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Walker L, Sillence E. Examining Healthcare Professionals' Communication Around Decision-Making with Internet-Informed Patients. Health Commun 2024; 39:1094-1101. [PMID: 37150845 DOI: 10.1080/10410236.2023.2204580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
In the last ten years the use of the internet as a health resource has transformed, and while patients increasingly consult online resources for health decision-making, less is known about how healthcare professionals (HCPs) currently discuss decision-making with internet informed patients (IIPs). In this paper we examine how HCPs perceive IIPs and specifically how bringing online information into appointments can prompt different communicative strategies around decision-making. Ten HCPs with experience working across different healthcare roles, took part in semi-structured interviews and discussed their interactions with IIPs around decision-making. Vignettes based on descriptions of real patients bringing online health information to their HCPs were used to prompt further discussion. The analysis identified two themes in relation to communication: (i) being honest about information sources and (ii) from compliance to co-construction: improving communication around decision-making. HCPs were overwhelmingly positive toward IIPs and encouraged patients to be transparent about their online searching to understand their motivations, priorities, and concerns. Although compliance remains part of the narrative, HCPs recognized practical ways in which discussing online health information could improve HCP-patient communication around shared decision-making. We discuss the findings in relation to early work on communicative strategies between HCP's and patients bringing resources to their consultations. We argue that for HCPs the concept of the internet as a provider of health information is no longer seen as inherently damaging or risky. There is growing acceptance of pre-consultation internet searching with the caveat that any information sourced online should inform rather than dictate decision-making with HCPs.
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Affiliation(s)
- Lauren Walker
- School of Social Sciences, Humanities and Law, Teesside University
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Louch G, Berzins K, Walker L, Wormald G, Blackwell K, Stephens M, Brown M, Baker J. Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool. JMIR Form Res 2024; 8:e53726. [PMID: 38607663 PMCID: PMC11053394 DOI: 10.2196/53726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. OBJECTIVE This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. METHODS The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. RESULTS We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, "getting worse" or "getting better"; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. CONCLUSIONS Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively.
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Affiliation(s)
- Gemma Louch
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, United Kingdom
| | - Kathryn Berzins
- Health Technology Assessment Unit, Applied Health Research Hub, Implementation and Capacity Building Team, NIHR Applied Research Collaboration North West Coast, University of Central Lancashire, Preston, United Kingdom
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Gemma Wormald
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Kirstin Blackwell
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | | | - Mark Brown
- Social Spider CIC, London, United Kingdom
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, United Kingdom
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Taylor O, Newbronner E, Cooke H, Walker L, Wadman R. Shaping research for people living with co-existing mental and physical health conditions: A research priority setting initiative from the United Kingdom. Health Expect 2024; 27:e14044. [PMID: 38613770 PMCID: PMC11015889 DOI: 10.1111/hex.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Those with severe and enduring mental ill health are at greater risk of long-term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. METHODS The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. RESULTS This priority setting exercise guided by people's needs and lived experience has produced a set of well-defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. CONCLUSIONS Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. PATIENT OR PUBLIC CONTRIBUTION This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops.
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Affiliation(s)
- Olivia Taylor
- Department of Health SciencesUniversity of YorkYorkUK
| | | | | | - Lauren Walker
- School of Health & Psychological SciencesCity University of LondonLondonUK
| | - Ruth Wadman
- Department of Health SciencesUniversity of YorkYorkUK
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Brotto LA, Walker L, Sears C, Woo S, Millman R, Zdaniuk B. A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors. J Sex Med 2024:qdae022. [PMID: 38465848 DOI: 10.1093/jsxmed/qdae022] [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] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Sexual difficulties and vaginal pain are common following treatment for breast cancer. AIM The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. METHODS Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. OUTCOMES Assessments were repeated at posttreatment and 6 months after the completion of the group. RESULTS There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. CONCLUSION Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. STRENGTHS AND LIMITATIONS We used a randomized methodology. Future studies should seek to diversify participants. CLINICAL IMPLICATIONS These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Lauren Walker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, T2N 4N2, Canada
| | - Carly Sears
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Shannon Woo
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Roanne Millman
- Private Practice, West Coast Centre for Sex Therapy , Vancouver, British Columbia, V6H 3H4, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
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Asiimwe IG, Walker L, Sofat R, Jorgensen AL, Pirmohamed M. Genetic Determinants of Thiazide-Induced Hyperuricemia, Hyperglycemia, and Urinary Electrolyte Disturbances - A Genome-Wide Evaluation of the UK Biobank. Clin Pharmacol Ther 2024. [PMID: 38425181 DOI: 10.1002/cpt.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Thiazide diuretics, widely used in hypertension, cause a variety of adverse reactions, including hyperglycemia, hyperuricemia, and electrolyte abnormalities. In this study, we aimed to identify genetic variants that interact with thiazide-use to increase the risk of these adverse reactions. Using UK Biobank data, we first performed genomewide variance quantitative trait locus (vQTL) analysis of ~ 6.2 million SNPs on 95,493 unrelated hypertensive White British participants (24,313 on self-reported bendroflumethiazide treatment at recruitment) for 2 blood (glucose and urate) and 2 urine (potassium and sodium) biomarkers. Second, we conducted direct gene-environment interaction (GEI) tests on the significant (P < 2.5 × 10-9 ) vQTLs, included a second UK Biobank cohort comprising 13,647 unrelated hypertensive White British participants (3,478 on thiazides other than bendroflumethiazide) and set significance at P = 0.05 divided by the number of vQTL SNPs tested for GEIs. The vQTL analysis identified eight statistically significant SNPs for blood glucose (5 SNPs) and serum urate (3 SNPs), with none being identified for the urinary biomarkers. Two of the SNPs (1 glucose SNP: CDKAL1 intron rs35612982, GEI P = 6.24 × 10-3 ; and 1 serum urate SNP: SLC2A9 intron rs938564, GEI P = 4.51 × 10-4 ) demonstrated significant GEI effects in the first, but not the second, cohort. Both genes are biologically plausible candidates, with the SLC2A9-mediated interaction having been previously reported. In conclusion, we used a two-stage approach to detect two biologically plausible genetic loci that can interact with thiazides to increase the risk of thiazide-associated biochemical abnormalities. Understanding how environmental exposures (including medications such as thiazides) and genetics interact, is an important step toward precision medicine and improved patient outcomes.
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Affiliation(s)
- Innocent G Asiimwe
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Lauren Walker
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Andrea L Jorgensen
- Department of Health Data Science, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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Jones G, Bailey L, Beeken RJ, Brady S, Cooper C, Copeland RJ, Crosland S, Dawson S, Faires M, Gilbody S, Haynes H, Hill A, Hillison E, Horspool M, Lee E, Li J, Machaczek KK, Parrott S, Quirk H, Stubbs B, Tew GA, Traviss-Turner G, Turton E, Walker L, Walters S, Weich S, Wildbore E, Peckham E. Supporting physical activity through co-production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud 2024; 10:32. [PMID: 38368380 PMCID: PMC10873949 DOI: 10.1186/s40814-024-01460-0] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways. METHOD This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation. DISCUSSION This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention. TRIAL REGISTRATION ISRCTN: ISRCTN83877229. Registered on 09.09.2022.
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Affiliation(s)
- Gareth Jones
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK.
- Sport and Physical Activity Research Centre, Health and Wellbeing Department, Sheffield Hallam University, Sheffield, UK.
| | - Laura Bailey
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Samantha Brady
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Robert J Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sam Dawson
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Matthew Faires
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Holly Haynes
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Andrew Hill
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Emily Hillison
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Michelle Horspool
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Ellen Lee
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Katarzyna K Machaczek
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Helen Quirk
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, WC2R 2LS, UK
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, YO31 7EX, UK
| | | | - Emily Turton
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Lauren Walker
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Ellie Wildbore
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Emily Peckham
- School of Medical and Health Sciences, Bangor University, Gwynedd, LL57 2DG, UK
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Walker L, Simpson H, Thomas AJ, Attems J. Prevalence, distribution, and severity of cerebral amyloid angiopathy differ between Lewy body diseases and Alzheimer's disease. Acta Neuropathol Commun 2024; 12:28. [PMID: 38360761 PMCID: PMC10870546 DOI: 10.1186/s40478-023-01714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024] Open
Abstract
Dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and Parkinson's disease (PD) collectively known as Lewy body diseases (LBDs) are neuropathologically characterised by α-synuclein deposits (Lewy bodies and Lewy neurites). However, LBDs also exhibit pathology associated with Alzheimer's disease (AD) (i.e. hyperphosphorylated tau and amyloid β (Aβ). Aβ can be deposited in the walls of blood vessels in the brains of individuals with AD, termed cerebral amyloid angiopathy (CAA). The aim of this study was to investigate the type and distribution of CAA in DLB, PDD, and PD and determine if this differs from AD. CAA type, severity, and topographical distribution was assessed in 94 AD, 30 DLB, 17 PDD, and 11 PD cases, and APOE genotype evaluated in a subset of cases where available. 96.3% AD cases, 70% DLB cases and 82.4% PDD cases exhibited CAA (type 1 or type 2). However only 45.5% PD cases had CAA. Type 1 CAA accounted for 37.2% of AD cases, 10% of DLB cases, and 5.9% of PDD cases, and was not observed in PD cases. There was a hierarchical topographical distribution in regions affected by CAA where AD and DLB displayed the same distribution pattern that differed from PDD and PD. APOE ε4 was associated with severity of CAA in AD cases. Topographical patterns and severity of CAA in DLB more closely resembled AD rather than PDD, and as type 1 CAA is associated with clinical dementia in AD, further investigations are warranted into whether the increased presence of type 1 CAA in DLB compared to PDD are related to the onset of cognitive symptoms and is a distinguishing factor between LBDs. Possible alignment of the the topographical distribution of CAA and microbleeds in DLB warrants further investigation. CAA in DLB more closely resembles AD rather than PDD or PD, and should be taken into consideration when stratifying patients for clinical trials or designing disease modifying therapies.
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Affiliation(s)
- Lauren Walker
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK.
| | - Harry Simpson
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
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Malik N, Miah MU, Galgani A, McAleese K, Walker L, LeBeau FE, Attems J, Outeiro TF, Thomas A, Koss DJ. Regional AT-8 reactive tau species correlate with intracellular Aβ levels in cases of low AD neuropathologic change. Acta Neuropathol 2024; 147:40. [PMID: 38353753 PMCID: PMC10866780 DOI: 10.1007/s00401-024-02691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
The amyloid cascade hypothesis states that Aβ aggregates induce pathological changes in tau, leading to neurofibrillary tangles (NFTs) and cell death. A caveat with this hypothesis is the spatio-temporal divide between plaques and NFTs. This has been addressed by the inclusion of soluble Aβ and tau species in the revised amyloid cascade hypothesis. Nevertheless, despite the potential for non-plaque Aβ to contribute to tau pathology, few studies have examined relative correlative strengths between total Aβ, plaque Aβ and intracellular Aβ with tau pathology within a single tissue cohort. Employing frozen and fixed frontal cortex grey and white matter tissue from non-AD controls (Con; n = 39) and Alzheimer's disease (AD) cases (n = 21), biochemical and immunohistochemical (IHC) measures of Aβ and AT-8 phosphorylated tau were assessed. Biochemical native-state dot blots from crude tissue lysates demonstrated robust correlations between total Aβ and AT-8 tau, when considered as a combined cohort (Con and AD) and when as Con and AD cases, separately. In contrast, no associations between Aβ plaques and AT-8 were reported when using IHC measurements in either Con or AD cases. However, when intracellular Aβ was measured via the Aβ specific antibody MOAB-2, a correlative relationship with AT-8 tau was reported in non-AD controls but not in AD cases. Collectively the data suggests that accumulating intracellular Aβ may influence AT-8 pathology, early in AD-related neuropathological change. Despite the lower levels of phospho-tau and Aβ in controls, the robust correlative relationships observed suggest a physiological association of Aβ production and tau phosphorylation, which may be modified during disease. This study is supportive of a revised amyloid cascade hypothesis and demonstrates regional associative relationships between tau pathology and intracellular Aβ, but not extracellular Aβ plaques.
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Affiliation(s)
- Nauman Malik
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Mohi-Uddin Miah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Alessandro Galgani
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Kirsty McAleese
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Lauren Walker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Fiona E LeBeau
- Biosciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Tiago F Outeiro
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Göttingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Alan Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - David J Koss
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
- Division of Cellular and Systems Medicine, School of Medicine, University of Dundee, Dundee, Scotland, UK.
