1
|
Mazariego C, Jefford M, Chan RJ, Roberts N, Millar L, Anazodo A, Hayes S, Brown B, Saunders C, Webber K, Vardy J, Girgis A, Koczwara B. Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study. J Cancer Surviv 2022; 16:33-43. [PMID: 35107792 PMCID: PMC8881271 DOI: 10.1007/s11764-021-01135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/06/2021] [Indexed: 12/13/2022]
Abstract
Purpose The aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care. Methods Development of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority. Results Round 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes. Conclusions This stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities. Implication for Cancer Survivors Routine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01135-2.
Collapse
Affiliation(s)
- C Mazariego
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling street, Woolloomooloo, NSW, 2011, Australia.
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - N Roberts
- Metro North Health Service, Herston, QLD, Australia.,University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - L Millar
- Medical School, University of Western Australia, Perth, WA, Australia
| | - A Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, Australia.,Kids Cancer Centre, Sydney, Sydney Children's Hospital, Randwick, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - S Hayes
- Consumer representative, Patients First: The Continuous Improvement in Care-Cancer Project, Perth, Australia
| | - B Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - C Saunders
- Medical School, University of Western Australia, Perth, WA, Australia
| | - K Webber
- School of Medical Sciences, Monash University, Clayton, Vic, Australia.,Oncology Department, Monash Health, Clayton, Vic, Australia
| | - J Vardy
- Sydney Medical School, University of Sydney, Camperdown, Australia.,Concord Cancer Centre, Concord Hospital, Concord, NSW, Australia
| | - A Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - B Koczwara
- Department of Clinical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | | |
Collapse
|
2
|
Slavova-Azmanova NS, Millar L, Ives A, Saunders CM. 'Nothing beats the doctor's face to impart trust in their judgement': the role of telehealth in cancer care. AUST HEALTH REV 2021; 45:521-522. [PMID: 33583489 DOI: 10.1071/ah20314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022]
Abstract
Despite Western Australia having low COVID-19 case numbers and limited community transmission, cancer service delivery changes were introduced early in the pandemic, including adoption of telehealth. Patients attending telehealth appointments during COVID-19 between 11 May 2020 and 7 August 2020 reported that telehealth lessened their concerns and met their needs to varying degrees. Despite this, 56% of patients still preferred in-person appointments.
Collapse
Affiliation(s)
- Neli S Slavova-Azmanova
- UWA Medical School, The University of Western Australia, Perth, WA, Australia. ; ; ; and Corresponding author.
| | - Lesley Millar
- UWA Medical School, The University of Western Australia, Perth, WA, Australia. ; ;
| | - Angela Ives
- UWA Medical School, The University of Western Australia, Perth, WA, Australia. ; ;
| | | |
Collapse
|
3
|
Eakin EG, Reeves MM, Goode AD, Winkler EAH, Vardy JL, Boyle F, Haas MR, Hiller JE, Mishra GD, Jefford M, Koczwara B, Saunders CM, Chapman K, Hing L, Boltong AG, Lane K, Baldwin P, Millar L, McKiernan S, Demark-Wahnefried W, Courneya KS, Job J, Reid N, Robson E, Moretto N, Gordon L, Hayes SC. Translating research into practice: outcomes from the Healthy Living after Cancer partnership project. BMC Cancer 2020; 20:963. [PMID: 33023538 PMCID: PMC7539431 DOI: 10.1186/s12885-020-07454-4] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. METHODS In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. RESULTS Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. CONCLUSIONS This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).
Collapse
Affiliation(s)
- Elizabeth G Eakin
- The University of Queensland, Brisbane, QLD, Australia.
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | | | - Ana D Goode
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Frances Boyle
- University of Sydney, Sydney, NSW, Australia
- Mater Hospital, Sydney, NSW, Australia
| | - Marion R Haas
- University of Technology Sydney, Sydney, NSW, Australia
| | - Janet E Hiller
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gita D Mishra
- The University of Queensland, Brisbane, QLD, Australia
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- University of Melbourne, Carlton, VIC, Australia
| | | | | | - Kathy Chapman
- University of Sydney, Sydney, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Liz Hing
- Cancer Council New South Wales, Woolloomooloo, Australia
| | - Anna G Boltong
- University of Melbourne, Carlton, VIC, Australia
- Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | | | - Polly Baldwin
- Cancer Council South Australia, Adelaide, SA, Australia
| | - Lesley Millar
- University of Western Australia, Perth, WA, Australia
| | | | | | | | - Jennifer Job
- The University of Queensland, Brisbane, QLD, Australia
| | - Natasha Reid
- The University of Queensland, Brisbane, QLD, Australia
| | - Erin Robson
- The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Moretto
- The University of Queensland, Brisbane, QLD, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Griffith University, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| |
Collapse
|
4
|
McGlashan J, Hayward J, Brown A, Owen B, Millar L, Johnstone M, Creighton D, Allender S. Comparing complex perspectives on obesity drivers: action-driven communities and evidence-oriented experts. Obes Sci Pract 2018; 4:575-581. [PMID: 30574350 PMCID: PMC6298210 DOI: 10.1002/osp4.306] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The Foresight obesity map represents an expert-developed systems map describing the complex drivers of obesity. Recently, community-led causal loop diagrams have been developed to support community-based obesity prevention interventions. This paper presents a quantitative comparison between the Foresight obesity systems map and a community-developed map of the drivers of obesity. METHODS Variables from a community-developed map were coded against the thematic clusters defined in the Foresight map to allow comparison of their sizes and strength of adjoining causal relationships. Central variables were identified using techniques from network analysis. These properties were compared to understand the similarities and differences between the systems as defined by the two groups. RESULTS The community map focused on environmental influences, such as built physical activity environment (18% of variables) and social psychology (38%). The Foresight map's largest cluster was physiology (23%), a minimal focus in the community map (2%). Network analysis highlighted media and available time within both maps, but variables related to school and sporting club environments were unique to the community map. CONCLUSION Community stakeholders focus on modifiable social and environmental drivers of obesity. Capturing local perspectives is critical when using systems maps to guide community-based obesity prevention.
