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Calvary Mater Newcastle, Newcastle, New South Wales, Australia
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McGill K, Spittal MJ, Bryant J, Lewin TJ, Whyte IM, Madden C, Carter G. Comparison of accredited person and medical officer discharge decisions under the Mental Health Act of NSW: A cohort study of deliberate self-poisoning patients. Aust N Z J Psychiatry 2022; 56:178-185. [PMID: 33951922 DOI: 10.1177/00048674211009613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Accredited Persons Programme was introduced in 2003. The relevant Mental Health Acts (NSW) authorised reviews by appropriately credentialed non-medical health professionals as part of the process of detaining and treating a person without consent: an authority previously held by medical officers. Evaluations of the Programme are needed. OBJECTIVE To compare discharge decisions for hospital-treated deliberate self-poisoning patients made by an Accredited Person and Medical Officers. METHODS For a 10-year cohort (2003-2012) of index hospital-treated deliberate self-poisoning admissions at the Calvary Mater Newcastle, we compared Accredited Person and Medical Officer discharge decisions from the general hospital. We specifically examined discharges to the psychiatric hospital under a Mental Health Act certificate (used as an index of the Accredited Person's use of the authority under the Accredited Persons Programme) compared to any other discharge destination. Unadjusted and adjusted logistic regression models and a propensity score analysis were used to explore the relationship between clinician type and discharge destination. RESULTS There were 2237 index assessments (Accredited Person = 884; Medical Officer = 1443). One-quarter (27%) were referred for assessment under the Act at the psychiatric hospital, with the Accredited Person significantly more likely (32%) to require this compared to the Medical Officers (24%); Risk Difference: 8.3% (4.5 to 12.1). However, after adjusting for patient characteristics; Risk Difference: -3.0% (-5.9 to -0.1) and for propensity score, Risk Difference: -3.3% (-6.7 to 0.1), the Accredited Person and Medical Officer likelihood of discharging for an assessment under the Act was similar. CONCLUSIONS The Accredited Person assessed more clinically complex patients than the Medical Officers. After adjusting for clinical complexity and propensity score, the likelihood of referral for involuntary psychiatric hospital care was similar for Accredited Person and Medical Officers. Our evaluation of the Accredited Person programme in the general hospital was favourable, and wider implementation and evaluation is warranted.
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Affiliation(s)
- Katie McGill
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia.,MH-READ, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Bryant
- Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Terry J Lewin
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia.,MH-READ, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Ian M Whyte
- Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Clare Madden
- Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Greg Carter
- Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia.,Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Waratah, NSW, Australia.,Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
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11
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Gale L, McGill K, Twaddell S, Whyte IM, Lewin TJ, Carter GL. Hospital-treated deliberate self-poisoning patients: Drug-induced delirium and clinical outcomes. Aust N Z J Psychiatry 2022; 56:154-163. [PMID: 33938265 DOI: 10.1177/00048674211009608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Drug-induced delirium has been attributed to opioid, benzodiazepine, antipsychotic, antihistaminic and anticholinergic drug groups at therapeutic doses. Delirium also occurs in hospital-treated self-poisoning (at supra-therapeutic doses), although the causative drug classes are not well established and co-ingestion is common. We tested the magnitude and direction of association of five major drug groups with incident cases of delirium. METHODS A retrospective longitudinal cohort (n = 5131) study was undertaken of deliberate and recreational/chronic misuse poisoning cases from a regional sentinel toxicology unit. We described ingestion and co-ingestion patterns and estimated the unadjusted and adjusted odds for developing a drug-induced delirium. We also estimated the odds of drug-induced delirium being associated with three outcomes: intensive care unit admission, general hospital length of stay and discharge to home. RESULTS Drug-induced delirium occurred in 3.9% of cases (n = 200). The unadjusted odds ratios for development of delirium were increased for anticholinergics 10.79 (5.43-21.48), antihistamines 6.10 (4.20-8.84) and antipsychotics 2.99 (2.20-4.06); non-significant for opioids 1.31 (95% confidence interval = [0.81, 2.13]); and reduced for benzodiazepines 0.37 (0.24-0.58); with little change after adjustment for age, gender and co-ingestion. Delirium was associated with intensive care unit admission, longer length of stay and discharge destination. CONCLUSION Drug-induced delirium was uncommon in this population. Co-ingestion was common but did not alter the risk. In contrast to drug-induced delirium at therapeutic doses in older populations, opioids were not associated with delirium and benzodiazepines were protective. Drug-induced delirium required increased clinical services. Clinical services should be funded and prepared to provide additional supportive care for these deliriogenic drug group ingestions.
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Affiliation(s)
- Lindsay Gale
- Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Scott Twaddell
- Department of Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Ian M Whyte
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Terry J Lewin
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Gregory L Carter
- Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
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12
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Zbukvic I, Rheinberger D, Rosebrock H, Lim J, McGillivray L, Mok K, Stamate E, McGill K, Shand F, Moullin JC. Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework. Implementation Research and Practice 2022; 3:26334895211065786. [PMID: 37091106 PMCID: PMC9924249 DOI: 10.1177/26334895211065786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.
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Affiliation(s)
- Isabel Zbukvic
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Demee Rheinberger
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Hannah Rosebrock
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jaclyn Lim
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren McGillivray
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine Mok
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Eve Stamate
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, New South Wales, Australia
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Fiona Shand
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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13
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Licht-Mayer S, Campbell GR, Canizares M, Mehta AR, Gane AB, McGill K, Ghosh A, Fullerton A, Menezes N, Dean J, Dunham J, Al-Azki S, Pryce G, Zandee S, Zhao C, Kipp M, Smith KJ, Baker D, Altmann D, Anderton SM, Kap YS, Laman JD, Hart BA', Rodriguez M, Watzlawick R, Schwab JM, Carter R, Morton N, Zagnoni M, Franklin RJM, Mitchell R, Fleetwood-Walker S, Lyons DA, Chandran S, Lassmann H, Trapp BD, Mahad DJ. Enhanced axonal response of mitochondria to demyelination offers neuroprotection: implications for multiple sclerosis. Acta Neuropathol 2020; 140:143-167. [PMID: 32572598 PMCID: PMC7360646 DOI: 10.1007/s00401-020-02179-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/25/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
Axonal loss is the key pathological substrate of neurological disability in demyelinating disorders, including multiple sclerosis (MS). However, the consequences of demyelination on neuronal and axonal biology are poorly understood. The abundance of mitochondria in demyelinated axons in MS raises the possibility that increased mitochondrial content serves as a compensatory response to demyelination. Here, we show that upon demyelination mitochondria move from the neuronal cell body to the demyelinated axon, increasing axonal mitochondrial content, which we term the axonal response of mitochondria to demyelination (ARMD). However, following demyelination axons degenerate before the homeostatic ARMD reaches its peak. Enhancement of ARMD, by targeting mitochondrial biogenesis and mitochondrial transport from the cell body to axon, protects acutely demyelinated axons from degeneration. To determine the relevance of ARMD to disease state, we examined MS autopsy tissue and found a positive correlation between mitochondrial content in demyelinated dorsal column axons and cytochrome c oxidase (complex IV) deficiency in dorsal root ganglia (DRG) neuronal cell bodies. We experimentally demyelinated DRG neuron-specific complex IV deficient mice, as established disease models do not recapitulate complex IV deficiency in neurons, and found that these mice are able to demonstrate ARMD, despite the mitochondrial perturbation. Enhancement of mitochondrial dynamics in complex IV deficient neurons protects the axon upon demyelination. Consequently, increased mobilisation of mitochondria from the neuronal cell body to the axon is a novel neuroprotective strategy for the vulnerable, acutely demyelinated axon. We propose that promoting ARMD is likely to be a crucial preceding step for implementing potential regenerative strategies for demyelinating disorders.