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Read H, Zagorac S, Neumann N, Kramer I, Walker L, Thomas E. Occupational Therapy: A Potential Solution to the Behavioral Health Workforce Shortage. Psychiatr Serv 2024:appips20230298. [PMID: 38321919 DOI: 10.1176/appi.ps.20230298] [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: 02/08/2024]
Abstract
Occupational therapy practitioners (OTPs) are clinically prepared to treat patients with behavioral health conditions. Yet, many state and national policies defining qualified behavioral health providers do not include occupational therapy. In this Open Forum, the authors argue that OTPs should be considered qualified to work as behavioral health professionals, especially given the severe behavioral health workforce shortage in the United States. The authors summarize policy barriers preventing OTPs from working on behavioral health teams and the evidence to support their presence. They also propose a policy and advocacy agenda to include and recognize OTPs as members of the behavioral health workforce.
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Affiliation(s)
- Halley Read
- Occupational Therapy Program, Western Oregon University, Monmouth (Read); REACH Momentum for Health, San Jose, California (Zagorac); Psychosis Education, Assessment, Care and Empowerment, Philadelphia (Neumann); Moss Rehabilitation Hospital, Elkins Park, Pennsylvania (Kramer); Northwestern Memorial Hospital, Chicago (Walker); College of Public Health, Temple University, Philadelphia (Thomas)
| | - Sarah Zagorac
- Occupational Therapy Program, Western Oregon University, Monmouth (Read); REACH Momentum for Health, San Jose, California (Zagorac); Psychosis Education, Assessment, Care and Empowerment, Philadelphia (Neumann); Moss Rehabilitation Hospital, Elkins Park, Pennsylvania (Kramer); Northwestern Memorial Hospital, Chicago (Walker); College of Public Health, Temple University, Philadelphia (Thomas)
| | - Nuriya Neumann
- Occupational Therapy Program, Western Oregon University, Monmouth (Read); REACH Momentum for Health, San Jose, California (Zagorac); Psychosis Education, Assessment, Care and Empowerment, Philadelphia (Neumann); Moss Rehabilitation Hospital, Elkins Park, Pennsylvania (Kramer); Northwestern Memorial Hospital, Chicago (Walker); College of Public Health, Temple University, Philadelphia (Thomas)
| | - Ilyse Kramer
- Occupational Therapy Program, Western Oregon University, Monmouth (Read); REACH Momentum for Health, San Jose, California (Zagorac); Psychosis Education, Assessment, Care and Empowerment, Philadelphia (Neumann); Moss Rehabilitation Hospital, Elkins Park, Pennsylvania (Kramer); Northwestern Memorial Hospital, Chicago (Walker); College of Public Health, Temple University, Philadelphia (Thomas)
| | - Lauren Walker
- Occupational Therapy Program, Western Oregon University, Monmouth (Read); REACH Momentum for Health, San Jose, California (Zagorac); Psychosis Education, Assessment, Care and Empowerment, Philadelphia (Neumann); Moss Rehabilitation Hospital, Elkins Park, Pennsylvania (Kramer); Northwestern Memorial Hospital, Chicago (Walker); College of Public Health, Temple University, Philadelphia (Thomas)
| | - Elizabeth Thomas
- Occupational Therapy Program, Western Oregon University, Monmouth (Read); REACH Momentum for Health, San Jose, California (Zagorac); Psychosis Education, Assessment, Care and Empowerment, Philadelphia (Neumann); Moss Rehabilitation Hospital, Elkins Park, Pennsylvania (Kramer); Northwestern Memorial Hospital, Chicago (Walker); College of Public Health, Temple University, Philadelphia (Thomas)
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Kendal S, Louch G, Walker L, Shafiq S, Halligan D, Brierley-Jones L, Baker J. Implementing and evaluating patient-focused safety technology on adult acute mental health wards. J Psychiatr Ment Health Nurs 2024. [PMID: 38279658 DOI: 10.1111/jpm.13028] [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: 09/29/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. WHAT ARE THE IMPLICATIONS FOR PRACTICE This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines. ABSTRACT INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. AIM Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff. METHOD Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. RESULTS Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. DISCUSSION Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context. IMPLICATIONS FOR PRACTICE The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.
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Affiliation(s)
| | - Gemma Louch
- Bradford Institute for Health Research, Bradford, UK
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11
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Baumgartner JS, Renner A, Wochele-Thoma T, Wehle P, Barbui C, Purgato M, Tedeschi F, Tarsitani L, Roselli V, Acartürk C, Uygun E, Anttila M, Lantta T, Välimäki M, Churchill R, Walker L, Sijbrandij M, Cuijpers P, Koesters M, Klein T, White RG, Aichberger MC, Wancata J. Impairments in psychological functioning in refugees and asylum seekers. Front Psychol 2024; 14:1295031. [PMID: 38259575 PMCID: PMC10801113 DOI: 10.3389/fpsyg.2023.1295031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.
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Affiliation(s)
- Josef S. Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Renner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Peter Wehle
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Psychosocial Services in Vienna, Vienna, Austria
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Roselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ceren Acartürk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Türkiye
| | - Ersin Uygun
- Emergency and Disaster Management, Vocational School of Health Services, Bilgi University, Istanbul, Türkiye
| | - Minna Anttila
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, Faculty of Social Sciences, University of York, York, United Kingdom
| | - Lauren Walker
- Centre for Reviews and Dissemination, Faculty of Social Sciences, University of York, York, United Kingdom
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Markus Koesters
- Department of Psychiatry and Psychotherapy ll, District Hospital Guenzburg, Ulm University, Ulm, Germany
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thomas Klein
- Department of Psychiatry and Psychotherapy ll, District Hospital Guenzburg, Ulm University, Ulm, Germany
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Ross G. White
- Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Marion C. Aichberger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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12
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Spanakis P, Wadman R, Walker L, Heron P, Mathers A, Baker J, Johnston G, Gilbody S, Peckham E. Measuring the digital divide among people with severe mental ill health using the essential digital skills framework. Perspect Public Health 2024; 144:21-30. [PMID: 35929589 PMCID: PMC10757390 DOI: 10.1177/17579139221106399] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 11/15/2022]
Abstract
AIMS Amid the vast digitalisation of health and other services during the pandemic, people with no digital skills are at risk of digital exclusion. This risk might not abate by the end of the pandemic. This article seeks to understand whether people with severe mental ill health (SMI) have the necessary digital skills to adapt to these changes and avoid digital exclusion. METHODS Two hundred and forty-nine adults with SMI across England completed a survey online or offline. They provided information on their digital skills based on the Essential Digital Skills (EDS) framework, sociodemographic information, and digital access. This is the first time that the EDS is benchmarked in people with SMI. RESULTS 42.2% had no Foundation Skills, and 46.2% lacked skills for daily life (lacking Foundation or Life Skills). 23.0% of those working lacked skills for professional life (lacking Foundation or Work Skills). The most commonly missing skills were handling passwords and using the device settings (Foundation Skills) and online problem solving (Skills for Life). People were interested in learning more about approximately half of the skills they did not have. People were more likely to lack Foundation Skills if they were older, not in employment, had a psychosis-spectrum disorder, or had no Internet access at home. CONCLUSION A significant portion of people with SMI lacked Foundation Skills in this objective and benchmarked survey. This points to a high risk for digital exclusion and the need for focused policy and tailored health sector support to ensure people retain access to key services and develop digital skills and confidence. To our knowledge, this is the first time this has been described using the EDS framework. Services, including the National Health Service (NHS), need to be aware of and mitigate the risks.
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Affiliation(s)
- P Spanakis
- Department of Health Sciences, University of York, ARRC Building, Heslington, York YO10 5DD, UK Department of Psychology, University of Crete, Rethymnon, Greece
- School of Psychology, Mediterranean College, Athens, Greece
| | - R Wadman
- Department of Health Sciences, University of York, York, UK
| | - L Walker
- Department of Health Sciences, University of York, York, UK
| | - P Heron
- Department of Health Sciences, University of York, York, UK
| | - A Mathers
- The Good Things Foundation, Sheffield, UK; Royal Society of Arts, London, UK
| | - J Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - G Johnston
- Independent Peer Researcher, Clackmannan, UK
| | - S Gilbody
- Department of Health Sciences, University of York, York, UK
| | - E Peckham
- Department of Health Sciences, University of York, York, UK
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13
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Walker L, Attems J. Prevalence of Concomitant Pathologies in Parkinson's Disease: Implications for Prognosis, Diagnosis, and Insights into Common Pathogenic Mechanisms. J Parkinsons Dis 2024; 14:35-52. [PMID: 38143370 PMCID: PMC10836576 DOI: 10.3233/jpd-230154] [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] [Indexed: 12/26/2023]
Abstract
Pathologies characteristic of Alzheimer's disease (i.e., hyperphosphorylated tau and amyloid-β (Aβ) plaques), cardiovascular disease, and limbic predominant TDP-43 encephalopathy (LATE) often co-exist in patients with Parkinson's disease (PD), in addition to Lewy body pathology (α-synuclein). Numerous studies point to a putative synergistic relationship between hyperphosphorylation tau, Aβ, cardiovascular lesions, and TDP-43 with α-synuclein, which may alter the stereotypical pattern of pathological progression and accelerate cognitive decline. Here we discuss the prevalence and relationships between common concomitant pathologies observed in PD. In addition, we highlight shared genetic risk factors and developing biomarkers that may provide better diagnostic accuracy for patients with PD that have co-existing pathologies. The tremendous heterogeneity observed across the PD spectrum is most likely caused by the complex interplay between pathogenic, genetic, and environmental factors, and increasing our understanding of how these relate to idiopathic PD will drive research into finding accurate diagnostic tools and disease modifying therapies.
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Affiliation(s)
- Lauren Walker
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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14
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Walker L, Burke S, McGeechan GJ. Understanding perceptions of the public and key stakeholders toward a localised cancer screening promotion campaign. PSYCHOL HEALTH MED 2024; 29:317-333. [PMID: 36907829 DOI: 10.1080/13548506.2023.2188230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
The aim of this study was to explore perceptions of members of the public and key stakeholders of a localised campaign to increase engagement with cervical cancer screening. Whilst numerous interventions have been trialled to increase engagement with cancer screening, the evidence for their effectiveness is somewhat mixed. In addition, few studies have explored the perceptions of members of the public targeted by such campaigns nor the perceptions of healthcare professionals who may be involved in delivering such campaigns in the United Kingdom. Members of the public who had potentially been exposed to the campaign in the North-East of England were approached to take part in individual interviews whilst stakeholders were invited to take part in a focus group. A total of 25 participants (13 members of the public, 12 stakeholders) took part. All interviews were audio recorded, transcribed verbatim and analysed using applied thematic analysis. Four themes were identified, two of which were cross-cutting (barriers to screening and factors promoting screening), with one theme identified as specific to the public interviews (knowledge of and attitudes toward awareness campaigns) and one theme specific to the focus group (keeping campaigns relevant. Awareness of the localised campaign was limited; however, when made aware, participants were mostly positive towards the approach, although mixed responses were noted in relation to financial incentives. Members of the public and stakeholders identified some common barriers to screening although differed in their perceptions of promotional factors. This study highlights the importance of multiple strategies to promote cervical screening as one size fits all approach may limit engagement.
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Affiliation(s)
- Lauren Walker
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Shani Burke
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
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15
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Kane L, Portman RM, Eberhardt J, Walker L, Proctor E, Poulter H, O'Neill C. Peer supporters' mental health and emotional wellbeing needs: Key factors and opportunities for co-produced training. Health Expect 2023; 26:2387-2395. [PMID: 37565576 PMCID: PMC10632624 DOI: 10.1111/hex.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Peer supporters are a valuable asset to mental health and support services, but their own mental health needs are often overlooked in research and practice. This study explored peer supporters' perceived challenges of maintaining their mental health and emotional wellbeing and co-produced training needs. METHODS A qualitative approach was used to explore factors affecting peer supporters' mental health and emotional wellbeing. Semi-structured interviews and focus groups were conducted online with 11 peer supporters across North East England. RESULTS A thematic analysis identified: 'Lack of training and support', 'Role ambiguity' and 'Emotional labour' as challenges experienced by peer supporters in relation to maintaining their mental health and emotional wellbeing. Peer supporters' own lived experiences had the potential to act as a barrier towards providing support to others. Conflict with peer 'supportees' sometimes negatively impacted on the peer supporter experience. Participant responses emphasised a need for person-centred, co-produced training. CONCLUSION This work highlights the need for targeted training for peer supporters, including both role-specific education and strategies to support their mental health and emotional wellbeing. PATIENT OR PUBLIC CONTRIBUTION Participants were contacted and asked to provide feedback on finalised themes to ensure the analysis was congruent with their experiences, further enabling the future development of an emotional wellbeing training programme for peer supporters.