Collapse
Affiliation(s)
- J. McGlashan
- Global Obesity Centre (GLOBE), School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Institute for Intelligent Systems Research and InnovationDeakin UniversityGeelongVictoriaAustralia
| | - J. Hayward
- Global Obesity Centre (GLOBE), School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - A. Brown
- Global Obesity Centre (GLOBE), School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - B. Owen
- Global Obesity Centre (GLOBE), School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - L. Millar
- Australian Health Policy CollaborationVictoria UniversityMelbourneVictoriaAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthSt AlbansVictoriaAustralia
| | - M. Johnstone
- Institute for Intelligent Systems Research and InnovationDeakin UniversityGeelongVictoriaAustralia
| | - D. Creighton
- Institute for Intelligent Systems Research and InnovationDeakin UniversityGeelongVictoriaAustralia
| | - S. Allender
- Global Obesity Centre (GLOBE), School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| |
Collapse
|
5
|
Whelan J, Love P, Millar L, Allender S, Bell C. Sustaining obesity prevention in communities: a systematic narrative synthesis review. Obes Rev 2018; 19:839-851. [PMID: 29603583 DOI: 10.1111/obr.12675] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 09/12/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 01/01/2023]
Abstract
Obesity is a global problem for which sustainable solutions are yet to be realized. Community-based interventions have improved obesity-related behaviours and obesity in the short term. Few papers have explored how to make the interventions and their intended outcomes sustainable. The aim of this paper is to identify factors that contribute to the sustainability of community-based obesity prevention interventions and their intended outcomes. A systematic narrative synthesis review was conducted of published community-based obesity prevention interventions to identify factors contributing to intervention sustainability. Data extracted were included study authors' perspectives of intervention success and sustainability. Eighty-one papers met the inclusion criteria, and from these we identified ten factors that contribute to sustainability: resourcing, leadership, workforce development, community engagement, partnerships, policy, communications, adaptability, evaluation and governance. This review of community-based obesity prevention interventions gives rise to optimism that sustainable change is possible. We propose a framework to help practitioners build sustainability into their interventions and report on them so that others can also benefit.
Collapse
Affiliation(s)
- J Whelan
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Medicine
| | - P Love
- Deakin University, Geelong, Australia, School of Exercise and Nutrition Sciences
| | - L Millar
- Victoria University, Melbourne, Australia, Australian Health Policy Collaboration
| | - S Allender
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Health and Social Development
| | - C Bell
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Medicine
| |
Collapse
|
6
|
Eakin E, Hayes S, Reeves M, Goode A, Vardy J, Boyle F, Haas M, Hiller J, Mishra G, Jefford M, Koczwara B, Saunders C, Chapman K, Boltong A, Lane K, Baldwin P, Robertson A, Millar L, McKiernan S, Demark-Wahnefried W, Courneya K, Robson E. Translating Research into Community Practice: The Healthy Living after Cancer Partnership Project. Obesity (Silver Spring) 2017; 25 Suppl 2:S31. [PMID: 29086517 DOI: 10.1002/oby.22015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Eakin
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra Hayes
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marina Reeves
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Ana Goode
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Janette Vardy
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Janet Hiller
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Gita Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | | | - Kathy Chapman
- Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Anna Boltong
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | | | - Polly Baldwin
- Cancer Council South Australia, Adelaide, South Australia, Australia
| | - Amanda Robertson
- Cancer Council South Australia, Adelaide, South Australia, Australia
| | - Lesley Millar
- Cancer Council Western Australia, Perth, Western Australia, Australia
| | - Sandy McKiernan
- Cancer Council Western Australia, Perth, Western Australia, Australia
| | | | | | - Erin Robson
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Millar L, Dhutia H, Keteepe-Arachi T, Finocchiaro G, Malhotra A, Di Silva A, Prakash K, Carr-White J, Webb J, Merghani A, Bunce N, Anderson L, Narain R, Sharma R, Sharma S. P1531Clinical parameters to differentiate athlete's heart from dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Eakin EG, Hayes SC, Haas MR, Reeves MM, Vardy JL, Boyle F, Hiller JE, Mishra GD, Goode AD, Jefford M, Koczwara B, Saunders CM, Demark-Wahnefried W, Courneya KS, Schmitz KH, Girgis A, White K, Chapman K, Boltong AG, Lane K, McKiernan S, Millar L, O'Brien L, Sharplin G, Baldwin P, Robson EL. Healthy Living after Cancer: a dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors. BMC Cancer 2015; 15:992. [PMID: 26690258 PMCID: PMC4687340 DOI: 10.1186/s12885-015-2003-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Given evidence shows physical activity, a healthful diet and weight management can improve cancer outcomes and reduce chronic disease risk, the major cancer organisations and health authorities have endorsed related guidelines for cancer survivors. Despite these, and a growing evidence base on effective lifestyle interventions, there is limited uptake into survivorship care. METHODS/DESIGN Healthy Living after Cancer (HLaC) is a national dissemination and implementation study that will evaluate the integration of an evidence-based lifestyle intervention for cancer survivors into an existing telephone cancer information and support service delivered by Australian state-based Cancer Councils. Eligible participants (adults having completed cancer treatment with curative intent) will receive 12 health coaching calls over 6 months from Cancer Council nurses/allied health professionals targeting national guidelines for physical activity, healthy eating and weight control. Using the RE-AIM evaluation framework, primary outcomes are service-level indicators of program reach, adoption, implementation/costs and maintenance, with secondary (effectiveness) outcomes of patient-reported anthropometric, behavioural and psychosocial variables collected at pre- and post-program completion. The total participant accrual target across four participating Cancer Councils is 900 over 3 years. DISCUSSION The national scope of the project and broad inclusion of cancer survivors, alongside evaluation of service-level indicators, associated costs and patient-reported outcomes, will provide the necessary practice-based evidence needed to inform future allocation of resources to support healthy living among cancer survivors. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR)--ACTRN12615000882527 (registered on 24/08/2015).