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Affiliation(s)
- Simon Licht-Mayer
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Graham R Campbell
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marco Canizares
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Arpan R Mehta
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Angus B Gane
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Katie McGill
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Aniket Ghosh
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Alexander Fullerton
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Niels Menezes
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jasmine Dean
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jordon Dunham
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, OH44195, USA
| | - Sarah Al-Azki
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Gareth Pryce
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Stephanie Zandee
- Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Chao Zhao
- Wellcome Trust-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Markus Kipp
- Institute of Anatomy, Rostock University Medical Center, Gertrudenstrasse 9, 18057, Rostock, Germany
| | - Kenneth J Smith
- Department of Neuroinflammation, The UCL Queen Square Institute of Neurology, University College London, 1 Wakefield Street, London, WC1N 1PJ, UK
| | - David Baker
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Daniel Altmann
- Faculty of Medicine, Department of Medicine, Hammersmith Campus, London, UK
| | - Stephen M Anderton
- Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Yolanda S Kap
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Jon D Laman
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
- Dept. Biomedical Sciences of Cells and Systems and MS Center Noord Nederland (MSCNN), University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | - Bert A 't Hart
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
- Dept. Biomedical Sciences of Cells and Systems and MS Center Noord Nederland (MSCNN), University Medical Center Groningen, University Groningen, Groningen, The Netherlands
- Department Anatomy and Neuroscience, Amsterdam University Medical Center (V|UMC|), Amsterdam, Netherlands
| | - Moses Rodriguez
- Department of Neurology and Immunology, Mayo College of Medicine and Science, Rochester, MN, MN55905, USA
| | - Ralf Watzlawick
- Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
| | - Jan M Schwab
- Spinal Cord Injury Medicine, Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, USA
| | - Roderick Carter
- Centre for Cardiovascular Science, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, UK
| | - Nicholas Morton
- Centre for Cardiovascular Science, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, UK
| | - Michele Zagnoni
- Centre for Microsystems and Photonics, Electronic and Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - Robin J M Franklin
- Wellcome Trust-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Rory Mitchell
- Centre for Discovery Brain Science, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sue Fleetwood-Walker
- Centre for Discovery Brain Science, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David A Lyons
- Centre for Discovery Brain Science, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria
| | - Bruce D Trapp
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, OH44195, USA
| | - Don J Mahad
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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14
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Jackson M, McGill K, Lewin TJ, Bryant J, Whyte I, Carter G. Hospital-treated deliberate self-poisoning in the older adult: Identifying specific clinical assessment needs. Aust N Z J Psychiatry 2020; 54:591-601. [PMID: 31957465 DOI: 10.1177/0004867419897818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. OBJECTIVE To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45-64 years) during an index episode of hospital-treated deliberate self-poisoning. METHODS A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003-2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. RESULTS There were (n = 157) older-aged and (n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. CONCLUSION Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.
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Affiliation(s)
- Mariann Jackson
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Terry J Lewin
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Ian Whyte
- Calvary Mater Newcastle, Waratah, NSW, Australia.,Discipline of Clinical Pharmacology, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, Australia
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15
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McGill K, Hiles SA, Handley TE, Page A, Lewin TJ, Whyte I, Carter GL. Is the reported increase in young female hospital-treated intentional self-harm real or artefactual? Aust N Z J Psychiatry 2019; 53:663-672. [PMID: 30518227 DOI: 10.1177/0004867418815977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Australian Institute of Health and Welfare has reported an increased rate of hospital-treated intentional self-harm in young females (2000-2012) in Australia. These reported increases arise from institutional data that are acknowledged to underestimate the true rate, although the degree of underestimation is not known. OBJECTIVE To consider whether the reported increase in young females' hospital-treated intentional self-harm is real or artefactual and specify the degree of institutional underestimation. METHODS Averages for age- and gender-standardised event rates for hospital-treated intentional self-harm (national: Australian Institute of Health and Welfare; state: New South Wales Ministry of Health) were compared with sentinel hospital event rates for intentional self-poisoning (Hunter Area Toxicology Service, Calvary Mater Newcastle) in young people (15-24 years) for the period 2000-2012. A time series analysis of the event rates for the sentinel hospital was conducted. RESULTS The sentinel hospital event rates for young females of 444 per 100,000 were higher than the state (378 per 100,000) and national (331 per 100,000) rates. There was little difference in young male event rates - sentinel unit: 166; state: 166 and national: 153 per 100,000. The sentinel hospital rates showed no change over time for either gender. CONCLUSION There was no indication from the sentinel unit data of any increase in rates of intentional self-poisoning for young females. The sentinel and state rates were higher than the national rates, demonstrating the possible magnitude of underestimation of the national data. The reported increases in national rates of hospital-treated self-harm among young females might be due to artefactual factors, such as changes in clinical practice (greater proportion admitted), improved administrative coding of suicidal behaviours or possibly increased hospital presentations of community self-injury cases, but not intentional self-poisoning. A national system of sentinel units is needed for the accurate and timely monitoring of all hospital-treated self-harm.