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Affiliation(s)
- Laura Kane
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
| | - Robert M. Portman
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
| | - Judith Eberhardt
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
| | - Lauren Walker
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
| | - Emma‐Lily Proctor
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
| | - Hannah Poulter
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
| | - Catherine O'Neill
- Department of Psychology, Centre for Applied Psychological Science, School of Social Sciences, Humanities & LawTeesside UniversityMiddlesbroughUK
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16
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Katanga JA, Hamilton CA, Walker L, Attems J, Thomas AJ. Age-related hearing loss and dementia-related neuropathology: An analysis of the United Kingdom brains for dementia research cohort. Brain Pathol 2023; 33:e13188. [PMID: 37551936 PMCID: PMC10580004 DOI: 10.1111/bpa.13188] [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: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 08/09/2023] Open
Abstract
Age-related hearing loss frequently precedes or coexists with mild cognitive impairment and dementia. The role specific neuropathologies play in this association, as either a cause or a consequence, is unclear. We therefore aimed to investigate whether specific dementia related neuropathologies were associated with hearing impairment in later life. We analysed data on ante-mortem hearing impairment with post-mortem neuropathological data for 442 participants from the Brains for Dementia Research Cohort. Binary logistic regression models were used to estimate the association of hearing impairment with the presence of each dementia-related neuropathology overall, and with specific staged changes. All analyses adjusted for age and sex, and several sensitivity analyses were conducted to test the robustness of findings. Presence and density of neuritic plaques were associated with higher odds of hearing impairment ante-mortem (OR = 3.65, 95% CI 1.78-7.46 for frequent density of plaques). Presence of any LB disease was likewise associated with hearing impairment (OR = 2.10, 95% CI 1.27-3.48), but this did not increase with higher cortical pathology (OR = 1.53, 95% CI 0.75-3.11). Nonspecific amyloid deposition, neurofibrillary tangle staging, overall AD neuropathology level, and cerebrovascular disease were not clearly associated with increased risks of hearing impairment. Our results provide some support for an association between dementia-related neuropathology and hearing loss and suggest that hearing loss may be associated with a high neuritic plaque burden and more common in Lewy body disease.
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Affiliation(s)
- Jessica A. Katanga
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Calum A. Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Lauren Walker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Johannes Attems
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
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Panebianco M, Walker L, Marson AG. Immunomodulatory interventions for focal epilepsy. Cochrane Database Syst Rev 2023; 10:CD009945. [PMID: 37842826 PMCID: PMC10577807 DOI: 10.1002/14651858.cd009945.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND This is an updated version of an original Cochrane Review published in 2013 (Walker 2013). Epilepsy is a common neurological disorder affecting 0.5% to 1% of the population. Pharmacological treatment remains the first choice to control epilepsy. However, up to 30% of people do not respond to drug treatment, and therefore do not achieve seizure remission. Experimental and clinical evidence supports a role for inflammatory pathway activation in the pathogenesis of epilepsy which, if effectively targeted by immunomodulatory interventions, highlights a potentially novel therapeutic strategy. OBJECTIVES To assess the efficacy and tolerability of immunomodulatory interventions on seizures, adverse effect profile, cognition, and quality of life, compared to placebo controls, when used as additional therapy for focal epilepsy in children and adults. SEARCH METHODS For the latest update, we searched the following databases on 11 November 2021: Cochrane Register of Studies (CRS Web) and Medline (Ovid) 1946 to 10 November 2021. CRS Web includes randomised or quasi-randomised, controlled trials from PubMed, EMBASE, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialized Registers of Cochrane Review Groups including Epilepsy. We placed no language restrictions. We reviewed the bibliographies of retrieved studies to search for additional reports of relevant studies. SELECTION CRITERIA Randomised placebo-controlled trials of add-on immunomodulatory drug interventions, in which an adequate method of concealment of randomisation was used. The studies were double-, single- or unblinded. Eligible participants were children (aged over 2 years) and adults with focal epilepsy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. We assessed the following outcomes. 1. 50% or greater reduction in seizure frequency. 2. Seizure freedom. 3. Treatment withdrawal for any reason. 4. Quality of life. 5. ADVERSE EFFECTS We used an intention-to-treat (ITT) population for all primary analyses, and we presented results as risk ratios (RRs) with 95% confidence intervals (95% Cl). MAIN RESULTS We included three randomised, double-blind, placebo-controlled trials on a total of 172 participants. All trials included children and adults over two years of age with focal epilepsy. Treatment phases lasted six weeks and follow-up from six weeks to six months. One of the three included trials described an adequate method of concealment of randomisation, whilst the other two trials were rated as having an unclear risk of bias due to lack of reported information around study design. Effective blinding of studies was reported in all three trials. All analyses were by ITT. One trial was sponsored by the manufacturer of an immunomodulatory agent and therefore was at high risk of funding bias. Immunomodulatory interventions were significantly more effective than placebo in reducing seizure frequency (risk ratio (RR) 2.30, 95% confidence interval (CI) 1.15 to 4.60; 3 studies, 172 participants; moderate-certainty evidence). For treatment withdrawal, there was insufficient evidence to conclude that people were more likely to discontinue immunomodulatory intervention than placebo (RR 1.04, 95% CI 0.28 to 3.80; 3 studies, 172 participants; low-certainty evidence). The RR for adverse effects was 1.16 (95% CI 0.84 to 1.59; 1 study, 66 participants; low-certainty evidence). Certain adverse effects such as dizziness, headache, fatigue, and gastrointestinal disorders were more often associated with immunomodulatory interventions. There were little to no data on cognitive effects and quality of life. No important heterogeneity between studies was found for any of the outcomes. We judged the overall certainty of evidence (using the GRADE approach) as low to moderate due to potential attrition bias resulting from missing outcome data and imprecise results with wide confidence intervals. AUTHORS' CONCLUSIONS Immunomodulatory interventions as add-on treatment for children and adults with focal epilepsy appear to be effective in reducing seizure frequency. It is not possible to draw any conclusions about the tolerability of these agents in children and adults with epilepsy. Further randomised controlled trials are needed.
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Affiliation(s)
- Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Lauren Walker
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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18
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Zhang R, Walker L, Wen X, Doherty C, Gorczyca L, Buckley B, Barrett ES, Aleksunes LM. Placental BCRP transporter reduces cadmium accumulation and toxicity in immortalized human trophoblasts. Reprod Toxicol 2023; 121:108466. [PMID: 37660740 PMCID: PMC10591833 DOI: 10.1016/j.reprotox.2023.108466] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
Cadmium (Cd) is a ubiquitous environmental metal detectable in most pregnant women. Animal and human studies demonstrate that in utero exposure to Cd reduces birth weight and impairs perinatal growth due to placental toxicity. BCRP is a prominent transporter that can efflux xenobiotics from the placenta. This study sought to investigate Cd transport and toxicity in cultured human BeWo trophoblasts with reduced expression and function of the placental barrier transporter BCRP. Knockdown (KD) of BCRP protein expression and function in BeWo trophoblasts increased the intracellular accumulation of Cd by 100% following treatment with 1 μM CdCl2. No change in the expression of Cd uptake transporters was observed between control and BCRP-KD cells. Reduced BCRP expression impaired viability of BeWo cells exposed to CdCl2 for 48 hr (BCRP-KD IC50: 11 μM, control cells IC50: 18 μM). Moreover, BCRP-KD cells were more sensitive to CdCl2-induced cytotoxicity compared to control BeWo cells. CdCl2 treatment strongly induced the expression of the metal-binding protein metallothionein (MT) in both control and BCRP-KD cells, with significantly greater MT upregulation in Cd-treated BCRP-KD cells. These data suggest that the BCRP transporter reduces Cd accumulation in syncytiotrophoblasts, which may be one mechanism to reduce subsequent toxicity to the placenta and developing fetus.
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Affiliation(s)
- Ranran Zhang
- Department of Biostatistics and Epidemiology, Rutgers University, Piscataway, NJ 08854, USA
| | - Lauren Walker
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ 08854, USA
| | - Xia Wen
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
| | - Cathleen Doherty
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
| | - Ludwik Gorczyca
- Joint Graduate Program in Toxicology, Rutgers University, Piscataway, NJ 08854, USA
| | - Brian Buckley
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers University, Piscataway, NJ 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA.
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19
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Spanakis P, Lorimer B, Newbronner E, Wadman R, Crosland S, Gilbody S, Johnston G, Walker L, Peckham E. Digital health literacy and digital engagement for people with severe mental ill health across the course of the COVID-19 pandemic in England. BMC Med Inform Decis Mak 2023; 23:193. [PMID: 37752460 PMCID: PMC10523616 DOI: 10.1186/s12911-023-02299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND An unprecedented acceleration in digital mental health services happened during the COVID-19 pandemic. However, people with severe mental ill health (SMI) might be at risk of digital exclusion, partly because of a lack of digital skills, such as digital health literacy. The study seeks to examine how the use of the Internet has changed during the pandemic for people with SMI, and explore digital exclusion, symptomatic/health related barriers to internet engagement, and digital health literacy. METHODS Over the period from July 2020 to February 2022, n = 177 people with an SMI diagnosis (psychosis-spectrum disorder or bipolar affective disorder) in England completed three surveys providing sociodemographic information and answering questions regarding their health, use of the Internet, and digital health literacy. RESULTS 42.5% of participants reported experiences of digital exclusion. Cochrane-Q analysis showed that there was significantly more use of the Internet at the last two assessments (80.8%, and 82.2%) compared to that at the beginning of the pandemic (65.8%; ps < 0.001). Although 34.2% of participants reported that their digital skills had improved during the pandemic, 54.4% still rated their Internet knowledge as being fair or worse than fair. Concentration difficulties (62.6%) and depression (56.1%) were among the most frequently reported symptomatic barriers to use the Internet. The sample was found to have generally moderate levels of digital health literacy (M = 26.0, SD = 9.6). Multiple regression analysis showed that higher literacy was associated with having outstanding/good self-reported knowledge of the Internet (ES = 6.00; 95% CI: 3.18-8.82; p < .001), a diagnosis of bipolar disorder (compared to psychosis spectrum disorder - ES = 5.14; 95% CI: 2.47-7.81; p < .001), and being female (ES = 3.18; 95% CI: 0.59-5.76; p = .016). CONCLUSIONS These findings underline the need for training and support among people with SMI to increase digital skills, facilitate digital engagement, and reduce digital engagement, as well as offering non-digital engagement options to service users with SMI.
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Affiliation(s)
- P Spanakis
- Department of Health Sciences, University of York, York, UK.
- Department of Psychology, University of Crete, Rethymnon, Greece.
| | - B Lorimer
- Department of Health Sciences, University of York, York, UK
| | - E Newbronner
- Department of Health Sciences, University of York, York, UK
| | - R Wadman
- Department of Health Sciences, University of York, York, UK
| | - S Crosland
- Department of Health Sciences, University of York, York, UK
| | - S Gilbody
- Department of Health Sciences, University of York, York, UK
| | - G Johnston
- Independent Peer Researcher, Clackmannan, UK
| | - L Walker
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - E Peckham
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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20
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Levandowski BA, Murphy HR, Silk J, Barbosu CM, Urban M, Walker L, Aladin B, Dye TD. Sharing the Details: Implementing and Evaluating the Integration of New York State AIDS Institute Health Equity Competencies for Health Care Providers into Clinical Training Activities. Health Equity 2023; 7:555-561. [PMID: 37731782 PMCID: PMC10507923 DOI: 10.1089/heq.2023.0123] [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: 07/12/2023] [Indexed: 09/22/2023] Open
Abstract
Background The New York State (NYS) Department of Health (DOH) AIDS Institute (AI) Clinical Education Initiative (CEI) trains the NYS health care workforce to improve health outcomes related to HIV, sexual health, hepatitis C, and for people who use drugs. Methods In 2019, CEI began consistently integrating health equity into CEI activities through a working group that mapped NYS DOH AI health equity competencies for providers onto planned clinical education. We conducted a convergent mixed methods study on qualitative and quantitative participant feedback form (PFF) data to evaluate these competencies between April 1, 2021, and September 30, 2022, and conducted an annual survey of NYS clinician needs in 2021 and 2022. Results The CEI Health Equity Working Group analyzed 25 measures within 4 health equity competencies that were grouped into 4 interventions: resources, internal tools, activity creation, and evaluation. Eighty-nine percent of PFF respondents (n=20,166) strongly agreed/agreed that CEI activities included multiple viewpoints; qualitative comments described informative and helpful activities. When asked how they address patient-identified social determinants of health (SDOH) needs, 84% and 71% of annual survey respondents reported they made the highest number of referrals for health insurance coverage assistance in 2021 and 2022, respectively. Discussion CEI continues to address participant feedback and seamless incorporation of health equity components into their work. Health Equity Implications Health equity in clinical practice and trainings is crucial in acknowledging and addressing SDOH that continue to impact NYS clinicians and their patients.