Collapse
Affiliation(s)
- Elizabeth G Eakin
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Sandra C Hayes
- Queensland University of Technology, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Brisbane, Australia.
| | - Marion R Haas
- University of Technology Sydney, Centre for Health Economics Research and Evaluation, Sydney, Australia.
| | - Marina M Reeves
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Janette L Vardy
- The University of Sydney, Concord Clinical School, Sydney, Australia.
| | - Frances Boyle
- Mater Hospital Sydney, The Patricia Ritchie Centre for Cancer Care and Research, Sydney, Australia.
| | - Janet E Hiller
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia.
| | - Gita D Mishra
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Ana D Goode
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Department of Cancer Experiences Research, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Bogda Koczwara
- Flinders Medical Centre, Department of Medical Oncology, Bedford Park, Australia.
| | | | | | - Kerry S Courneya
- University of Alberta, Faculty of Physical Education and Recreation, Edmonton, Canada.
| | - Kathryn H Schmitz
- University of Pennsylvania, Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, USA.
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia.
| | - Kate White
- University of Sydney, Sydney Nursing School, Sydney, Australia.
| | | | - Anna G Boltong
- Cancer Council Victoria, Melbourne, Australia.
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | | | | | | | | | - Greg Sharplin
- Cancer Council South Australia, Adelaide, Australia.
| | - Polly Baldwin
- Cancer Council South Australia, Adelaide, Australia.
| | - Erin L Robson
- The University of Queensland, School of Public Health, Brisbane, Australia.
| |
Collapse
|
9
|
Swinburn B, Malakellis M, Moodie M, Waters E, Gibbs L, Millar L, Herbert J, Virgo-Milton M, Mavoa H, Kremer P, de Silva-Sanigorski A. Large reductions in child overweight and obesity in intervention and comparison communities 3 years after a community project. Pediatr Obes 2014; 9:455-62. [PMID: 24203373 DOI: 10.1111/j.2047-6310.2013.00201.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 02/07/2013] [Revised: 05/25/2013] [Accepted: 07/06/2013] [Indexed: 11/29/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Childhood obesity has been increasing over decades and scalable, population-wide solutions are urgently needed to reverse this trend. Evidence is emerging that community-based approaches can reduce unhealthy weight gain in children. In some countries, such as Australia, the prevalence of childhood obesity appears to be flattening, suggesting that some population-wide changes may be underway. WHAT THIS STUDY ADDS A community-based intervention project for obesity prevention in a rural town appears to have increasing effects 3 years after the end of the project, substantially reducing overweight and obesity by 6% points in new cohorts of children, 6 years after the original baseline. An apparent and unanticipated 'spillover' of effects into the surrounding region appeared to have occurred with 10%-point reductions in childhood overweight and obesity over the same time period. A 'viral-like' spread of obesity prevention efforts may be becoming possible and an increase in endogenous community activities appears to be surprisingly successful in reducing childhood obesity prevalence. BACKGROUND The long-term evaluations of community-based childhood obesity prevention interventions are needed to determine their sustainability and scalability. OBJECTIVES To measure the impacts of the successful Be Active Eat Well (BAEW) programme in Victoria, Australia (2003-2006), 3 years after the programme finished (2009). METHODS A serial cross-sectional study of children in six intervention and 10 comparison primary schools in 2003 (n = 1674, response rate 47%) and 2009 (n = 1281, response rate 37%). Height, weight, lunch box audits, self-reported behaviours and economic investment in obesity prevention were measured. RESULTS Compared with 2003, the 2009 prevalence of overweight/obesity (World Health Organization criteria) was significantly lower (P < 0.001) in both intervention (39.2% vs. 32.8%) and comparison (39.6% vs. 29.1%) areas, as was the mean standardized body mass index (0.79 vs. 0.65, 0.77 vs. 0.57, respectively) with no significant differences between areas. Some behaviours improved and a few deteriorated with any group differences favouring the comparison area. In 2009, the investment in obesity prevention in intervention schools was about 30 000 Australian dollars (AUD) per school per year, less than half the amount during BAEW. By contrast, the comparison schools increased from a very low base to over 66 000 AUD per school per year in 2009. CONCLUSIONS The 8%-point reduction in overweight/obesity in both areas over 6 years from baseline to 3 years post-intervention was substantial. While the benefits of BAEW increased in the intervention community in the long term, the surrounding communities appeared to have more than caught up in programme investments and health gains, suggesting a possible 'viral spread' of obesity prevention actions across the wider region.