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Affiliation(s)
- Katie McGill
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,2 MH-READ, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Sarah A Hiles
- 3 School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Tonelle E Handley
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,4 Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Page
- 5 Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Terry J Lewin
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,2 MH-READ, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Ian Whyte
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,6 Discipline of Clinical Pharmacology and Toxicology, University of Newcastle, Callaghan, NSW, Australia.,7 Department of Clinical Pharmacology and Toxicology, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Gregory L Carter
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,8 Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle, Waratah, NSW, Australia
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16
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McGill K, Hackney S, Skehan J. Information needs of people after a suicide attempt: A thematic analysis. Patient Educ Couns 2019; 102:1119-1124. [PMID: 30679002 DOI: 10.1016/j.pec.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/18/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to identify the information that people who have attempted suicide and those who support them believed to be helpful to receive after an attempt. METHODS Thirty-seven people with lived experience of suicide attempt(s) (suicide attempt survivors and family members/friends of survivors) were recruited through two national lived experience community groups in Australia. Participants completed a semi-structured telephone interview that included questions about the types of information they believed important to receive after an attempt. RESULTS Using thematic analysis, the key information participants identified was helpful to receive following a suicide attempt was that which could challenge stigma and address negative community attitudes towards suicide. Participants spoke of a need for practical information and information that provided hope. Personal stories of recovery were identified as an important way of communicating this sort of health information. CONCLUSIONS People who have attempted suicide and their family members and friends want information that challenges stigma and supports recovery expectations. PRACTICE IMPLICATIONS Providing people with accurate information about recovery and using personal stories to communicate health information is one way people affected by suicide attempt identify can challenge stigma, and address information needs after a suicide attempt.
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Affiliation(s)
- Katie McGill
- Mental Health-Research, Analysis, Evaluation and Dissemination Unit, Hunter New England Local Health District, P.O. Box 833, Newcastle, NSW, 2300, Australia; School of Medicine & Public Health, University of Newcastle, University Drive, Newcastle, Callaghan, NSW, 2308, Australia; Everymind, Hunter New England Local Health District, P.O. Box 833, Newcastle, NSW, 2300, Australia.
| | - Sue Hackney
- Western New South Wales Primary Health Network, P.O. Box 890, Dubbo, NSW, 2830, Australia
| | - Jaelea Skehan
- School of Medicine & Public Health, University of Newcastle, University Drive, Newcastle, Callaghan, NSW, 2308, Australia; Everymind, Hunter New England Local Health District, P.O. Box 833, Newcastle, NSW, 2300, Australia
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17
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Woodford R, Spittal MJ, Milner A, McGill K, Kapur N, Pirkis J, Mitchell A, Carter G. Accuracy of Clinician Predictions of Future Self-Harm: A Systematic Review and Meta-Analysis of Predictive Studies. Suicide Life Threat Behav 2019; 49:23-40. [PMID: 28972271 DOI: 10.1111/sltb.12395] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
Assessment of a patient after hospital-treated self-harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self-harm. Through systematic review and a series of meta-analyses looking at unassisted clinician risk classification (eight studies; N = 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18-0.50), specificity 0.85 (0.75-0.92), positive predictive value 0.22 (0.21-0.23), and negative predictive value 0.89 (0.86-0.92). Clinician classification was too inaccurate to be clinically useful. After-care should therefore be allocated on the basis of a needs rather than risk assessment.
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Affiliation(s)
- Rachel Woodford
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Allison Milner
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Katie McGill
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
| | - Navneet Kapur
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Jane Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Alex Mitchell
- Cancer Studies & Molecular Medicine, University of Leicester, Leicester, UK
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
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Mitchell R, Campbell G, Mikolajczak M, McGill K, Mahad D, Fleetwood-Walker SM. A Targeted Mutation Disrupting Mitochondrial Complex IV Function in Primary Afferent Neurons Leads to Pain Hypersensitivity Through P2Y 1 Receptor Activation. Mol Neurobiol 2019; 56:5917-5933. [PMID: 30689196 DOI: 10.1007/s12035-018-1455-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/14/2018] [Indexed: 01/20/2023]
Abstract
As mitochondrial dysfunction is evident in neurodegenerative disorders that are accompanied by pain, we generated inducible mutant mice with disruption of mitochondrial respiratory chain complex IV, by COX10 deletion limited to sensory afferent neurons through the use of an Advillin Cre-reporter. COX10 deletion results in a selective energy-deficiency phenotype with minimal production of reactive oxygen species. Mutant mice showed reduced activity of mitochondrial respiratory chain complex IV in many sensory neurons, increased ADP/ATP ratios in dorsal root ganglia and dorsal spinal cord synaptoneurosomes, as well as impaired mitochondrial membrane potential, in these synaptoneurosome preparations. These changes were accompanied by marked pain hypersensitivity in mechanical and thermal (hot and cold) tests without altered motor function. To address the underlying basis, we measured Ca2+ fluorescence responses of dorsal spinal cord synaptoneurosomes to activation of the GluK1 (kainate) receptor, which we showed to be widely expressed in small but not large nociceptive afferents, and is minimally expressed elsewhere in the spinal cord. Synaptoneurosomes from mutant mice showed greatly increased responses to GluK1 agonist. To explore whether altered nucleotide levels may play a part in this hypersensitivity, we pharmacologically interrogated potential roles of AMP-kinase and ADP-sensitive purinergic receptors. The ADP-sensitive P2Y1 receptor was clearly implicated. Its expression in small nociceptive afferents was increased in mutants, whose in vivo pain hypersensitivity, in mechanical, thermal and cold tests, was reversed by a selective P2Y1 antagonist. Energy depletion and ADP elevation in sensory afferents, due to mitochondrial respiratory chain complex IV deficiency, appear sufficient to induce pain hypersensitivity, by ADP activation of P2Y1 receptors.