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Affiliation(s)
- Brooke A. Levandowski
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Hannah R. Murphy
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Jessica Silk
- Institute for Advanced Medicine, Mount Sinai Health System, New York City, New York, USA
| | - Cabiria M. Barbosu
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Marguerite Urban
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Lauren Walker
- Institute for Advanced Medicine, Mount Sinai Health System, New York City, New York, USA
| | - Beatrice Aladin
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | - Timothy D. Dye
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
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21
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Braithwaite E, Todd OM, Atkin A, Hulatt R, Tadrous R, Alldred DP, Pirmohamed M, Walker L, Lawton R, Clegg A. Interventions for reducing anticholinergic medication burden in older adults-a systematic review and meta-analysis. Age Ageing 2023; 52:afad176. [PMID: 37740900 PMCID: PMC10517713 DOI: 10.1093/ageing/afad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION Anticholinergic medications block the neurotransmitter acetylcholine in the brain and peripheral nervous system. Many medications have anticholinergic properties, and the cumulative effect of these medications is termed anticholinergic burden. Increased anticholinergic burden can have short-term side effects such as dry mouth, blurred vision and urinary retention as well as long-term effects including dementia, worsening physical function and falls. METHODS We carried out a systematic review (SR) with meta-analysis (MA) looking at randomised controlled trials addressing interventions to reduce anticholinergic burden in older adults. RESULTS We identified seven papers suitable for inclusion in our SR and MA. Interventions included multi-disciplinary involvement in medication reviews and deprescribing of AC medications. Pooled data revealed no significant difference in outcomes between control and intervention group for falls (OR = 0.76, 95% CI: 0.52-1.11, n = 647), cognition (mean difference = 1.54, 95% CI: -0.04 to 3.13, n = 405), anticholinergic burden (mean difference = 0.04, 95% CI: -0.11 to 0.18, n = 710) or quality of life (mean difference = 0.04, 95% CI: -0.04 to 0.12, n = 461). DISCUSSION Overall, there was no significant difference with interventions to reduce anticholinergic burden. As we did not see a significant change in anticholinergic burden scores following interventions, it is likely other outcomes would not change. Short follow-up time and lack of training and support surrounding successful deprescribing may have contributed.
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Affiliation(s)
- Eve Braithwaite
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Oliver M Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Abigail Atkin
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Rachel Hulatt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ragy Tadrous
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - David P Alldred
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Yorkshire & Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Munir Pirmohamed
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Lauren Walker
- Department of Clinical Pharmacology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7DE, UK
| | - Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
- Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
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22
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Challenger E, Penchala SD, Hale C, Fitzgerald R, Walker L, Reynolds H, Chiong J, Fletcher T, Khoo S, Else L. Development and validation of an LC-MS/MS method for quantification of favipiravir in human plasma. J Pharm Biomed Anal 2023; 233:115436. [PMID: 37148698 DOI: 10.1016/j.jpba.2023.115436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
Favipiravir (FVP) is a broad-spectrum antiviral that selectively inhibits viral RNA-dependent RNA polymerase, first trialled for the treatment of influenza infection. It has been shown to be effective against a number of RNA virus families including arenaviruses, flaviviruses and enteroviruses. Most recently, FVP has been investigated as a potential therapeutic for severe acute respiratory syndrome coronavirus 2 infection. A liquid chromatography tandem mass spectrometry method for the quantification of FVP in human plasma has been developed and validated for use in clinical trials investigating favipiravir as treatment for coronavirus disease-2019. Samples were extracted by protein precipitation using acetonitrile, using 13C, 15N- Favipiravir as internal standard. Elution was performed on a Synergi Polar-RP 150 × 2.1 mm 4 µm column using a gradient mobile phase programme consisting of 0.2% formic acid in water and 0.2% formic acid in methanol. The assay was validated over the range 500-50,000 ng/mL; this method was found to be precise and accurate and recovery of FVP from the matrix was high. Stability experiments confirmed and expanded on the known stability of FVP, including under heat treatment and for a period of 10 months at - 80 °C.
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Affiliation(s)
- Elizabeth Challenger
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 8TX, UK.
| | - Sujan Dilly Penchala
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 8TX, UK
| | - Colin Hale
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
| | - Richard Fitzgerald
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
| | - Lauren Walker
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
| | - Helen Reynolds
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 8TX, UK
| | - Justin Chiong
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 8TX, UK
| | - Tom Fletcher
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 8TX, UK; Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
| | - Laura Else
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 8TX, UK
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23
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Peckham E, Lorimer B, Spanakis P, Heron P, Crosland S, Walker L, Gilbody S. Health-risk behaviours among people with severe mental ill health: understanding modifiable risk in the Closing the Gap Health Study. Br J Psychiatry 2023; 222:160-166. [PMID: 36650735 PMCID: PMC10895492 DOI: 10.1192/bjp.2022.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People with severe mental ill health (SMI) experience some of the largest health inequalities of any sector within society. For these inequalities to be reduced, an understanding of the behavioural determinants of health in this population is needed. AIMS Utilising data from the Closing the Gap Health Study, we aimed to assess the extent to which people with SMI report health-risk factors and behaviours, their interest in modifying them, and the factors associated with being motivated to modify these behaviours. METHOD Adult (≥18 years old) participants were recruited via primary and secondary care in the English National Health Service. To be eligible, participants needed to have a documented diagnosis of schizophrenia, psychotic disorders or bipolar disorder. Data were collected by survey on demographics, general physical health, diet, physical activity, alcohol, smoking and body mass index. RESULTS Between April 2016 and March 2020, n = 9914 participants were recruited. Among people with SMI, high rates of obesity (37.5%), infrequent physical activity (62.0%), not meeting current guidelines (≥5) for the consumption of fruit and vegetables (85.0%) and smoking (42.2%) were observed. However, most participants were motivated to reduce health-risk behaviours. Perceiving the importance of health-promoting behaviours, being of poorer general health and being female were significantly associated with being motivated to modify health-risk behaviours. CONCLUSIONS Despite experiencing poor physical and mental health outcomes compared with the general population, and contrary to popular misconceptions, people with SMI perceive health as important and are motivated to make behavioural changes to improve health.
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Affiliation(s)
- Emily Peckham
- Department of Health Sciences, University of York, UK
| | - Ben Lorimer
- Department of Health Sciences, University of York, UK
| | | | - Paul Heron
- Department of Health Sciences, University of York, UK
| | | | - Lauren Walker
- Department of Health Sciences, University of York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, UK and Hull York Medical School, UK
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24
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Woodall A, Prosser A, Griffiths M, Shooter B, Garfitt J, Walker L, Buchan I. Cardiovascular risk estimation in rural psychiatric inpatient populations: Cross-sectional preliminary study. Psychiatry Res Commun 2023; 3:100103. [PMID: 37654699 PMCID: PMC7614998 DOI: 10.1016/j.psycom.2023.100103] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Cardiovascular risk was evaluated in patients admitted to rural inpatient psychiatric services over a one-year period in a sparsely populated region of the United Kingdom. Care records were analysed for risk factor recording, and cardiovascular risk estimated using the QRISK3 calculator, which estimates 10-year risk of myocardial infarction or stroke. Of eligible patients, risk factor recording as part of routine care was completed in 86% of possible QRISK3 inputs, enabling QIRSK3 estimation in all eligible patients. QRISK3 for this group was significantly raised relative to an age, sex and ethnicity-matched population, and high risk of cardiovascular disease (QRISK3 score >10%) was detected in 28% of patients. The results demonstrate that there is significant unmet need in rural patients for cardiovascular risk reduction that could be identified as part of routine care. An opportunity exists to integrate mental and physical healthcare by routinely assessing cardiovascular risk in rural psychiatric inpatients. Resources and training are needed to produce this risk information and act on it.
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Affiliation(s)
- Alan Woodall
- Bronllys Hospital, Powys Teaching Health Board, Brecon, LD3 OLY, Wales, United Kingdom
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, L69 3GF, Wales, United Kingdom
| | - Amy Prosser
- Bronllys Hospital, Powys Teaching Health Board, Brecon, LD3 OLY, Wales, United Kingdom
| | - Millie Griffiths
- Bronllys Hospital, Powys Teaching Health Board, Brecon, LD3 OLY, Wales, United Kingdom
| | - Ben Shooter
- Bronllys Hospital, Powys Teaching Health Board, Brecon, LD3 OLY, Wales, United Kingdom
| | - Joy Garfitt
- Bronllys Hospital, Powys Teaching Health Board, Brecon, LD3 OLY, Wales, United Kingdom
| | - Lauren Walker
- Department of Clinical Pharmacology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, L69 7DE, United Kingdom
| | - Iain Buchan
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, L69 3GF, United Kingdom
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25
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Fahmi A, Wong D, Walker L, Buchan I, Pirmohamed M, Sharma A, Cant H, Ashcroft DM, van Staa TP. Combinations of medicines in patients with polypharmacy aged 65-100 in primary care: Large variability in risks of adverse drug related and emergency hospital admissions. PLoS One 2023; 18:e0281466. [PMID: 36753492 PMCID: PMC9907844 DOI: 10.1371/journal.pone.0281466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Polypharmacy can be a consequence of overprescribing that is prevalent in older adults with multimorbidity. Polypharmacy can cause adverse reactions and result in hospital admission. This study predicted risks of adverse drug reaction (ADR)-related and emergency hospital admissions by medicine classes. METHODS We used electronic health record data from general practices of Clinical Practice Research Datalink (CPRD GOLD) and Aurum. Older patients who received at least five medicines were included. Medicines were classified using the British National Formulary sections. Hospital admission cases were propensity-matched to controls by age, sex, and propensity for specific diseases. The matched data were used to develop and validate random forest (RF) models to predict the risk of ADR-related and emergency hospital admissions. Shapley Additive eXplanation (SHAP) values were calculated to explain the predictions. RESULTS In total, 89,235 cases with polypharmacy and hospitalised with an ADR-related admission were matched to 443,497 controls. There were over 112,000 different combinations of the 50 medicine classes most implicated in ADR-related hospital admission in the RF models, with the most important medicine classes being loop diuretics, domperidone and/or metoclopramide, medicines for iron-deficiency anaemias and for hypoplastic/haemolytic/renal anaemias, and sulfonamides and/or trimethoprim. The RF models strongly predicted risks of ADR-related and emergency hospital admission. The observed Odds Ratio in the highest RF decile was 7.16 (95% CI 6.65-7.72) in the validation dataset. The C-statistics for ADR-related hospital admissions were 0.58 for age and sex and 0.66 for RF probabilities. CONCLUSIONS Polypharmacy involves a very large number of different combinations of medicines, with substantial differences in risks of ADR-related and emergency hospital admissions. Although the medicines may not be causally related to increased risks, RF model predictions may be useful in prioritising medication reviews. Simple tools based on few medicine classes may not be effective in identifying high risk patients.