Collapse
Affiliation(s)
- B Swinburn
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia; School of Population Health, University of Auckland, Auckland, New Zealand
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tong L, Huang C, Ramalli A, Tortoli P, Luo J, D'hooge J, Tzemos N, Mordi I, Bishay T, Bishay T, Negishi T, Hristova K, Kurosawa K, Bansal M, Thavendiranathan P, Yuda S, Popescu B, Vinereanu D, Penicka M, Marwick T, Hamed W, Kamel M, Yaseen R, El-Barbary H, Nemes A, Kis O, Gavaller H, Kanyo E, Forster T, Angelis A, Vlachopoulos C, Ioakimidis N, Felekos I, Chrysohoou C, Aznaouridis K, Abdelrasoul M, Terentes D, Ageli K, Stefanadis C, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Gual Capllonch F, Lopez Ayerbe J, Teis A, Ferrer E, Vallejo N, Junca G, Pla R, Bayes-Genis A, Schwaiger J, Knight D, Gallimore A, Schreiber B, Handler C, Coghlan J, Bruno RM, Giardini G, Malacrida S, Catuzzo B, Armenia S, Brustia R, Ghiadoni L, Cauchy E, Pratali L, Kim K, Lee K, Cho J, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Cho S, Nastase O, Enache R, Mateescu A, Botezatu D, Popescu B, Ginghina C, Gu H, Sinha M, Simpson J, Chowienczyk P, Fazlinezhad A, Tashakori Behesthi A, Homaei F, Mostafavi H, Hosseini G, Bakaeiyan M, Boutsikou M, Petrou E, Dimopoulos A, Dritsas A, Leontiadis E, Karatasakis G, Sahin ST, Yurdakul S, Yilmaz N, Cengiz B, Cagatay Y, Aytekin S, Yavuz S, Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H, Nasr G, Nasr A, Eleraki A, Elrefai S, Mordi I, Sonecki P, Tzemos N, Gustafsson U, Naar J, Stahlberg M, Cerne A, Capotosto L, Rosato E, D'angeli I, Azzano A, Truscelli G, De Maio M, Salsano F, Terzano C, Mangieri E, Vitarelli A, Renard S, Najih H, Mancini J, Jacquier A, Haentjens J, Gaubert J, Habib G, Caminiti G, D'antoni V, D'antoni V, Cardaci V, Cardaci V, Conti V, Conti V, Volterrani M, Volterrani M, Ahn J, Kim D, Lee H, Iliuta L, Lo Iudice F, Esposito R, Lembo M, Santoro C, Ballo P, Mondillo S, De Simone G, Galderisi M, Hwang Y, Kim J, Kim J, Moon K, Yoo K, Kim C, Tagliamonte E, Rigo F, Cirillo T, Caruso A, Astarita C, Cice G, Quaranta G, Romano C, Capuano N, Calabro' R, Zagatina A, Zhuravskaya N, Guseva O, Huttin O, Benichou M, Voilliot D, Venner C, Micard E, Girerd N, Sadoul N, Moulin F, Juilliere Y, Selton-Suty C, Baron T, Christersson C, Johansson K, Flachskampf F, Lee S, Lee J, Hur S, Park J, Yun J, Song S, Kim W, Ko J, Nyktari E, Bilal S, Ali S, Izgi C, Prasad S, Aly M, Kleijn S, Kandil H, Kamp O, Beladan C, Calin A, Rosca M, Craciun A, Gurzun M, Calin C, Enache R, Mateescu A, Ginghina C, Popescu B, Mornos C, Mornos A, Ionac A, Cozma D, Crisan S, Popescu I, Ionescu G, Petrescu L, Camacho S, Gamaza Chulian S, Carmona R, Diaz E, Giraldez A, Gutierrez A, Toro R, Benezet J, Antonini-Canterin F, Vriz O, La Carrubba S, Poli S, Leiballi E, Zito C, Careri S, Caruso R, Pellegrinet M, Nicolosi G, Kong W, Kyu K, Wong R, Tay E, Yip J, Yeo T, Poh K, Correia M, Delgado A, Marmelo B, Correia E, Abreu L, Cabral C, Gama P, Santos O, Rahman M, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Okura H, Kanai M, Murata E, Kataoka T, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Carigi S, Baldazzi F, Bologna F, Amati S, Venturi P, Grosseto D, Biagetti C, Fabbri E, Arlotti M, Piovaccari G, Rahbi H, Bin Abdulhaq A, Tleyjeh I, Santoro C, Galderisi M, Costantino M, Tarsia G, Innelli P, Dores E, Esposito G, Matera A, De Simone G, Trimarco B, Capotosto L, Azzano A, Mukred K, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Merlo M, Gigli M, Stolfo D, Pinamonti B, Antonini Canterin F, Muca M, D'angelo G, Scapol S, Di Nucci M, Sinagra G, Behaghel A, Feneon D, Fournet M, Thebault C, Martins R, Mabo P, Leclercq C, Daubert C, Donal E, Davinder Pal S, Prakash Chand N, Sanjeev A, Rajeev M, Ankur D, Ram Gopal S, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Demkina A, Hashieva F, Krylova N, Kovalevskaya E, Potehkina N, Zaroui A, Ben Said R, Smaali S, Rekik B, Ben Hlima M, Mizouni H, Mechmeche R, Mourali M, Malhotra A, Sheikh N, Dhutia H, Siva A, Narain R, Merghani A, Millar L, Walker M, Sharma S, Papadakis M, Siam-Tsieu V, Mansencal N, Arslan M, Deblaise J, Dubourg O, Zaroui A, Rekik B, Ben Said R, Boudiche S, Larbi N, Tababi N, Hannachi S, Mechmeche R, Mourali M, Mechmeche R, Zaroui A, Chalbia T, Ben Halima M, Rekik B, Boussada R, Mourali M, Lipari P, Bonapace S, Valbusa F, Rossi A, Zenari L, Lanzoni L, Targher G, Canali G, Molon G, Barbieri