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MESH Headings
- Adenosine Diphosphate/metabolism
- Adenosine Monophosphate/metabolism
- Alkyl and Aryl Transferases/metabolism
- Animals
- Behavior, Animal
- Calcium/metabolism
- Cells, Cultured
- Electron Transport Complex IV/genetics
- Electron Transport Complex IV/metabolism
- Fluorescence
- Ganglia, Spinal/drug effects
- Ganglia, Spinal/metabolism
- Hypersensitivity/complications
- Hypersensitivity/pathology
- Membrane Proteins/metabolism
- Mice, Inbred C57BL
- Mice, Transgenic
- Mitochondria/drug effects
- Mitochondria/metabolism
- Mutation/genetics
- Neurons, Afferent/drug effects
- Neurons, Afferent/metabolism
- Neurons, Afferent/pathology
- Nociception/drug effects
- Pain/complications
- Pain/pathology
- Phenotype
- Purinergic P2Y Receptor Antagonists/pharmacology
- Receptors, Kainic Acid/metabolism
- Receptors, Purinergic P2Y1/metabolism
- Spinal Cord/pathology
- Synapses/drug effects
- Synapses/metabolism
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Affiliation(s)
- Rory Mitchell
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh, EH8 9XD, UK
| | - Graham Campbell
- Centre for Clinical Brain Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Chancellor's Building, Little France, Edinburgh, Edinburgh, EH16 4SB, UK
| | - Marta Mikolajczak
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh, EH8 9XD, UK
| | - Katie McGill
- Centre for Clinical Brain Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Chancellor's Building, Little France, Edinburgh, Edinburgh, EH16 4SB, UK
| | - Don Mahad
- Centre for Clinical Brain Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Chancellor's Building, Little France, Edinburgh, Edinburgh, EH16 4SB, UK
| | - Sue M Fleetwood-Walker
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh, EH8 9XD, UK.
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19
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McMaster ME, Ashley-Sing C, Dos Santos Tavares AA, Corral CA, McGill K, McNeil D, Jansen MA, Simpson AHRW. The inhalation effects of by-products from chlorination of heated indoor swimming pools on spinal development in pup mice. Environ Res 2018; 166:668-676. [PMID: 30015251 DOI: 10.1016/j.envres.2018.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION It has been postulated that swimming in heated indoor swimming pools in the first year of life is associated with the development of spinal deformity in children. We explored in pup mice whether exposure to certain disinfection by-products resulting from chlorination of heated pools would affect the future development of the spinal column. METHODS Mice, from birth and for 28 consecutive days, were exposed to chemicals known to be created by disinfection by-products of indoor heated swimming pools. The study made use of a body fluid analogue and a chlorine source to recreate the conditions found in municipal pools. A cohort of 51 wild-type C57B6 mice, male and female, were divided into two groups: experimental (n = 29) and controls (n = 22). 24 mice were observed for 8 months (32 weeks), with 27 culled at 4 months (16 weeks). Serial CT scanning was used to assess the spines. RESULTS Exposure to disinfection by-products resulted in an increase in the normal thoracic kyphotic spinal angle of the mice when compared with their controls at 10 weeks; experimental mice kyphosis range 35-82° versus 29-38° in controls. At 14 weeks the kyphosis of the experimental mice had reduced in size but never to that of the control group. CONCLUSION We have demonstrated the ability to influence spinal development in pup mice through environmental factors and shown that the developmental deformity became evident only after a significant latent period.
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Affiliation(s)
| | | | | | - Carlos Alcaide Corral
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Katie McGill
- Central Bioresearch Services, University of Edinburgh, Edinburgh, UK.
| | - Duncan McNeil
- Central Bioresearch Services, University of Edinburgh, Edinburgh, UK.
| | - Maurits A Jansen
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK.
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20
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Carter G, Milner A, McGill K, Pirkis J, Kapur N, Spittal MJ. Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales. Br J Psychiatry 2017; 210:387-395. [PMID: 28302700 DOI: 10.1192/bjp.bp.116.182717] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 10/16/2016] [Accepted: 11/16/2016] [Indexed: 01/17/2023]
Abstract
BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as 'high risk' to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9-7.9%), self-harm 26.3% (95% CI 21.8-31.3%) and self-harm plus suicide 35.9% (95% CI 25.8-47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3-22.3%) for high-quality studies, 32.5% (95% CI 26.1-39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5-35.6%) for psychiatric in-patients.ConclusionsNo 'high-risk' classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
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Affiliation(s)
- Gregory Carter
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Milner
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie McGill
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane Pirkis
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nav Kapur
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Matthew J Spittal
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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21
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Acke E, McGill K, Lawlor A, Jones BR, Fanning S, Whyte P. Genetic diversity among Campylobacter jejuni
isolates from pets in Ireland. Vet Rec 2010; 166:102-6. [DOI: 10.1136/vr.c357] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E. Acke
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin, Belfield; Dublin 4 Ireland
- Veterinary Teaching Hospital; Institute of Veterinary, Animal and Biomedical Sciences; Massey University; Private Bag 11222 Palmerston North 4442 New Zealand
| | - K. McGill
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin, Belfield; Dublin 4 Ireland
| | - A. Lawlor
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin, Belfield; Dublin 4 Ireland
| | - B. R. Jones
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin, Belfield; Dublin 4 Ireland
| | - S. Fanning
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin, Belfield; Dublin 4 Ireland
| | - P. Whyte
- School of Agriculture, Food Science and Veterinary Medicine; University College Dublin, Belfield; Dublin 4 Ireland
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22
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McGill K, Kelly L, Madden R, Moran L, Carroll C, O'Leary A, Moore J, McNamara E, O'Mahony M, Fanning S, Whyte P. Comparison of disc diffusion and epsilometer (E-test) testing techniques to determine antimicrobial susceptibiliy of Campylobacter isolates of food and human clinical origin. J Microbiol Methods 2009; 79:238-41. [DOI: 10.1016/j.mimet.2009.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
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23
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Teixeira J, McGill K, Binenbaum S, Forrester G. Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience. Surg Endosc 2009; 23:1409-14. [PMID: 19288157 DOI: 10.1007/s00464-009-0411-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 01/19/2009] [Accepted: 02/11/2009] [Indexed: 01/20/2023]
Abstract
BACKGROUND Laparoendoscopic single-site (LESS) surgery for cholecystectomy and appendectomy are described in the literature. The benefits of these procedures compared with traditional laparoscopic approaches have yet to be determined. To date, no series of LESS surgeries for placement of an adjustable gastric band has been published or documented. This study aimed to determine the safety and feasibility of LESS surgery for placement of an adjustable gastric band. METHODS From December 2007 to June 2008, LESS surgery to place an adjustable gastric band via a transumbilical incision was performed for 10 patients with institutional review board approval. Essentially, multiple ports were placed through a single incision in the umbilicus to allow for liver retraction, visualization, and working instruments. All critical steps using a standard pars flaccida technique were performed without alteration. RESULTS For this study, 10 patients (9 women and 1 man) were carefully selected. These patients ranged in age from 32 to 61 years (mean, 47 years) and had a mean body mass index (BMI) of 42 kg/m2 (range, 35-45 kg/m2). The patients were selected for absence of both hepatomegaly and central obesity. Superobese patients were not considered for inclusion in the study. The mean operative time was 1 h and 10 min (range, 53 min to 1 h and 48 min). All the patients were discharged home within 23 h of admission, and no perioperative complications were noted. In addition, no wound-related complications occurred. Notably, only 2 of the 10 patients required the use of narcotic analgesia after discharge from the recovery room. There were no intra- or postoperative complications. CONCLUSIONS In our experience, LESS surgery for adjustable gastric banding shows this technique to be both feasible and safe for selected patients. Although technical limitations exist that will be improved upon, further studies are needed to compare LESS surgery for placement of an adjustable gastric band with traditional laparoscopic techniques.