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Affiliation(s)
- Ali Fahmi
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- * E-mail:
| | - David Wong
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Lauren Walker
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, United Kingdom
| | - Iain Buchan
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Institute of Systems, Molecular and Integrative Biology (ISMIB) University of Liverpool, Liverpool, United Kingdom
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, United Kingdom
| | - Harriet Cant
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tjeerd Pieter van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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26
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Khoo SH, FitzGerald R, Saunders G, Middleton C, Ahmad S, Edwards CJ, Hadjiyiannakis D, Walker L, Lyon R, Shaw V, Mozgunov P, Periselneris J, Woods C, Bullock K, Hale C, Reynolds H, Downs N, Ewings S, Buadi A, Cameron D, Edwards T, Knox E, Donovan-Banfield I, Greenhalf W, Chiong J, Lavelle-Langham L, Jacobs M, Northey J, Painter W, Holman W, Lalloo DG, Tetlow M, Hiscox JA, Jaki T, Fletcher T, Griffiths G, Hayden F, Darbyshire J, Lucas A, Lorch U, Freedman A, Knight R, Julious S, Byrne R, Cubas Atienzar A, Jones J, Williams C, Song A, Dixon J, Alexandersson A, Hatchard P, Tilt E, Titman A, Doce Carracedo A, Chandran Gorner V, Davies A, Woodhouse L, Carlucci N, Okenyi E, Bula M, Dodd K, Gibney J, Dry L, Rashid Gardner Z, Sammour A, Cole C, Rowland T, Tsakiroglu M, Yip V, Osanlou R, Stewart A, Parker B, Turgut T, Ahmed A, Starkey K, Subin S, Stockdale J, Herring L, Baker J, Oliver A, Pacurar M, Owens D, Munro A, Babbage G, Faust S, Harvey M, Pratt D, Nagra D, Vyas A. Molnupiravir versus placebo in unvaccinated and vaccinated patients with early SARS-CoV-2 infection in the UK (AGILE CST-2): a randomised, placebo-controlled, double-blind, phase 2 trial. Lancet Infect Dis 2023; 23:183-195. [PMID: 36272432 PMCID: PMC9662684 DOI: 10.1016/s1473-3099(22)00644-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The antiviral drug molnupiravir was licensed for treating at-risk patients with COVID-19 on the basis of data from unvaccinated adults. We aimed to evaluate the safety and virological efficacy of molnupiravir in vaccinated and unvaccinated individuals with COVID-19. METHODS This randomised, placebo-controlled, double-blind, phase 2 trial (AGILE CST-2) was done at five National Institute for Health and Care Research sites in the UK. Eligible participants were adult (aged ≥18 years) outpatients with PCR-confirmed, mild-to-moderate SARS-CoV-2 infection who were within 5 days of symptom onset. Using permuted blocks (block size 2 or 4) and stratifying by site, participants were randomly assigned (1:1) to receive either molnupiravir (orally; 800 mg twice daily for 5 days) plus standard of care or matching placebo plus standard of care. The primary outcome was the time from randomisation to SARS-CoV-2 PCR negativity on nasopharyngeal swabs and was analysed by use of a Bayesian Cox proportional hazards model for estimating the probability of a superior virological response (hazard ratio [HR]>1) for molnupiravir versus placebo. Our primary model used a two-point prior based on equal prior probabilities (50%) that the HR was 1·0 or 1·5. We defined a priori that if the probability of a HR of more than 1 was more than 80% molnupiravir would be recommended for further testing. The primary outcome was analysed in the intention-to-treat population and safety was analysed in the safety population, comprising participants who had received at least one dose of allocated treatment. This trial is registered in ClinicalTrials.gov, NCT04746183, and the ISRCTN registry, ISRCTN27106947, and is ongoing. FINDINGS Between Nov 18, 2020, and March 16, 2022, 1723 patients were assessed for eligibility, of whom 180 were randomly assigned to receive either molnupiravir (n=90) or placebo (n=90) and were included in the intention-to-treat analysis. 103 (57%) of 180 participants were female and 77 (43%) were male and 90 (50%) participants had received at least one dose of a COVID-19 vaccine. SARS-CoV-2 infections with the delta (B.1.617.2; 72 [40%] of 180), alpha (B.1.1.7; 37 [21%]), omicron (B.1.1.529; 38 [21%]), and EU1 (B.1.177; 28 [16%]) variants were represented. All 180 participants received at least one dose of treatment and four participants discontinued the study (one in the molnupiravir group and three in the placebo group). Participants in the molnupiravir group had a faster median time from randomisation to negative PCR (8 days [95% CI 8-9]) than participants in the placebo group (11 days [10-11]; HR 1·30, 95% credible interval 0·92-1·71; log-rank p=0·074). The probability of molnupiravir being superior to placebo (HR>1) was 75·4%, which was less than our threshold of 80%. 73 (81%) of 90 participants in the molnupiravir group and 68 (76%) of 90 participants in the placebo group had at least one adverse event by day 29. One participant in the molnupiravir group and three participants in the placebo group had an adverse event of a Common Terminology Criteria for Adverse Events grade 3 or higher severity. No participants died (due to any cause) during the trial. INTERPRETATION We found molnupiravir to be well tolerated and, although our predefined threshold was not reached, we observed some evidence that molnupiravir has antiviral activity in vaccinated and unvaccinated individuals infected with a broad range of SARS-CoV-2 variants, although this evidence is not conclusive. FUNDING Ridgeback Biotherapeutics, the UK National Institute for Health and Care Research, the Medical Research Council, and the Wellcome Trust.
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Affiliation(s)
- Saye H Khoo
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK; Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
| | - Richard FitzGerald
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK,NIHR Royal Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Geoffrey Saunders
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Calley Middleton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Shazaad Ahmad
- NIHR Manchester Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher J Edwards
- Human Development and Health School, University of Southampton, Southampton, UK,NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dennis Hadjiyiannakis
- NIHR Lancashire Clinical Research Facility, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Lauren Walker
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK,NIHR Royal Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Rebecca Lyon
- NIHR Royal Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Victoria Shaw
- Clinical Directorate, University of Liverpool, Liverpool, UK
| | - Pavel Mozgunov
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Jimstan Periselneris
- NIHR Kings Clinical Research Facility, King's College Hospital NHS Foundation Trust, London, UK
| | - Christie Woods
- NIHR Royal Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Katie Bullock
- Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Colin Hale
- NIHR Royal Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Helen Reynolds
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Nichola Downs
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Amanda Buadi
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Cameron
- NIHR Lancashire Clinical Research Facility, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Emma Knox
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - I'ah Donovan-Banfield
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK,National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - William Greenhalf
- Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Justin Chiong
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | | | - Michael Jacobs
- Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Josh Northey
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | | | | | - Michelle Tetlow
- Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Julian A Hiscox
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK,National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Thomas Jaki
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK,Computational Statistics, University of Regensburg, Regensburg, Germany
| | - Thomas Fletcher
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK,Clinical Sciences, Liverpool, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
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Tew GA, Bailey L, Beeken RJ, Cooper C, Copeland R, Brady S, Heron P, Hill A, Lee E, Spanakis P, Stubbs B, Traviss-Turner G, Walker L, Walters S, Gilbody S, Peckham E. Physical Activity in Adults with Schizophrenia and Bipolar Disorder: A Large Cross-Sectional Survey Exploring Patterns, Preferences, Barriers, and Motivating Factors. Int J Environ Res Public Health 2023; 20:2548. [PMID: 36767931 PMCID: PMC9916302 DOI: 10.3390/ijerph20032548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Adults with severe mental ill health may have specific attitudes toward physical activity. To inform intervention development, we conducted a survey to assess the physical activity patterns, preferences, barriers, and motivations of adults with severe mental ill health living in the community. Data were summarised using descriptive statistics, and logistic regressions were used to explore relationships between physical activity status and participant characteristics. Five-hundred and twenty-nine participants (58% male, mean age 49.3 years) completed the survey. Large numbers were insufficiently active and excessively sedentary. Self-reported levels of physical activity below that recommended in national guidelines were associated with professional inactivity, consumption of fewer than five portions of fruit and vegetables per day, older age, and poor mental health. Participants indicated a preference for low-intensity activities and physical activity that they can do on their own, at their own time and pace, and close to home. The most commonly endorsed source of support was social support from family and friends. Common motivations included improving mental health, physical fitness, and energy levels. However, poor mental and physical health and being too tired were also common barriers. These findings can inform the development of physical activity interventions for this group of people.
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Affiliation(s)
- Garry A. Tew
- Institute for Health and Care Improvement, York St John University, York YO31 7EX, UK
| | - Laura Bailey
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | | | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK
| | - Samantha Brady
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Paul Heron
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Andrew Hill
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Ellen Lee
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Panagiotis Spanakis
- Department of Health Sciences, University of York, York YO10 5DD, UK
- School of Psychology, Mediterranean College, 104 34 Athens, Greece
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | | | - Lauren Walker
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York YO10 5DD, UK
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Newbronner E, Walker L, Wadman R, Crosland S, Johnston G, Heron P, Spanakis P, Gilbody S, Peckham E. Influences on the physical and mental health of people with serious mental ill-health during the COVID-19 pandemic: a qualitative interview study. Int J Qual Stud Health Well-being 2022; 17:2122135. [PMID: 36073745 PMCID: PMC9467576 DOI: 10.1080/17482631.2022.2122135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/15/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE People with severe mental ill-health (SMI) experience profound health inequalities. The Optimizing Wellbeing in Self-isolation study (OWLS) explored the effects of the COVID-19 pandemic restrictions on people with SMI, including how and why their physical and mental health may have changed during the pandemic. METHODS The OLWS study comprised two surveys and two nested qualitative studies. Of 367 people recruited to the study, 235 expressed interest in taking part in a qualitative interview. In the first qualitative study eighteen interviews were conducted with a purposive sample of participants. RESULTS We identified six factors which influenced peoples' health, positively and negatively: Staying Physically Active; Maintaining a Balanced and Healthy Diet; Work or Not Working; Daily Routine and Good Sleep; Staying Connected to Family, Friends and the Local Community; and Habits, Addictions and Coping with Anxiety Created by the Pandemic. CONCLUSIONS Different aspects of lifestyle are highly interconnected. For people with SMI, loss of routine and good sleep, poor diet and lack of exercise can compound each other, leading to a decline in physical and mental health. If people are supported to understand what helps them stay well, they can establish their own frameworks to draw on during difficult times.
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Affiliation(s)
- Elizabeth Newbronner
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Lauren Walker
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Ruth Wadman
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Suzanne Crosland
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | | | - Paul Heron
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Panagiotis Spanakis
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
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Barbui C, Tedeschi F, Acarturk C, Anttila M, Au T, Baumgartner J, Carswell K, Churchill R, Cuijpers P, Karyotaki E, Klein T, Koesters M, Lantta T, Nosè M, Ostuzzi G, Pasquini M, Prina E, Sijbrandij M, Tarsitani L, Turrini G, Uygun E, Välimäki M, Walker L, Wancata J, White RG, Purgato M. Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies. Int J Soc Psychiatry 2022; 69:664-674. [PMID: 36326024 DOI: 10.1177/00207640221132430] [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: 11/06/2022]
Abstract
BACKGROUND In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. AIM This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. METHODS Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. RESULTS A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level (p = .034), a shorter duration of journey (p = .057) and arriving from countries with war-related contexts (p = .017), were more at risk of developing mental disorders. Psychological distress (p = .004), depression (p = .001) and exposure to potentially traumatic events (p = .020) were predictors of mental disorder development. CONCLUSIONS This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.
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Affiliation(s)
- Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Minna Anttila
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ken Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands.,Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Germany
| | | | - Tella Lantta
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ersin Uygun
- Trauma and Disaster Mental Health, Istanbul Bilgi University, Turkey
| | - Maritta Välimäki
- University of Turku, Department of Nursing Science, University of Turku, Finland.,Xiangya Nursing School, Central South University, Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Changsha, China
| | - Lauren Walker
- Department of Health Sciences, University of York, UK
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ross G White
- School of Psychology, Queen's University Belfast, UK
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
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30
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Heron PN, Henderson LM, Crosland S, Gilbody SM, Johnston GA, Moriarty AS, Newbronner E, Paterson A, Spanakis P, Wadman R, Walker L, Peckham E. Sleep health among people with severe mental ill health during the COVID-19 pandemic: Results from a linked UK population cohort study. Front Psychiatry 2022; 13:975593. [PMID: 36299533 PMCID: PMC9589097 DOI: 10.3389/fpsyt.2022.975593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Sleep problems are a transdiagnostic feature of nearly all psychiatric conditions, and a strong risk factor for initial and recurrent episodes. However, people with severe mental ill health (SMI) are often excluded from general population surveys, and as such the extent and associates of poor sleep in this population are less well understood. This study explores sleep health in an SMI sample during the COVID-19 pandemic, using multiple regression to identify risk factors, including daily routine, wellbeing and demographics. Methods An existing cohort of people with an SMI diagnosis were sampled. Participants were invited to complete a self-report survey about their health and the impacts of COVID-19 and associated public health measures. Sleep duration, efficiency, and quality were measured using items from the Pittsburgh Sleep Quality Index (PSQI). Results Two hundred forty-nine adults (aged 21-84 years) completed the survey. Mean sleep duration and efficiency were similar to general population estimates, at 7 h 19 min and 78%, respectively. However, 43% reported "bad" sleep quality that was associated with being younger in age as well as disturbed routine and declined wellbeing. Indeed, 37% reported a disturbed routine during the pandemic. Conclusions High estimates of perceived poor sleep quality in the SMI population align with previous findings. Supporting people with SMI to maintain routine regularity may work to protect sleep quality and wellbeing. Future research should more closely examine sleep health in people with SMI, using accessible and scalable measures of objective and subjective sleep, examining longitudinal trends.