E, Novo G, Giambanco S, Sutera M, Bonomo V, Giambanco F, Rotolo A, Evola S, Assennato P, Novo S, Budnik M, Piatkowski R, Kochanowski J, Opolski G, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Maragoudakis F, Papadaki H, Vardas P, Rodrigues A, Perandini L, Souza T, Sa-Pinto A, Borba E, Arruda A, Furtado M, Carvalho F, Bonfa E, Andrade J, Hlubocka Z, Malinova V, Palecek T, Danzig V, Kuchynka P, Dostalova G, Zeman J, Linhart A, Chatzistamatiou E, Konstantinidis D, Memo G, Mpampatzeva Vagena I, Moustakas G, Manakos K, Trachanas K, Vergi N, Feretou A, Kallikazaros I, Corut H, Sade L, Ozin B, Atar I, Turgay O, Muderrisoglu H, Ledakowicz-Polak A, Polak L, Krauza G, Zielinska M, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nogueira M, Branco L, Agapito A, Galrinho A, Borba A, Teixeira P, Monteiro A, Ramos R, Cacela D, Cruz Ferreira R, Guala A, Camporeale C, Tosello F, Canuto C, Ridolfi L, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hristova K, Marinov R, Stamenov G, Mihova M, Persenska S, Racheva A, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Ramush Bejiqi R, Retkoceri R, Bejiqi H, Beha A, Surdulli S, Dreyfus J, Durand-Viel G, Cimadevilla C, Brochet E, Vahanian A, Messika-Zeitoun D, Jin C, Fang F, Meng F, Kam K, Sun J, Tsui G, Wong K, Wan S, Yu C, Lee A, Cho IJ, Chung H, Heo R, Ha S, Hong G, Shim C, Chang H, Ha J, Chung N, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Alexopoulos A, Dawson D, Nihoyannopoulos P, Zainal Abidin HA, Ismail J, Arshad K, Ibrahim Z, Lim C, Abd Rahman E, Kasim S, Peteiro J, Barrio A, Escudero A, Bouzas-Mosquera A, Yanez J, Martinez D, Castro-Beiras A, Scali M, Simioniuc A, Mandoli G, Lombardo A, Massaro F, Di Bello V, Marzilli M, Dini F, Adachi H, Tomono J, Oshima S, Merchan Ortega G, Bravo Bustos D, Lazaro Garcia R, Sanchez Espino A, Macancela Quinones J, Ikuta I, Ruiz Lopez M, Valencia Serrano F, Bonaque Gonzalez J, Gomez Recio M, Romano G, D'ancona G, Pilato G, Di Gesaro G, Clemenza F, Raffa G, Scardulla C, Sciacca S, Lancellotti P, Pilato M, Addetia K, Takeuchi M, Maffessanti F, Weinert L, Hamilton J, Mor-Avi V, Lang R, Sugano A, Seo Y, Watabe H, Kakefuda Y, Aihara H, Nishina H, Ishizu T, Fumikura Y, Noguchi Y, Aonuma K, Luo X, Fang F, Lee A, Shang Q, Yu C, Sammut EC, Chabinok R, Jackson T, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Byrne D, Walsh J, Ellis L, Mckiernan S, Norris S, King G, Murphy R, Hristova K, Katova T, Simova I, Kostova V, Shuie I, Ferferieva V, Bogdanova V, Castelon X, Nemes A, Sasi V, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Grapsa J, Demir O, Dawson D, Sharma R, Senior R, Nihoyannopoulos P, Pilichowska E, Zaborska B, Baran J, Stec S, Kulakowski P, Budaj A, Kosmala W, Kaye G, Saito M, Negishi K, Marwick T, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Dulai RS, Taylor A, Gupta S. Poster session 1: Wednesday 3 December 2014, 09:00-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014; 15:ii25-ii51. [DOI: 10.1093/ehjci/jeu248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
|
11
|
Narain R, Mellor G, Kumar N, Dhutia H, Malhotra A, Merghani A, Millar L, Pulikal A, Mayers J, Sheikh N, Papadakis M, Sharma S. The prevalence of early repolarisation pattern in young Indian population. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
12
|
Hoare E, Millar L, Fuller-Tyskiewicz M, Skouteris H, Nichols M, Jacka F, Swinburn B, Chikwendu C, Allender S. Associations between obesogenic risk and depressive symptomatology in Australian adolescents: a cross-sectional study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Hayward J, Millar L, Petersen S, Swinburn B, Lewis AJ. When ignorance is bliss: weight perception, body mass index and quality of life in adolescents. Int J Obes (Lond) 2014; 38:1328-34. [PMID: 24824556 PMCID: PMC4189380 DOI: 10.1038/ijo.2014.78] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/14/2014] [Accepted: 04/30/2014] [Indexed: 11/11/2022]
Abstract