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Affiliation(s)
- J Teixeira
- Department of Surgery, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
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24
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Acke E, McGill K, Golden O, Jones BR, Fanning S, Whyte P. A comparison of different culture methods for the recovery of Campylobacter species from pets. Zoonoses Public Health 2009; 56:490-5. [PMID: 19243565 DOI: 10.1111/j.1863-2378.2008.01205.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Five culture methods for the recovery of Campylobacter species (spp.) were evaluated on 361 rectal swabs collected from cats and dogs in Ireland. Speciation using PCR methods was performed on all isolates to assess the sensitivity of each culture method for isolation of Campylobacter spp., and to establish the prevalence of Campylobacter jejuni, C. coli, C. upsaliensis, C. lari and C. helveticus. Overall 163 of 361 (45.2%) samples were confirmed Campylobacter spp. positive. Direct plating onto modified charcoal cefoperazone deoxycholate agar (mCCDA) with cefoperazone, amphotericin and teicoplanin (CAT) selective supplement yielded a significantly higher prevalence of Campylobacter spp. (33.0%) than each of the other four methods (P < or = 0.05). This method was also the most sensitive method for isolation of C. upsaliensis compared with any of the other four methods used in the current study (P < or = 0.05). A direct plating method onto mCCDA agar with CCDA selective supplement and a filtration method onto blood agar after pre-enrichment in CAT supplemented broth yielded lower Campylobacter spp. prevalences of 19.7% and 17.5% respectively. A filtration method onto CAT agar and pre-enrichment in Preston broth before plating onto mCCDA agar were less sensitive for the isolation of Campylobacter spp. Speciation results of Campylobacter isolates revealed the majority of Campylobacter isolates were C. upsaliensis (50.0%) and C. jejuni (41.9%). A small number of isolates were C. coli (2.6%), C. lari (1.5%) and C. helveticus (1.1%). The overall detection of Campylobacter spp. in the 361 pets sampled was significantly increased by using a combination of isolation methods (P < or = 0.05), producing a more accurate determination of the prevalence of Campylobacter spp. in pets in Ireland and of the actual Campylobacter species. As the majority of Campylobacter spp. were recovered by direct plating onto mCCDA agar with CAT supplement, this method is the method of choice if only a single method is selected for isolation of the most common Campylobacter spp. detected in pets and humans.
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Affiliation(s)
- E Acke
- Veterinary Public Health and Food Safety Laboratory, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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25
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Acke E, McGill K, Golden O, Jones BR, Fanning S, Whyte P. Prevalence of thermophilic Campylobacter
species in household cats and dogs in Ireland. Vet Rec 2009; 164:44-7. [DOI: 10.1136/vr.164.2.44] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- E. Acke
- Veterinary Public Health and Food Safety Laboratory
| | - K. McGill
- Veterinary Public Health and Food Safety Laboratory
| | | | - B. R. Jones
- Small Animal Clinical Studies; School of Agriculture, Food Science and Veterinary Medicine; University College Dublin; Belfield Dublin 4 Ireland
| | - S. Fanning
- Veterinary Public Health and Food Safety Laboratory
| | - P. Whyte
- Veterinary Public Health and Food Safety Laboratory
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26
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McGill K, Drost G, Lateva Z, van Dijk J, Trip J, Stegeman D. FC33.4 Analysis of CMAP decrement during repetitive nerve stimulation in myotonia congenita. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McGill K, Cowley D, Moran L, Scates P, O'Leary A, Madden RH, Carroll C, McNamara E, Moore JE, Fanning S, Collins JD, Whyte P. Antibiotic resistance of retail food and human Campylobacter isolates on the island of Ireland from 2001-2002. Epidemiol Infect 2006; 134:1282-91. [PMID: 16623987 PMCID: PMC2870507 DOI: 10.1017/s0950268806006200] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2006] [Indexed: 11/05/2022] Open
Abstract
The antimicrobial resistance profiles of Campylobacter isolates recovered from a range of retail food samples (n=374) and humans (n=314) to eight antimicrobial compounds were investigated. High levels of resistance in food C. jejuni isolates were observed for ceftiofur (58%), ampicillin (25%) and nalidixic acid (17%) with lower levels observed for streptomycin (7.9%) and chloramphenicol (8.3%). A total of 80% of human C. jejuni isolates were resistant to ceftiofur, while 17% showed resistance to ampicillin and nalidixic acid, 8.6% to streptomycin and 4.1% to chloramphenicol. Resistance to clinically relevant antimicrobials such as erythromycin, ciprofloxacin and tetracycline was 6.7, 12, and 15% respectively for all food isolates and was similar to corresponding resistance prevalences observed for human isolates, where 6.4, 12 and 13% respectively were found to be resistant. Comparisons of C. jejuni isolates in each location showed a high degree of similarity although some regional variations did exist. Comparison of total C. jejuni and C. coli populations showed minor differences, with C. jejuni isolates more resistant to ampicillin and ceftiofur. Multidrug resistance patterns showed some profiles common to human and clinical isolates.
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Affiliation(s)
- K McGill
- Veterinary Public Health and Food Safety Research Laboratory, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland.
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Gormley E, Doyle MB, Fitzsimons T, McGill K, Collins JD. Diagnosis of Mycobacterium bovis infection in cattle by use of the gamma-interferon (Bovigam®) assay. Vet Microbiol 2006; 112:171-9. [PMID: 16321478 DOI: 10.1016/j.vetmic.2005.11.029] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The strategic use of the gamma-interferon (IFN-gamma) assay (Bovigam) can provide a means for the early identification of Mycobacterium bovis infected cattle, thus ensuring their removal from an infected herd. When used in parallel with the tuberculin test, it is capable of identifying infected cattle, which might otherwise not be detected until later, if at all. The early detection and removal of these animals reduces the risk that they will become a source of infection for other cattle. When targeted in herds of high prevalence the benefits to the herd owner directly concerned can be considerable as the assay provides a means of shortening the period of restriction for such herds. This serves to generate confidence among herd owners and other stakeholders that effective schemes, based on sound scientific principles, can be developed to eradicate tuberculosis from infected cattle populations.