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Affiliation(s)
- Paul N. Heron
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | | | - Suzanne Crosland
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Simon M. Gilbody
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | | | - Andrew S. Moriarty
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Elizabeth Newbronner
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Alastair Paterson
- Faculty of Medical and Human Sciences, Manchester University, Manchester, United Kingdom
| | - Panagiotis Spanakis
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
- Department of Psychology, University of Crete, Rethymmon, Greece
- School of Psychology, Mediterranean College, Athens, Greece
| | - Ruth Wadman
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Lauren Walker
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Emily Peckham
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
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31
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Aldalati A, Garcia S, Jonsson B, Canterbury E, Clements C, Walker L. 295 Updating Patient Care: Where Do We Begin. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.322] [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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32
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Loveday C, Garrett A, Law P, Hanks S, Poyastro-Pearson E, Adlard JW, Barwell J, Berg J, Brady AF, Brewer C, Chapman C, Cook J, Davidson R, Donaldson A, Douglas F, Greenhalgh L, Henderson A, Izatt L, Kumar A, Lalloo F, Miedzybrodzka Z, Morrison PJ, Paterson J, Porteous M, Rogers MT, Walker L, Eccles D, Evans DG, Snape K, Hanson H, Houlston RS, Turnbull C. Analysis of rare disruptive germline mutations in 2,135 enriched BRCA-negative breast cancers excludes additional high-impact susceptibility genes. Ann Oncol 2022; 33:1318-1327. [PMID: 36122798 DOI: 10.1016/j.annonc.2022.09.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/15/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Breast cancer has a significant heritable basis, of which approximately 60% remains unexplained. Testing for BRCA1/BRCA2 offers useful discrimination of breast cancer risk within families, and identification of additional breast cancer susceptibility genes could offer clinical utility. PATIENTS AND METHODS We included 2,135 invasive breast cancer cases recruited via the BOCS study, a retrospective UK study of familial breast cancer. ELIGIBILITY CRITERIA female, BRCA-negative, white European ethnicity, and one of: i) breast cancer family history, ii) bilateral disease, iii) young age of onset (<30 years), iv) concomitant ovarian cancer. We undertook exome sequencing of cases and performed gene-level burden testing of rare damaging variants against those from 51,377 ethnicity-matched population controls from gnomAD. RESULTS 159/2135 (7.4%) cases had a qualifying variant in an established breast cancer susceptibility gene, with minimal evidence of signal in other cancer susceptibility genes. Known breast cancer susceptibility genes PALB2, CHEK2 and ATM were the only genes to retain statistical significance after correcting for multiple testing. Due to the enrichment of hereditary cases in the series, we had good power (>80%) to detect a gene of BRCA1-like risk (odds ratio = 10.6) down to a population minor allele frequency of 4.6 x 10-5 (1 in 10,799, less than one tenth that of BRCA1)and of PALB2-like risk (odds ratio = 5.0) down to a population minor allele frequency of 2.8 x 10-4 (1 in 1,779, less than half that of PALB2). Power was lower for identification of novel moderate penetrance genes (odds ratio = 2-3) like CHEK2 and ATM. CONCLUSIONS This is the largest case-control whole-exome analysis of enriched breast cancer published to date. Whilst additional breast cancer susceptibility genes likely exist, those of high penetrance are likely to be of very low mutational frequency. Contention exists regarding the clinical utility of such genes.
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Affiliation(s)
- C Loveday
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - A Garrett
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - P Law
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - S Hanks
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - E Poyastro-Pearson
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - J W Adlard
- Yorkshire Regional Genetics Service, St James's University Hospital, Leeds, UK
| | - J Barwell
- Leicestershire Genetics Centre, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - J Berg
- Division of Medical Sciences, Human Genetics, University of Dundee, Dundee, UK
| | - A F Brady
- North West Thames Regional Genetics Service, Kennedy Galton Centre, London, UK
| | - C Brewer
- Peninsula Regional Genetics Service, Royal Devon & Exeter Hospital, Exeter, UK
| | - C Chapman
- West Midlands Regional Genetics Service, Birmingham Women's Hospital, Birmingham, UK
| | - J Cook
- Sheffield Regional Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - R Davidson
- West of Scotland Regional Genetics Service, Ferguson Smith Centre for Clinical Genetics, Glasgow, UK
| | - A Donaldson
- South Western Regional Genetics Service, University Hospitals of Bristol NHS Foundation Trust, Bristol, UK
| | - F Douglas
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L Greenhalgh
- Cheshire and Merseyside Clinical Genetics Service, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Henderson
- Northern Genetics Service (Cumbria), Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - L Izatt
- South East Thames Regional Genetics Service, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - A Kumar
- North East Thames Regional Genetics Service, Great Ormond St. Hospital, London, UK
| | - F Lalloo
- University Department of Medical Genetics & Regional Genetics Service, St. Mary's Hospital, Manchester, UK
| | - Z Miedzybrodzka
- University of Aberdeen and North of Scotland Clinical Genetics Service, Aberdeen Royal Infirmary, Aberdeen, UK
| | - P J Morrison
- Belfast Health and Social Care (HSC) Trust & Department of Medical Genetics, Northern Ireland Regional Genetics Service, Queen's University Belfast, Belfast, UK
| | - J Paterson
- East Anglian Regional Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Porteous
- South East of Scotland Clinical Genetics Service, Western General Hospital, Edinburgh, UK
| | - M T Rogers
- All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - L Walker
- Oxford Regional Genetics Service, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
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- Individual collaborators and their affiliations are listed in the Appendix
| | - D Eccles
- Faculty of Medicine, University of Southampton, Southampton University Hospitals NHS Trust, Southampton, UK
| | - D G Evans
- University Department of Medical Genetics & Regional Genetics Service, St. Mary's Hospital, Manchester, UK
| | - K Snape
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.; South West Thames Regional Genetics Service, St. George's Hospital, London, UK
| | - H Hanson
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.; South West Thames Regional Genetics Service, St. George's Hospital, London, UK
| | - R S Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - C Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.; Royal Marsden NHS Foundation Hospital, London, UK.
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Walker L, Gardner C, Bodenlos K, Sachdev D, Wang S, Laskin D, Aleksunes L. SOC-II-10 Human placental macrophages as targets of cadmium toxicity. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.113] [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: 11/27/2022]
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FitzGerald R, Dickinson L, Else L, Fletcher T, Hale C, Amara A, Walker L, Penchala SD, Lyon R, Shaw V, Greenhalf W, Bullock K, Lavelle-Langham L, Reynolds H, Painter W, Holman W, Ewings S, Griffiths G, Khoo S. Pharmacokinetics of ß-d-N4-Hydroxycytidine, the Parent Nucleoside of Prodrug Molnupiravir, in Nonplasma Compartments of Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Clin Infect Dis 2022; 75:e525-e528. [PMID: 35271729 PMCID: PMC8992239 DOI: 10.1093/cid/ciac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 12/04/2022] Open
Abstract
ß-d-N4-hydroxycytidine (NHC), the parent nucleoside of molnupiravir, a COVID-19 antiviral, was quantified at SARS-CoV-2 transmission sites in 12 patients enrolled in AGILE Candidate-Specific Trial-2. Saliva, nasal, and tear NHC concentrations were 3%, 21%, and 22% that of plasma. Saliva and nasal NHC were significantly correlated with plasma (P < .0001). Clinical Trials Registration. NCT04746183.
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Affiliation(s)
- Richard FitzGerald
- National Institute for Health Research Royal Liverpool & Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Laura Dickinson
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Laura Else
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Colin Hale
- National Institute for Health Research Royal Liverpool & Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Alieu Amara
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Lauren Walker
- National Institute for Health Research Royal Liverpool & Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sujan Dilly Penchala
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca Lyon
- National Institute for Health Research Royal Liverpool & Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Victoria Shaw
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - William Greenhalf
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Katie Bullock
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Lara Lavelle-Langham
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Helen Reynolds
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Sean Ewings
- National Institute for Health Research Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- National Institute for Health Research Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Saye Khoo
- National Institute for Health Research Royal Liverpool & Broadgreen Clinical Research Facility, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, United Kingdom
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35
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Dougherty G, Akoth S, Hawken M, Leting I, Mutei R, Ngugi C, Naitore D, Tsiouris F, Wakoli A, Walker L, Rabkin M. Improving viral load utilisation to enhance care for Kenyan adolescents with HIV. BMJ Open Qual 2022; 11:bmjoq-2022-001900. [PMID: 35948387 PMCID: PMC9379533 DOI: 10.1136/bmjoq-2022-001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022] Open
Abstract
Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation.
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Affiliation(s)
- Gillian Dougherty
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | | | | | | | | | | | | | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | | | - Lauren Walker
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Miriam Rabkin
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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36
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Wu LM, Valdimarsdottir HB, Amidi A, Reid KJ, Ancoli-Israel S, Bovbjerg K, Fox RS, Walker L, Matharu A, Kaseda ET, Galvin JP, Adekola K, Winkel G, Penedo F, Redd WH. Examining the Efficacy of Bright Light Therapy on Cognitive Function in Hematopoietic Stem Cell Transplant Survivors. J Biol Rhythms 2022; 37:471-483. [PMID: 35904252 DOI: 10.1177/07487304221107833] [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
Patients who have undergone hematopoietic stem cell transplant (HSCT) may experience cognitive impairment that can persist after treatment. Several studies have shown that bright light therapy may improve cognition, potentially due to its effects on the circadian system via brain regions that respond preferentially to light. In this double-blind randomized controlled trial, the efficacy of bright light therapy on cognition was examined in HSCT survivors. Forty-seven HSCT survivors at an urban hospital in the United States were screened for mild cognitive impairment, randomized to either bright white light (BWL) or comparison dim red light (DRL) conditions using a block randomization approach, and instructed to use their assigned light box every morning upon awakening for 30 min for 4 weeks. Assessments occurred at baseline, the end of the second week of the intervention, the end of the intervention, and at follow-up (8 weeks later). The primary outcome was objective cognitive function as measured by a global composite score on neuropsychological tests. Secondary outcomes included cognitive performance in individual domains, self-reported cognitive function, fatigue, sleep and sleep quality, and circadian rhythm robustness. Repeated-measures linear mixed models for both objective and self-reported cognitive function indicated significant main effects for time (ps < 0.05) suggesting significant improvements in both conditions over time. Time by light condition interaction effects were not significant. Models focused on secondary outcomes yielded no significant effects. Both BWL and DRL groups demonstrated significant improvements in objective cognitive and self-reported cognitive function over time, but there was no hypothesized effect of BWL over DRL nor associations with circadian rhythm robustness. Therapeutic effects of both light conditions, practice effects, and/or placebo effects may account for the findings.Trial registration: ClinicalTrials.gov Identifier: NCT02677987 (9 February 2016).
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Affiliation(s)
- Lisa M Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Heiddis B Valdimarsdottir
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Ali Amidi
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kathryn J Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Lauren Walker
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amreen Matharu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - John P Galvin
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gary Winkel
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - William H Redd
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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37
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Elliott C, Truman E, Nelson MR, Scheibe C, Hudders L, De Jans S, Brisson-Boivin K, McAleese S, Johnson M, Walker L, Ellison K. Food Promotion and Children's Health: Considering Best Practices for Teaching and Evaluating Media Literacy on Food Marketing. Front Public Health 2022; 10:929473. [PMID: 35899161 PMCID: PMC9309718 DOI: 10.3389/fpubh.2022.929473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Food marketing to children is ubiquitous and persuasive. It primarily promotes foods of poor nutritional quality, influences children's food preferences and habits, and is a factor in childhood obesity. Given that food marketing relentlessly targets children in traditional/digital media and the built environment, children need critical media literacy skills that build their understanding of food marketing's persuasive effects. However, little research connects media literacy with food marketing and health, including effective strategies for teaching and evaluating such programming for children. This perspective presents the outcomes of a stakeholder meeting on best practices in teaching and evaluation on media literacy and food marketing to children. Strategies for promoting critical thinking (teaching content, teaching practices, teaching supports, and parent/caregiver involvement), and strategies for measuring critical thinking (program effectiveness and broader long-term impacts) were identified. These include, among other things, the need to capture the range of marketing formats and current food promotion trends, to include inquiry-based and co-creation activities, and to support ongoing media literacy development. Overall, these strategies suggest useful criteria for media literacy programming related to food marketing, and highlight the importance of media literacy for giving children the skills to navigate a complex food environment.