Background/Objectives: Body weight is negatively associated with adolescent Health-Related Quality of Life (HRQoL). Despite this well-established relationship, some adolescents with obesity do not display the expected HRQoL decreases. This study hypothesised weight perception as a moderator of the association between weight status and adolescent HRQoL. Subjects/Methods: Subjects were secondary school students from an obesity prevention project in the Barwon South-West region of Victoria, Australia, entitled It's Your Move (N=3040). Measures included standardised body mass index (BMI-z; World Health Organization growth standards), weight perception and HRQoL, measured by the Paediatric Quality of Life Inventory. Linear regression and average marginal effect analyses were conducted on cross-sectional baseline data to determine the significance of any interaction between weight perception and measured weight status in shaping adolescent HRQoL. Results: The BMI-z/perceived weight status interaction was significantly associated with adolescent HRQoL outcomes. Adolescents with BMI z-scores in the overweight/obesity range who perceived themselves as overweight had lower HRQoL than those who perceived themselves as ‘about right.' Conversely, adolescents with BMI scores in the lower end of the normal range or in the thinness range who perceived themselves as underweight had lower HRQoL than those with ‘about right' perceptions. Conclusions: This was the first study to report third-variable impacts of a body-perception variable on the relationship between adolescent weight status and HRQoL. Adolescents' weight perceptions significantly moderated the relationship between overweight/obesity and reduced HRQoL. Adolescents who were outside the normal weight range and misperceived their objectively measured weight status enjoyed a higher HRQoL than adolescents whose weight perception was concordant with their actual weight status. These findings suggest that practitioners may need to exercise caution when educating adolescents about their weight status, as such ‘reality checks' may negatively impact on adolescent HRQoL. It is suggested that more research be conducted to examine this potential effect.
Collapse
Affiliation(s)
- J Hayward
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - L Millar
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - S Petersen
- 1] WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia [2] Child and Adolescent Psychiatry, Clinical Sciences, Umeå University, Umeå, Sweden
| | - B Swinburn
- 1] WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia [2] School of Population Health, University of Auckland, Auckland, New Zealand
| | - A J Lewis
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
14
|
Hoare E, Millar L, Fuller-Tyszkiewicz M, Skouteris H, Nichols M, Jacka F, Swinburn B, Chikwendu C, Allender S. Associations between obesogenic risk and depressive symptomatology in Australian adolescents: a cross-sectional study. J Epidemiol Community Health 2014; 68:767-72. [PMID: 24711573 DOI: 10.1136/jech-2013-203562] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 11/04/2022]
Abstract
BACKGROUND Depression and obesity are significant health concerns currently facing adolescents worldwide. This paper investigates the associations between obesity and related risk behaviours and depressive symptomatology in an Australian adolescent population. METHODS Data from the Australian Capital Territory It's Your Move project, an Australian community-based intervention project were used. In 2012, 800 students (440 females, 360 males) aged 11-14 years (M=13.11 years, SD=0.62 years), from 6 secondary schools were weighed and measured and completed a questionnaire which included physical activity, sedentary behaviour and dietary intake. Weight status was defined by WHO criteria. A cut-off score ≥10 on the Short Mood and Feelings Questionnaire indicated symptomatic depression. Logistic regression was used to test associations. RESULTS After controlling for potential confounders, results showed significantly higher odds of depressive symptomatology in males (OR=1.22, p<0.05) and females (OR=1.12, p<0.05) who exceeded guidelines for daily screen-time leisure sedentary activities. Higher odds of depressive symptoms were seen in females who consumed greater amounts of sweet drink (OR=1.18, p<0.05), compared to lower female consumers of sweet drinks, and males who were overweight/obese also had greater odds of depressive symptoms (OR=1.83, p<0.05) compared to male normal weight adolescents. CONCLUSIONS This study demonstrates the associations between obesogenic risks and depression in adolescents. Further research should explore the direction of these associations and identify common determinants of obesity and depression. Mental health outcomes need to be included in the rationale and evaluation for diet and activity interventions.