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Affiliation(s)
- E Gormley
- Large Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Dublin 4, Ireland.
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Acke E, Whyte P, Jones BR, McGill K, Collins JD, Fanning S. Prevalence of thermophilic Campylobacter
species in cats and dogs in two animal shelters in Ireland. Vet Rec 2006; 158:51-4. [PMID: 16415232 DOI: 10.1136/vr.158.2.51] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rectal swabs or faecal samples for the isolation of Campylobacter species were taken from 120 dogs and cats in an animal shelter in which only one kitten showed signs of gastrointestinal disease, and rectal swabs were taken from 46 dogs, 22 of which showed signs of gastrointestinal disease, in another shelter. At the first shelter, the swabs from 24 of 47 dogs (51.1 per cent) and 36 of 48 cats (75 per cent) yielded a Campylobacter species. The rate of isolation was significantly higher from dogs and cats less than six months old, and significantly higher from cats than from dogs (P< or =0.05). At the second shelter Campylobacter species were isolated from 40 of 46 dogs (87 per cent), but there was no significant difference between the age groups. Campylobacter species were isolated from 19 (86.4 per cent) of the 22 dogs with signs of gastrointestinal disease and from 21 (87.5 per cent) of the 24 unaffected dogs. Several culture methods were applied to the samples collected from both shelters, and the combination significantly increased the recovery of Campylobacter species.
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Affiliation(s)
- E Acke
- Faculty of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Gormley E, Doyle MB, McGill K, Costello E, Good M, Collins JD. The effect of the tuberculin test and the consequences of a delay in blood culture on the sensitivity of a gamma-interferon assay for the detection of Mycobacterium bovis infection in cattle. Vet Immunol Immunopathol 2004; 102:413-20. [PMID: 15541794 DOI: 10.1016/j.vetimm.2004.08.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 06/01/2004] [Accepted: 08/11/2004] [Indexed: 10/26/2022]
Abstract
The strategic use of the gamma-interferon (IFN-gamma) assay (Bovigam) can provide a means for the early identification of Mycobacterium bovis infected cattle, thus ensuring their removal from an infected herd. It has been reported that performance of the test can be influenced by various factors including a recent tuberculin skin test and the length of delay between collection and processing of blood samples. In this study, single intradermal comparative tuberculin test (SICTT) reactor and non-reactor cattle were recruited from herds infected with M. bovis and grouped according to their SICTT responses. Group 1 comprised reactor cattle selected on the basis of their SICTT response to PPD-bovine (purified protein derivative of tuberculin) exceeding that of PPD-avian by at least 12mm. Group 2 animals were selected from herds undergoing routine surveillance for bovine tuberculosis and contained standard SICTT reactor cattle (PPD-bovine exceeding that of PPD-avian by at least 4mm) and non-reactors. We investigated the effects of the SICTT on the assay results by measuring the in vitro IFN-gamma responses of Group 1 reactor cattle at time intervals pre- and post-skin test. No significant differences were measured in the IFN-gamma responses of the reactor animals to PPD-bovine and PPD-avian for up to 65 days. To investigate if a delay in processing of blood affected the performance of the assay, we compared results using duplicate blood samples from Group 1 and Group 2 cattle stimulated with PPD antigen at 8h and at 24h after collection. In both groups of animals the mean optical density (OD) values of the assay at 24h post-collection were significantly lower than those at 8h. Our results demonstrated that a delay in processing of the blood samples from cattle subjected to routine surveillance could significantly impact on the outcome of the IFN-gamma assay resulting in a change of the IFN-gamma status of the animals.
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Affiliation(s)
- E Gormley
- Large Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Dublin 4, Ireland.
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Whyte P, McGill K, Cowley D, Madden RH, Moran L, Scates P, Carroll C, O'Leary A, Fanning S, Collins JD, McNamara E, Moore JE, Cormican M. Occurrence of Campylobacter in retail foods in Ireland. Int J Food Microbiol 2004; 95:111-8. [PMID: 15282123 DOI: 10.1016/j.ijfoodmicro.2003.10.018] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 10/01/2003] [Accepted: 10/31/2003] [Indexed: 11/24/2022]
Abstract
A surveillance study was carried out to determine the prevalence of Campylobacter in a range of retail foods purchased in three Irish cities over a 20-month period between March 2001 and October 2002. In total 2391 food samples were analysed during this period. Campylobacter was isolated from 444 raw chicken (49.9%), 33 turkey (37.5%) and 11 duck samples (45.8%). Lower isolation rates of 7/221 (3.2%), 10/197 (5.1%) and 31/262 (11.8%) were observed for raw beef, pork and lamb, respectively. One sample of pork paté from 120 samples analysed (0.8%) was Campylobacter-positive. A total of three shellfish samples (oysters) from 129 raw specimens examined (2.3%) were found to contain Campylobacter. Low prevalences of the organism (0.9%) were also isolated from fresh mushrooms. Of 62 raw bulk tank milk samples analysed, Campylobacter was recovered in a single sample (1.6%). Campylobacter was not detected in any of the comminuted pork puddings, prepared vegetables and salads, retail sandwiches or cheeses made from unpasteurised milk. In total, 543 Campylobacter were isolated from all of the food samples analysed, of which 453 (83.4%) were confirmed as Campylobacter jejuni and the remaining 90 (16.6%) as Campylobacter coli.
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Affiliation(s)
- P Whyte
- Veterinary Public Health and Food Safety Research Laboratory, Faculty of Veterinary Medicine, University College Dublin, Ballsbridge, Belfield, Dublin 4, Ireland.