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Affiliation(s)
- Charlene Elliott
- Department of Communication, Media and Film, University of Calgary, Calgary, AB, Canada
- *Correspondence: Charlene Elliott
| | - Emily Truman
- Department of Communication, Media and Film, University of Calgary, Calgary, AB, Canada
| | - Michelle R. Nelson
- Department of Advertising, College of Media, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Cyndy Scheibe
- Psychology, Ithaca College, Ithaca, NY, United States
| | - Liselot Hudders
- Department of Communication Sciences, Ghent University, Ghent, Belgium
| | - Steffi De Jans
- Department of Communication Sciences, Ghent University, Ghent, Belgium
| | | | | | | | | | - Kirsten Ellison
- Department of Communication, Media and Film, University of Calgary, Calgary, AB, Canada
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Abstract
OBJECTIVE To ascertain the burden and associated cost of adverse drug reactions (ADRs), polypharmacy and multimorbidity through a prospective analysis of all medical admissions to a large university teaching hospital over a 1-month period. DESIGN Prospective observational study. SETTING Liverpool University Hospital Foundation National Health Service (NHS) Trust, England. PARTICIPANTS All medical admissions with greater than 24-hour stay over a 1-month period. MAIN OUTCOME MEASURES Prevalence of admissions due to an ADR and associated mortality, prevalence and association of multimorbidity and polypharmacy with ADRs, and estimated local financial cost of admissions where an ADR was a contributing or main reason for admission with projected costs for NHS in England. RESULTS There were 218 identified patient admissions with an ADR giving a prevalence of 18.4%. The majority of these (90.4%) were ADRs that directly resulted in or contributed to admission. ADRs thus accounted for 16.5% of total admissions. Those with an ADR were on average taking more medicines (10.5 vs 7.8, p<0.01) and had more comorbidities than those without an ADR (6.1 vs 5.2, p<0.01). Drugs most commonly implicated were diuretics, steroid inhalers, anticoagulants and antiplatelets, proton pump inhibitors, chemotherapeutic agents and antihypertensives. 40.4% of ADRs were classified avoidable or possibly avoidable. The mortality rate due to an ADR was 0.34%. The average length of stay for those with an ADR was 6 days. Direct 1-month cost to the Trust from ADR admissions was £490 716. Extrapolated nationally, the projected annual cost to the NHS in England is 2.21 billion. CONCLUSION The local prevalence of admission and mortality from ADRs is higher than previously reported. Important factors that could be contributing to this include polypharmacy and multimorbidity. ADRs place a significant burden on patients and healthcare services with associated financial implications. Reducing inappropriate polypharmacy should be a major aim for preventing ADRs.
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Affiliation(s)
- Rostam Osanlou
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Department of Pharmacology and Therapeutics, Liverpool University Hospital Foundation NHS Trust, Liverpool, UK
| | - Lauren Walker
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Department of Pharmacology and Therapeutics, Liverpool University Hospital Foundation NHS Trust, Liverpool, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Department of Pharmacology and Therapeutics, Liverpool University Hospital Foundation NHS Trust, Liverpool, UK
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39
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Essa H, Walker L, Mohee K, Oguguo C, Douglas H, Kahn M, Rao A, Bellieu J, Hadcroft J, Hartshorne-Evans N, Bliss J, Akpan A, Wong C, Cuthbertson DJ, Sankaranarayanan R. Multispecialty multidisciplinary input into comorbidities along with treatment optimisation in heart failure reduces hospitalisation and clinic attendance. Open Heart 2022; 9:openhrt-2022-001979. [PMID: 35858706 PMCID: PMC9305818 DOI: 10.1136/openhrt-2022-001979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Aims Heart failure (HF) is associated with comorbidities which independently influence treatment response and outcomes. This retrospective observational study (January 2020–June 2021) analysed the impact of monthly HF multispecialty multidisciplinary team (MDT) meetings to address management of HF comorbidities and thereby on provision, cost of care and HF outcomes. Methods Patients acted as their own controls, with outcomes compared for equal periods (for each patient) pre (HF MDT) versus post-MDT (multispecialty) meeting. The multispecialty MDT comprised HF cardiologists (primary, secondary, tertiary care), HF nurses, nephrologist, endocrinologist, palliative care, chest physician, pharmacist, clinical pharmacologist and geriatrician. Outcome measures were (1) all-cause hospitalisations, (2) outpatient clinic attendances and (3) cost. Results 334 patients (mean age 72.5±11 years) were discussed virtually through MDT meetings and follow-up duration was 13.9±4 months. Mean age-adjusted Charlson Comorbidity Index was 7.6±2.1 and Rockwood Frailty Score 5.5±1.6. Multispecialty interventions included optimising diabetes therapy (haemoglobin A1c-HbA1c pre-MDT 68±11 mmol/mol vs post-MDT 61±9 mmol/mol; p<0.001), deprescribing to reduce anticholinergic burden (pre-MDT 1.85±0.4 vs 1.5±0.3 post-MDT; p<0.001), initiation of renin–angiotensin aldosterone system inhibitors in HF with reduced ejection fraction (HFrEF) with advanced chronic kidney disease (9% pre vs 71% post-MDT; p<0.001). Other interventions included potassium binders, treatment of anaemia, falls assessment, management of chest conditions, day-case ascitic, pleural drains and palliative support. Total cost of funding monthly multispecialty meetings was £32 400 and resultant 64 clinic appointments cost £9600. The post-MDT study period was associated with reduction in 481 clinic appointments (cost saving £72150) and reduced all-cause hospitalisations (pre-MDT 1.1±0.4 vs 0.6±0.1 post-MDT; p<0.001), reduction of 1586 hospital bed-days and cost savings of £634 400. Total cost saving to the healthcare system was £664 550. Conclusion HF multispecialty virtual MDT model provides integrated, holistic care across all healthcare tiers for management of HF and associated comorbidities. This approach is associated with reduced clinic attendances and all-cause hospitalisations, leading to significant cost savings.
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Affiliation(s)
- Hani Essa
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Lauren Walker
- Pharmacology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Clinical Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Kevin Mohee
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Chukwuemeka Oguguo
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Homeyra Douglas
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Kahn
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Archana Rao
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Julie Bellieu
- Palliative Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Justine Hadcroft
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nick Hartshorne-Evans
- CEO and Founder, The Pumping Marvellous Foundation (Patient-Led Heart Failure Charity), Preston, UK
| | - Janet Bliss
- Chair, NHS Liverpool Clinical Commissioning Group, Liverpool, UK.,GP Senior Partner, Grey Road Surgery, Liverpool, UK
| | - Asangaedem Akpan
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Institute of Health, University of Cumbria, Cumbria, UK.,Geriatrics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Christopher Wong
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Nephrology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,School of Health and Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - Daniel J Cuthbertson
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Faculty of Health and Life Science, University of Liverpool, Liverpool, UK.,Diabetes and Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rajiv Sankaranarayanan
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK .,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,NIHR Research Scholar, NIHR CRN North West Coast, National Institute for Health and Care Research (NIHR), Liverpool, UK
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40
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Hatton C, Ghanem SS, Koss DJ, Abdi IY, Gibbons E, Guerreiro R, Bras J, Walker L, Gelpi E, Heywood W, Outeiro TF, Attems J, McFarland R, Forsyth R, El-Agnaf OM, Erskine D. Prion-like α-synuclein pathology in the brain of infants with Krabbe disease. Brain 2022; 145:1257-1263. [PMID: 34999780 PMCID: PMC9128812 DOI: 10.1093/brain/awac002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
Krabbe disease is an infantile neurodegenerative disorder resulting from pathogenic variants in the GALC gene that causes accumulation of the toxic sphingolipid psychosine. GALC variants are also associated with Lewy body diseases, an umbrella term for age-associated neurodegenerative diseases in which the protein α-synuclein aggregates into Lewy bodies. To explore whether α-synuclein in Krabbe disease has pathological similarities to that in Lewy body disease, we performed an observational post-mortem study of Krabbe disease brain tissue (n = 4) compared to infant controls (n = 4) and identified widespread accumulations of α-synuclein. To determine whether α-synuclein in Krabbe disease brain displayed disease-associated pathogenic properties we evaluated its seeding capacity using the real-time quaking-induced conversion assay in two cases for which frozen tissue was available and strikingly identified aggregation into fibrils similar to those observed in Lewy body disease, confirming the prion-like capacity of Krabbe disease-derived α-synuclein. These observations constitute the first report of prion-like α-synuclein in the brain tissue of infants and challenge the putative view that α-synuclein pathology is merely an age-associated phenomenon, instead suggesting it results from alterations to biological pathways, such as sphingolipid metabolism. Our findings have important implications for understanding the mechanisms underlying Lewy body formation in Lewy body disease.
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Affiliation(s)
- Christopher Hatton
- Wellcome Centre for Mitochondrial Research, Claremont Road, Newcastle NE2 4AA, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
| | - Simona S. Ghanem
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha 34110, Qatar
| | - David J. Koss
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
| | - Ilham Y. Abdi
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha 34110, Qatar
| | - Elizabeth Gibbons
- Department of Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI 49503, USA
| | - Rita Guerreiro
- Department of Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI 49503, USA
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI 49503, USA
| | - Jose Bras
- Department of Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI 49503, USA
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI 49503, USA
| | | | - Lauren Walker
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Wendy Heywood
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Tiago F. Outeiro
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, 37073 Göttingen, Germany
- Max Planck Institute for Experimental Medicine, 37075 Göttingen, Germany
- Scientific employee with an honorary contract at Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), 37075 Göttingen, Germany
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Claremont Road, Newcastle NE2 4AA, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
- Department of Paediatric Neurology, Great North Children’s Hospital, Newcastle NE1 4LP, UK
| | - Rob Forsyth
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
- Department of Paediatric Neurology, Great North Children’s Hospital, Newcastle NE1 4LP, UK
| | - Omar M. El-Agnaf
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha 34110, Qatar
| | - Daniel Erskine
- Wellcome Centre for Mitochondrial Research, Claremont Road, Newcastle NE2 4AA, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle NE2 4AA, UK
- Correspondence to: Dr Daniel Erskine Wellcome Centre for Mitochondrial Research Newcastle University, Claremont Place Newcastle upon Tyne, NE2 4AA, UK E-mail:
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41
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Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Bone Marrow Transplant 2022; 57:1150-1163. [PMID: 35523848 DOI: 10.1038/s41409-022-01591-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
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Affiliation(s)
- Rachel Phelan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Rebecca L Hunter
- Division of Hematology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Burns
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hesham Eissa
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Pinki Prasad
- Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, Department of Pediatrics, New Orleans, LA, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Karen Baker
- Duke University Medical Center, Durham, NC, USA
| | - Grzegorz W Basak
- University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Arthur Flatau
- Association of Cancer Online Resources, Association of Cancer Online Resources, Austin, TX, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Dipnarine Maharaj
- South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, FL, USA
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, UK
| | - Seema Naik
- Division Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Milton Hershey Medical Center, Hershey, PA, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Zinaida Peric
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | | | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tal Schechter
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Division of Hematology/ Oncology/ Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - John A Snowden
- The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Douglas Tremblay
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Walker
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
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Walker L, Crosland S, Johnston G, Peckham EJ. Transformation Beyond COVID-19: Accessibility in Lived Experience Involvement in Research Post Pandemic. Experience, Reflections and Future Direction From the Closing the Gap Network and OWLS Study. Front Psychiatry 2022; 13:872341. [PMID: 35573358 PMCID: PMC9094435 DOI: 10.3389/fpsyt.2022.872341] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Research literature published during the COVID-19 pandemic highlights the loss of involvement opportunities for people with lived experience during the pandemic as well as the vital role lived experience advisors play at all times, including highlighting unseen aspects of the impacts of crises such as the COVID-19 pandemic. During the pandemic, researchers from the Closing the Gap Network (CtG) at the University of York worked to expand and diversify patient and public involvement (PPI) whist working on a study exploring the impact of the pandemic and associated restrictions on those with the most severe forms of mental ill health. CtG had a strong record of patient and public involvement pre-pandemic and researchers wanted to ensure that this continued during the pandemic. This paper describes the experience of lived experience involvement during the pandemic from multiple perspectives and makes recommendations for future involvement models, accessibility and recommendations for future research.