Collapse
Affiliation(s)
- E Hoare
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - L Millar
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia Faculty of Health, WHO Collaborating Centre for Obesity Prevention, Population Health Strategic Research Centre, Deakin University, Geelong, Victoria, Australia Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia Population Nutrition and Global Health, University of Auckland, Auckland, New Zealand Health Directorate, Australia Capital Territory Government, Canberra, Australian Capital Territory, Australia
| | - M Fuller-Tyszkiewicz
- Faculty of Health, WHO Collaborating Centre for Obesity Prevention, Population Health Strategic Research Centre, Deakin University, Geelong, Victoria, Australia Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - H Skouteris
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - M Nichols
- Faculty of Health, WHO Collaborating Centre for Obesity Prevention, Population Health Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
| | - F Jacka
- Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - B Swinburn
- Faculty of Health, WHO Collaborating Centre for Obesity Prevention, Population Health Strategic Research Centre, Deakin University, Geelong, Victoria, Australia Population Nutrition and Global Health, University of Auckland, Auckland, New Zealand
| | - C Chikwendu
- Health Directorate, Australia Capital Territory Government, Canberra, Australian Capital Territory, Australia
| | - S Allender
- Faculty of Health, WHO Collaborating Centre for Obesity Prevention, Population Health Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
15
|
Hoare E, Skouteris H, Fuller-Tyszkiewicz M, Millar L, Allender S. Associations between obesogenic risk factors and depression among adolescents: a systematic review. Obes Rev 2014; 15:40-51. [PMID: 23980942 DOI: 10.1111/obr.12069] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/09/2013] [Accepted: 07/28/2013] [Indexed: 12/17/2022]
Abstract
Adolescence is a transitional life phase that is associated with heightened risk for two major health conditions - obesity and mental health problems. Given the established comorbidity of obesity and depression, one avenue that warrants further exploration is the association between obesogenic risk and obesity in the expression and maintenance of depressive symptoms. The aim of the current systematic review was to identify and evaluate the empirical literature reporting the relationships between obesogenic risk factors (physical activity, sedentary behaviour, diet and weight status) and depression in adolescents. A search of five databases for studies published over the last decade found 24 studies eligible for review. Relationships were found between lack of physical exercise, heightened sedentary behaviour, poor diet quality, obese or overweight and depression in adolescence. However, the finding that obesogenic risk factors are associated with poor adolescent mental health should be interpreted with caution as data typically come from non-representative samples with less than optimal study design and methodology.
Collapse
Affiliation(s)
- E Hoare
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia; WHO Collaborating Centre for Obesity Prevention, Deakin University, Geelong, Victoria, Australia
| | | | | | | | | |
Collapse
|
16
|
Jensen BW, Nichols M, Allender S, de Silva-Sanigorski A, Millar L, Kremer P, Lacy K, Swinburn B. Inconsistent associations between sweet drink intake and 2-year change in BMI among Victorian children and adolescents. Pediatr Obes 2013; 8:271-83. [PMID: 23785025 DOI: 10.1111/j.2047-6310.2013.00174.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 12/04/2012] [Revised: 03/29/2013] [Accepted: 04/08/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether baseline (T1) or 2-year change in sweet drink intake in children and adolescents was associated with age- and gender-standardized body mass index (BMIz) at time two (T2), 2 years later. METHODS Data on 1465 children and adolescents from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. At two time points between 2003 and 2008 (mean interval: 2.2 years) height and weight were measured and sweet drink consumption (soft drink and fruit juice/cordial) was assessed. RESULTS No association was observed between T1 sweet drink intake and BMIz at T2 among children or adolescents. Children from higher socioeconomic status families who reported an increased intake of sweet drinks at T2 compared with T1 had higher mean BMIz at T2 (β: 0.13, P = 0.05). There was no evidence of a dose-response relationship between sweet drink intake and BMIz. In supplementary analyses, we observed that more frequent usual consumption of fruit juice/cordial was associated with a higher BMIz at T2 among children. CONCLUSION This study showed limited evidence of an association between sweet drink intake and BMIz. However, the association is complex and may be confounded by both dietary and activity behaviours.
Collapse
Affiliation(s)
- B W Jensen
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Bispebjerg; Frederiksberg Hospitals, Copenhagen University Hospital, Frederiksberg, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Layden J, Bunch H, Hekerem D, Millar L, Maxwell V. REMOTE AND RURAL: THE FORGOTTEN INEQUITY. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000453b.14] [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: 11/03/2022]
|
18
|
Hooley M, Skouteris H, Millar L. The relationship between childhood weight, dental caries and eating practices in children aged 4-8 years in Australia, 2004-2008. Pediatr Obes 2012; 7:461-70. [PMID: 22911896 DOI: 10.1111/j.2047-6310.2012.00072.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/13/2012] [Accepted: 05/18/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The association between overweight/obesity and dental caries in children is contentious with studies variously reporting positive or negative associations between the two conditions. Since 1995, Australia has experienced a rise in the prevalence of both conditions in its children. This study investigated the association between child weight, diet and dental problems in a nationally representative sample. METHOD Data from 4149 children (51.5% male) participating in the Longitudinal Study of Australian Children (LSAC) were used. The LSAC is a longitudinal study collecting data from a large representative cohort of Australian children; data from the first three waves were included with children aged 4-5 years, 6-7 years, and 8-9 years. Multivariate cross-sectional and prospective analyses were conducted to determine the relationships between child weight, diet and dental problems. RESULTS Overweight/obesity was associated with sweet drink consumption and dental problems associated with consumption of fatty foods and sweet drinks. Underweight was associated with dental problems cross-sectionally, but both underweight and overweight at age 6-7 years predicted dental problems at age 8-9 years. CONCLUSIONS Dental caries and body weight are influenced by diet. Overweight children may be consuming less fatty food but appear to be consuming more sweet drinks than normal-weight children, which can lead to both increased weight and dental caries. Dietary interventions designed to reduce the development of dental caries may also reduce the development and maintenance of overweight.