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Minihan D, Whyte P, O'Mahony M, Fanning S, McGill K, Collins JD. Campylobacter spp. in Irish feedlot cattle: a longitudinal study involving pre-harvest and harvest phases of the food chain. ACTA ACUST UNITED AC 2004; 51:28-33. [PMID: 14995974 DOI: 10.1046/j.1439-0450.2003.00722.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate faecal shedding and transmission of Campylobacter spp. in cohorts of cattle within a feedlot, to assess subsequent contamination of carcasses with this pathogen and to identify risk factors associated with faecal shedding of Campylobacter spp. A cohort of 133 heifers housed in four adjacent pens was examined over a five and a half month period, from entering the feedlot to slaughter. A parallel investigation of individual rectal faecal samples and pen environmental samples were taken at monthly intervals from November to February. The entire outer and inner surfaces of a carcass side of each animal were swabbed immediately following slaughter. Campylobacter spp. were isolated from 322 (54%) of the 600 rectal faecal samples. Campylobacter jejuni and C. coli accounted for 69 and 29.7% of the isolate recovered, respectively. A total of 159 environmental samples were examined, of these Campylobacter spp. was isolated from 46 samples (29%). Campylobacter jejuni and C. coli accounted for 35 and 59% of these isolates, respectively. Campylobacter spp. was not isolated from any of the dressed carcasses. Logistic regression indicated prevalence of Campylobacter spp. faecal shedding within pens was positively correlated to the pen, the month of sampling and the Campylobacter spp. contamination status of the pen dividing bars and the water trough surface. Campylobacter spp. should be considered as a pathogen shed in the faeces of a substantial proportion of feedlot cattle. However, with good hygienic practice during harvest, a very low level of this pathogen can be achieved on dressed carcasses.
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Affiliation(s)
- D Minihan
- Department of Agriculture and Food, Abbotstown, Castleknock, Dublin 15, Ireland.
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Aldrich R, Kemp L, Williams JS, Harris E, Simpson S, Wilson A, McGill K, Byles J, Lowe J, Jackson T. Using socioeconomic evidence in clinical practice guidelines. BMJ 2003; 327:1283-5. [PMID: 14644976 PMCID: PMC286256 DOI: 10.1136/bmj.327.7426.1283] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2003] [Indexed: 11/04/2022]
Abstract
The effects of socioeconomic position on health have been largely ignored in clinical guidelines. Australia's National Health and Medical Research Council has produced a framework to ensure that they are taken into account
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Affiliation(s)
- Rosemary Aldrich
- Newcastle Institute of Public Health, PO Box 664J, Newcastle, NSW 2300, Australia.
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Whyte P, McGill K, Collins J. An assessment of steam pasteurization and hot water immersion treatments for the microbiological decontamination of broiler carcasses. Food Microbiol 2003. [DOI: 10.1016/s0740-0020(02)00084-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sorkness C, McGill K, Busse WW. Evaluation of serum eosinophil cationic protein as a predictive marker for asthma exacerbation in patients with persistent disease. Clin Exp Allergy 2002; 32:1355-9. [PMID: 12220475 DOI: 10.1046/j.1365-2222.2002.01471.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Eosinophilic inflammation is a feature of asthma. However, serological markers to indicate eosinophil activation in this process are not fully defined. OBJECTIVE To evaluate the relationship of serum eosinophil cationic protein (ECP) to asthma worsening and a marker for treatment effectiveness, 26 adult patients with an asthma exacerbation were identified. METHODS Identified asthma subjects were treated with oral corticosteroids (prednisone) for 14 days. The lung function variables, forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF), were determined as percentage of predicted and the blood total eosinophil count and serum ECP levels were measured. Patients were re-evaluated after 14 days of corticosteroid treatment and then every 3 months thereafter during a 12-month period. RESULTS Eighteen patients responded to prednisone treatment, whereas eight did not, assessed as improvement of their lung function parameters. Different serum ECP patterns could be seen in the responders compared with the non-responders. All 18 responders had considerably increased serum ECP at the time of exacerbation, whereas the non-responders had lower serum ECP levels. The serum ECP levels decreased to a greater extent in the responder patient group than in the non-responder patients following prednisone treatment. This difference in patterns was not seen with total blood eosinophil counts. CONCLUSION Our findings suggest that serum ECP may be used to predict a response to corticosteroid therapy in adult patients with asthma.
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Affiliation(s)
- C Sorkness
- Department of Medicine, University of Wisconsin-Madison Medical School, Madison, Wisconsin 53792, USA
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Whyte P, Collins JD, McGill K, Monahan C, O'Mahony H. The effect of transportation stress on excretion rates of campylobacters in market-age broilers. Poult Sci 2001; 80:817-20. [PMID: 11441852 DOI: 10.1093/ps/80.6.817] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We determined the effects of transportation distance and holding times at a commercial slaughter facility on excretion rates of Campylobacter spp. in broilers. Fecal samples from broilers in each of 10 flocks were obtained at the following three sampling points: at the farms, following transportation, and after holding at the plant. The farms examined were divided into two groups based on distances and transport times to the plant. The prevalence and levels of Campylobacter spp. were evaluated for all specimens taken at the three sampling points. A statistically significant increase in counts was observed in samples from both groups following transportation (P < 0.05). The resting period at the abattoir prior to slaughter did not significantly reduce rates of Campylobacter spp. shedding in the flocks examined. Differences in distance travelled and transport durations between the two groups was not found to be a statistically significant factor in altering excretion rates of the organism. The present study demonstrated that transport-induced stress increased shedding of Campylobacter spp. in fecal material of broilers that may subsequently result in extensive carcass contamination.
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Affiliation(s)
- P Whyte
- Department of Large Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Ballsbridge, Ireland.
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Whyte P, Collins JD, McGill K, Monahan C, O'Mahony H. Distribution and prevalence of airborne microorganisms in three commercial poultry processing plants. J Food Prot 2001; 64:388-91. [PMID: 11252485 DOI: 10.4315/0362-028x-64.3.388] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Airborne microbial contaminants and indicator organisms were monitored within three poultry processing plants (plants A, B, and C). In total, 15 cubic feet (c.f.) of air was sampled per location during 15 visits to each plant and quantitatively analyzed for total mesophilic and psychrophilic aerobic counts, thermophilic campylobacters, Escherichia coli, and Enterobacteriaceae. The prevalence of Salmonella spp. in air samples was also evaluated. Significant reductions in total aerobic counts were observed between defeathering and evisceration areas of the three plants (P < 0.05). Mesophilic plate counts were highest in the defeathering areas of all plants compared to equivalent psychrophilic plate counts. Enterobacteriaceae counts were highest in the defeathering areas of all three plants with counts of log10 1.63, 1.53, and 1.18 CFU/15 c.f. recovered in plants A, B, and C, respectively. E. coli enumerated from air samples in the defeathering areas exhibited a similar trend to those obtained for Enterobacteriaceae with log10 1.67, 1.58, and 1.18 CFU for plants A, B, and C, respectively. Thermophilic campylobacters were most frequently isolated from samples in the defeathering areas followed by the evisceration areas. The highest mean counts of the organism were observed in plant A at 21 CFU/15 c.f. sample with plants B and C at 9 and 8 CFU/sample, respectively. With the exception of low levels of Enterobacteriaceae recovered from samples in the on-line air chill in plant A, E. coli, Enterobacteriaceae, or Campylobacter spp. were not isolated from samples in postevisceration sites in any of the plants examined. Salmonella spp. were not recovered from any samples during the course of the investigation.