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Affiliation(s)
- Lauren Walker
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | - Suzanne Crosland
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | | | - Emily J. Peckham
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
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Best K, Alderson S, Alldred D, Bonnet L, Buchan I, Butters O, Farrin A, Foy R, Johnson O, McInerney C, Mehdizadeh D, Lawton T, Lawton R, Rodgers S, Teale E, Walker L, West R, Young B, Pirmohamed M, Clegg A. 825 DEVELOPMENT OF THE ANTICHOLINERGIC MEDICATION INDEX (ACMI). Age Ageing 2022. [DOI: 10.1093/ageing/afac035.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Medications with Anticholinergic (AC) properties, are prescribed to treat a range of conditions. Older people are increasingly likely to be prescribed multiple AC medications, but are also more likely to experience unwanted adverse effects, such as falls and delirium. The risks of adverse outcomes increase with the number and potency of AC medications prescribed. The aim of this study was to use a prognostic modelling approach to develop an AC Medication Index (ACMI) that identifies patients at high risk of AC medication side effects.
Methods
The prognostic model was developed using data on patients aged 65–95 years, registered with a general practice contributing data to ‘Connected Bradford’ in 2019. A Time-dependent Cox model was fitted, with hospital admission for delirium or falls as the composite outcome and AC medications, age, sex and important clinical factors (e.g. dementia, arthritis, urinary incontinence) as predictors. Concordance and Negalkerke’s R2 derived from five-fold cross-validation were used to assess model performance.
Results
There were 151,604 patients included in the study, of whom 47,035 (31.0%) were prescribed ≥1 AC medication during 2019. Codeine, Prednisolone, Furosemide and Amitriptyline were most commonly prescribed with 7.4%, 4.0%, 3.8% and 3.1% of patients prescribed these medications at least once in 2019, respectively. During 2019, 6,078 (4.0%) patients experienced a hospital admission with delirium or a fall, with the rate being increased in those prescribed ≥1 AC medication during 2019 (4.8% vs 3.7%; p < 0.001). The prognostic model yielded a discrimination statistic of 0.86 with an R2 of 0.1.
Conclusion
The model used to develop the ACMI shows good discrimination. External validation will soon be performed using data from the SAIL databank and the ACMI will be further developed as a tool for use in primary care.
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Affiliation(s)
| | - S Alderson
- University of Leeds
- NHS Greater Huddersfield CCG
| | | | | | | | | | | | | | | | | | | | - T Lawton
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | | | - E Teale
- University of Leeds
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | | | | | | | - A Clegg
- University of Leeds
- Bradford Teaching Hospitals NHS Foundation Trust
- NHS Leeds CCG
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Essa H, Sankaranarayanan R, Walker L. Triple antithrombotic therapy and dual therapy - What is the evidence base? Br J Clin Pharmacol 2022; 88:3009-3012. [PMID: 35172379 DOI: 10.1111/bcp.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hani Essa
- Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Longmoor lane, Liverpool, L9 7AL, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Rajiv Sankaranarayanan
- Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Longmoor lane, Liverpool, L9 7AL, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Lauren Walker
- Clinical Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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Borrelli S, Walker L, Coolin K, Fumagalli S, Karema A, Konstantinidis S, Mets-Oja S, Nespoli A, Smit AM, Van Oost M, Spiby H. Midwifery students' perspectives of physical and virtual mobility activities including preferences for e-learning: A cross-sectional survey. Nurse Educ Today 2022; 109:105214. [PMID: 34799193 DOI: 10.1016/j.nedt.2021.105214] [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: 04/20/2021] [Revised: 10/25/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Contemporary higher education requires that all midwifery students have insight and understanding of global health practice and demonstrate intercultural sensitivity. However, the mobility models currently offered do not often fit the lives of large numbers of midwifery students. OBJECTIVES To investigate midwifery students' international physical mobility activities and factors that affect mobility; to determine midwifery students' learning needs and preferences for related e-learning packages. DESIGN Multi-centre, descriptive quantitative survey. SETTINGS Four European Higher Education Institutions based in the United Kingdom, Estonia, Italy and the Netherlands offering an undergraduate midwifery programme. PARTICIPANTS The sample included 205 midwifery students from Italy (n = 93), the Netherlands (n = 51); United Kingdom (n = 35) and Estonia (n = 26). METHODS Data were collected in June-July 2020 through an online cross-sectional, bespoke questionnaire and analysed using summary statistical analysis. RESULTS There is a high level of interest across a range of mobility opportunities, especially those of shorter duration. Barriers to mobility comprised finance, caring responsibilities, concerns about fitting mobility activities into the midwifery programme, negative impact on studies and language barriers. The most frequently identified facilitators of mobility included professional perspectives such as interest in other cultures and midwifery in other settings and an endorsement that mobility would add value to their development as a midwife. When engaging in virtual learning, the most preferred resources mentioned by the students were videos, video calls with peers, choice quiz and discussion forum. CONCLUSIONS The barriers identified require new approaches to enable all midwifery students to benefit from transnational learning. The survey findings provide insights into midwifery students' perspectives from which a new mobility model can be developed.
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Affiliation(s)
- S Borrelli
- University of Nottingham, School of Health Sciences, Medical School, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom of Great Britain and Northern Ireland.
| | - L Walker
- University of Nottingham, School of Health Sciences, Medical School, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom of Great Britain and Northern Ireland.
| | - K Coolin
- University of Nottingham, School of Health Sciences, Medical School, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom of Great Britain and Northern Ireland.
| | - S Fumagalli
- University of Milano Bicocca, Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), U38, Piano V, Stanza 5.36 Via Cadore 48, 20900 Monza, MB, Italy.
| | - A Karema
- Tallinn Health Care College, Kännu 67, Tallinn, Estonia.
| | - S Konstantinidis
- University of Nottingham, School of Health Sciences, Medical School, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom of Great Britain and Northern Ireland.
| | - S Mets-Oja
- Tallinn Health Care College, Kännu 67, Tallinn, Estonia.
| | - A Nespoli
- University of Milano Bicocca, Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), U38, Piano V, Stanza 5.36 Via Cadore 48, 20900 Monza, MB, Italy.
| | - A-M Smit
- Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Vlaardingenlaan 1, 1059, GL, Amsterdam, the Netherlands.
| | - M Van Oost
- Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Vlaardingenlaan 1, 1059, GL, Amsterdam, the Netherlands.
| | - H Spiby
- University of Nottingham, School of Health Sciences, Medical School, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom of Great Britain and Northern Ireland.
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Walker L, Constant J, Pollock C, Evans D, Jones A. An evaluation of a neuro out-patient physiotherapy service: Are we helping our patients to self-manage? Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.318] [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: 11/25/2022]
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Acarturk C, Uygun E, Ilkkursun Z, Carswell K, Tedeschi F, Batu M, Eskici S, Kurt G, Anttila M, Au T, Baumgartner J, Churchill R, Cuijpers P, Becker T, Koesters M, Lantta T, Nosè M, Ostuzzi G, Popa M, Purgato M, Sijbrandij M, Turrini G, Välimäki M, Walker L, Wancata J, Zanini E, White RG, van Ommeren M, Barbui C. Effectiveness of a WHO self-help psychological intervention for preventing mental disorders among Syrian refugees in Turkey: a randomized controlled trial. World Psychiatry 2022; 21:88-95. [PMID: 35015365 PMCID: PMC8751562 DOI: 10.1002/wps.20939] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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] [Indexed: 11/09/2022] Open
Abstract
Refugees are at high risk of developing mental disorders. There is no evidence from randomized controlled trials (RCTs) that psychological interventions can prevent the onset of mental disorders in this group. We assessed the effectiveness of a self-help psychological intervention developed by the World Health Organization, called Self-Help Plus, in preventing the development of mental disorders among Syrian refugees experiencing psychological distress in Turkey. A two-arm, assessor-masked RCT was conducted in two Turkish areas. Eligible participants were adult Syrian refugees experiencing psychological distress (General Health Questionnaire ≥3), but without a diagnosis of mental disorder. They were randomly assigned either to the Self-Help Plus arm (consisting of Self-Help Plus combined with Enhanced Care as Usual, ECAU) or to ECAU only in a 1:1 ratio. Self-Help Plus was delivered in a group format by two facilitators over five sessions. The primary outcome measure was the presence of any mental disorder assessed by the Mini International Neuropsychiatric Interview at six-month follow-up. Secondary outcome measures were the presence of mental disorders at post-intervention, and psychological distress, symptoms of post-traumatic stress disorder and depression, personally identified psychological outcomes, functional impairment, subjective well-being, and quality of life at post-intervention and six-month follow-up. Between October 1, 2018 and November 30, 2019, 1,186 refugees were assessed for inclusion. Five hundred forty-four people were ineligible, and 642 participants were enrolled and randomly assigned to either Self-Help Plus (N=322) or ECAU (N=320). Self-Help Plus participants were significantly less likely to have any mental disorders at six-month follow-up compared to the ECAU group (21.69% vs. 40.73%; Cramer's V = 0.205, p<0.001, risk ratio: 0.533, 95% CI: 0.408-0.696). Analysis of secondary outcomes suggested that Self-Help Plus was not effective immediately post-intervention, but was associated with beneficial effects at six-month follow-up in terms of symptoms of depression, personally identified psychological outcomes, and quality of life. This is the first prevention RCT ever conducted among refugees experiencing psychological distress but without a mental disorder. Self-Help Plus was found to be an effective strategy for preventing the onset of mental disorders. Based on these findings, this low-intensity self-help psychological intervention could be scaled up as a public health strategy to prevent mental disorders in refugee populations exposed to ongoing adversities.
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Affiliation(s)
- Ceren Acarturk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Ersin Uygun
- Department of Trauma and Disasters Mental Health, Bilgi University, Istanbul, Turkey
| | - Zeynep Ilkkursun
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mine Batu
- Department of Trauma and Disasters Mental Health, Bilgi University, Istanbul, Turkey
| | - Sevde Eskici
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Gulsah Kurt
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Elisa Zanini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ross G White
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Heron P, Spanakis P, Crosland S, Johnston G, Newbronner E, Wadman R, Walker L, Gilbody S, Peckham E. Loneliness among people with severe mental illness during the COVID-19 pandemic: Results from a linked UK population cohort study. PLoS One 2022; 17:e0262363. [PMID: 35025915 PMCID: PMC8757957 DOI: 10.1371/journal.pone.0262363] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
AIM/GOAL/PURPOSE Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health. DESIGN/METHODOLOGY/APPROACH We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale. FINDINGS In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91). PRACTICAL IMPLICATIONS Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends. ORIGINALITY Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.
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Affiliation(s)
- Paul Heron
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
- * E-mail:
| | - Panagiotis Spanakis
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | - Suzanne Crosland
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | | | - Elizabeth Newbronner
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | - Ruth Wadman
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | - Lauren Walker
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | - Simon Gilbody
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Emily Peckham
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
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49
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Stefil M, Dixon M, Bahar J, Saied S, Mashida K, Heron O, Shantsila E, Walker L, Akpan A, Lip GY, Sankaranarayanan R. Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist. Card Fail Rev 2022; 8:e34. [PMID: 36891063 PMCID: PMC9987511 DOI: 10.15420/cfr.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 12/23/2022] Open
Abstract
Heart failure (HF) is a common health condition that typically affects older adults. Many people with HF are cared for on an inpatient basis, by noncardiologists, such as acute medical physicians, geriatricians and other physicians. Treatment options for HF are ever increasing, and adherence to guidelines for prognostic therapy contributes to polypharmacy, which is very familiar to clinicians who care for older people. This article explores the recent trials in both HF with reduced ejection fraction and HF with preserved ejection fraction and the limitations of international guidance in their management with respect to older people. In addition, this article discusses the challenge of managing polypharmacy in those with advanced age, and the importance of involving a geriatrician and pharmacist in the HF multidisciplinary team to provide a holistic and person-centred approach to optimisation of HF therapies.
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Affiliation(s)
- Maria Stefil
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust Liverpool, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool, UK
| | - Matthew Dixon
- Department of Medicine for the Elderly, Wirral University Teaching Hospital NHS Foundation Trust Wirral, UK
| | - Jameela Bahar
- School of Medicine, University of Liverpool Liverpool, UK
| | - Schabnam Saied
- School of Medicine, University of Liverpool Liverpool, UK
| | | | - Olivia Heron
- School of Medicine, University of Liverpool Liverpool, UK
| | - Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool Liverpool, UK
| | - Lauren Walker
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool Liverpool, UK
| | - Asangaedem Akpan
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust Liverpool, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool, UK.,Department of Clinical Medicine, Aalborg University Aalborg, Denmark
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust Liverpool, UK
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Ghafouri K, Paton J, Coley K, White M, Day V, Wilson A, Hussein A, Wilson A, Walker L, Simms L, Mackin G, Timmins K, Stiles M. The Use of Pacemaker Impedance Data for Breath-by-Breath Respiration Sensing. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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