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Affiliation(s)
- P Whyte
- Department of Large Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Ballsbridge, Ireland.
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Whyte P, Collins JD, McGill K, Monahan C, O'Mahony H. Quantitative investigation of the effects of chemical decontamination procedures on the microbiological status of broiler carcasses during processing. J Food Prot 2001; 64:179-83. [PMID: 11271764 DOI: 10.4315/0362-028x-64.2.179] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The effects of elevated chlorine concentrations (25 ppm) added to water in the final carcass washing equipment on total viable counts (TVCs 22 degrees C) and Escherichia coli and Enterobacteriaceae levels on poultry carcasses were investigated. Mean TVC counts on neck skin samples were significantly reduced when pre-evisceration and postwash samples were compared with log10 4.98 to 4.52 CFU/g recovered, respectively (P < or = 0.05). No significant reductions in TVC counts were observed in control samples at corresponding sampling points subjected to wash water containing 1 to 2 ppm chlorine. E. coli and Enterobacteriaceae counts were not significantly altered following final carcass washing in the processing plant. A second trial assessed the microbial decontamination capabilities of sodium triphosphate (TSP) on broiler carcasses. Neck skin samples from carcasses were obtained before final washing (control), following a 15-s dip in potable water and after dipping in a 10% TSP solution (pH 12) for 15 s. Reductions in E. coli and Enterobacteriaceae counts were all statistically significant for both water and TSP-treated samples when compared with corresponding controls (P < or = 0.01). The TSP treatment resulted in higher reductions of log10 1.95 and 1.86/g for E. coli and Enterobacteriaceae, respectively. In contrast, reductions of log10 0.37 and 0.3 l/g were observed for E. coli and Enterobacteriaceae counts when water-dipped carcasses were compared with corresponding controls. Significantly, Salmonella was not detected in any of the TSP-treated carcasses, while log10 1.92 and 1.04/g were found in control and water-dipped samples, respectively. Thermophilic Campylobacter counts were significantly lower in both treatment groups when compared with corresponding controlsresulting in log10 0.55 and 1.71/g reductions for water- and TSP-dipped carcasses, respectively (P < or = 0.01).
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Affiliation(s)
- P Whyte
- Department of Large Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Ballsbridge, Ireland.
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Abstract
The lymphocyte response to F. hepatica during a primary infection in cattle was analysed to define the role of T cell subsets in the immune response. Blood lymphocytes were isolated from eight cattle infected with F. hepatica via trickle infection over a ten-day period and from two non-infected controls. CD4+, CD8+ and gamma delta + T cells were depleted from whole lymphocyte populations by magnetic bead depletion. Lymphocytes from infected animals demonstrated a transient, but marked elevation in responsiveness to F. hepatica antigen between weeks 3 and 8 post-infection. Responses were attenuated by depletion of CD4+ and CD8+ T cells during this period. Depletion of gamma delta + T cells attenuated antigen responses at one time point only, and at an earlier stage post-infection than when alpha beta + T cells were depleted. Responses to antigen correlated positively with both hepatic fluke burden and with the degree of hepatic damage. This suggests that the cellular immune response was not protective. Antigen responses in gamma delta + T cell-depleted populations were also associated with post-mortem fluke burden and with hepatic damage. This suggests that gamma delta + T cells are involved in down regulating alpha beta + lymphocytes which may have a role in a non-protective or immunopathological immune responses.
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Affiliation(s)
- D F McCole
- Department of Pharmacology, University College Dublin, Ireland
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McCole DF, Doherty ML, Baird AW, Davis WC, McGill K, Torgerson PR. Concanavalin A-stimulated proliferation of T cell subset-depleted lymphocyte populations isolated from Fasciola hepatica-infected cattle. Vet Immunol Immunopathol 1998; 66:289-300. [PMID: 9880105 DOI: 10.1016/s0165-2427(98)00207-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over 14 weeks, peripheral blood lymphocytes (PBL) were isolated from eight adult cattle which had been orally infected with Fasciola hepatica via trickle infection over a 10-day period. Two age, breed and sex-matched cattle served as controls. CD4+, CD8+ and gammadelta+ T cells were depleted from whole PBL populations by magnetic bead depletion. Lymphocyte proliferation assays demonstrated a transient, but marked elevation in responsiveness to Concanavalin A (Con A) between weeks 2 and 4 post-infection in PBL from infected animals. Proliferative responses to Con A were significantly greater in PBL from infected cattle than uninfected/control cattle over the initial period of the experiment. Con A-stimulated proliferation of PBL isolated from infected cattle followed a similar pattern to PBL responses to F. hepatica antigen. In both whole and subset-depleted lymphocyte populations from infected cattle, proliferative responses to Con A decreased from day 28 post-infection. Depletion of CD4+, CD8+ and gammadelta+ T cell subpopulations significantly augmented responses soon after infection. These findings suggest that the capacity of bovine PBL to proliferate in response to Con A stimulation, was in some way attenuated by F. hepatica infection and proliferative responses due to non-specific activation was suppressed by the coordinated activities of various lymphocyte subsets.
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Affiliation(s)
- D F McCole
- Department of Pharmacology, University College Dublin, Ireland
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Affiliation(s)
- W W Busse
- University of Wisconsin, Madison, USA
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42
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Affiliation(s)
- M L Monaghan
- Faculty of Veterinary Medicine, University College Dublin, Ireland
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Abstract
A study of macroscopically normal bovine kidneys from three age groups (neonatal calves, 2.5- to 3-year-old bullocks and cull cows), with no abnormalities on urine analysis, was carried out by light microscopy, immunofluorescence and electron microscopy. There was a slight increase in the proportion of involuted nephrons with increasing age but the proportion of nephrons affected was not greater than 10 per cent in any age group. In contrast to the findings of earlier workers, no evidence of diffuse proliferative glomerulonephritis was found in the material examined. It was concluded that the above techniques should be applied to the investigation of renal disease in cattle, as has already been done in man and small domestic animals.
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