Collapse
Affiliation(s)
- M Hooley
- School of Psychology, Deakin University, Melbourne, Vic., Australia.
| | | | | |
Collapse
|
19
|
Millar L, Nichols M, Allender S, Swinburn B. Using the SysANGELO approach to develop action plans for systems change. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Snowdon W, Malakellis M, Millar L, Swinburn B. Body mass index and waist circumference as indicators of risk for non-communicable diseases in Pacific Islanders. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Allender S, Swinburn B, Foulkes C, Waters E, Gill T, Coveney J, Nichols M, Armstrong R, Sanigorski ADS, Pettman T, Millar L. A new platform for increasing capacity in community based intervention: CO-OPS Mark II. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Allender S, Terry J, Nichols M, Millar L, Hayward J, Nicholls L, Chikwendu C, Swinburn B. Developing systems maps for interventions in the prevention of obesity in adolescents. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Millar L, Lacy K, Allender S, Malakellis M, Swinburn B. Relationships between health related quality of life, obesity, physical activity and screen-based media use among Australian adolescents. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.113] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
24
|
Wate J, Snowdon W, Millar L, Nichols M, Mavoa H, Kama A, Goundar R, Swinburn B. Adolescents’ dietary patterns in Fiji and relationship with standardized BMI. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Sheikh N, Papadakis M, Ghani S, Millar L, Bastiaenen R, Zaidi A, Gati S, Chandra N, Emmanuel N, Sharma S. 149 Ethnic differences in performance of the 2010 European Society of Cardiology criteria for ECG interpretation in athletes. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
26
|
Sheikh N, Papadakis M, Bastiaenen R, Millar L, Emmanuel N, Ghani S, Zaidi A, Gati S, Chandra N, Behr E, Sharma S. 072 Fragmented QRS: a predictor of myocardial scar and fibrosis in hypertrophic cardiomyopathy. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
27
|
Millar L, Kremer P, de Silva-Sanigorski A, McCabe MP, Mavoa H, Moodie M, Utter J, Bell C, Malakellis M, Mathews L, Roberts G, Robertson N, Swinburn BA. Reduction in overweight and obesity from a 3-year community-based intervention in Australia: the 'It's Your Move!' project. Obes Rev 2011; 12 Suppl 2:20-8. [PMID: 22008556 DOI: 10.1111/j.1467-789x.2011.00904.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
'It's Your Move!' was a 3-year intervention study implemented in secondary schools in Australia as part of the Pacific Obesity Prevention In Communities Project. This paper reports the outcome results of anthropometric indices and relevant obesity-related behaviours. The interventions focused on building the capacity of families, schools and communities to promote healthy eating and physical activity. Baseline response rates and follow-up rates were 53% and 69% respectively for the intervention group (n=5 schools) and 47% and 66% respectively for the comparison group (n=7 schools). Statistically significant relative reductions in the intervention versus comparison group were observed: weight (-0.74 kg, P < 0.04), and standardized body mass index (-0.07, P<0.03), and non-significant reductions in prevalence of overweight and obesity (0.75 odds ratio, P=0.12) and body mass index (-0.22, P=0.06). Obesity-related behavioural variables showed mixed results with no pattern of positive intervention outcomes. In conclusion, this is the first study to show that long-term, community-based interventions using a capacity-building approach can prevent unhealthy weight gain in adolescents. Obesity prevention efforts in this important transitional stage of life can be successful and these findings need to be translated to scale for a national effort to reverse the epidemic in children and adolescents.
Collapse
Affiliation(s)
- L Millar
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Geelong, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Schultz JT, Moodie M, Mavoa H, Utter J, Snowdon W, McCabe MP, Millar L, Kremer P, Swinburn BA. Experiences and challenges in implementing complex community-based research project: the Pacific Obesity Prevention in Communities project. Obes Rev 2011; 12 Suppl 2:12-9. [PMID: 22008555 DOI: 10.1111/j.1467-789x.2011.00911.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Policy makers throughout the world are struggling to find effective ways to prevent the rising trend of obesity globally, particularly among children. The Pacific Obesity Prevention in Communities project was the first large-scale, intervention research project conducted in the Pacific aiming to prevent obesity in adolescents. The project spanned four countries: Australia, New Zealand, Fiji and Tonga. This paper reports on the strengths and challenges experienced from this complex study implemented from 2004 to 2009 across eight cultural groups in different community settings. The key strengths of the project were its holistic collaborative approach, participatory processes and capacity building. The challenges inherent in such a large complex project were underestimated during the project's development. These related to the scale, complexity, duration, low research capacity in some sites and overall coordination across four different countries. Our experiences included the need for a longer lead-in time prior to intervention for training and up-skilling of staff in Fiji and Tonga, investment in overall coordination, data quality management across all sites and the need for realistic capacity building requirements for research staff. The enhanced research capacity and skills across all sites include the development and strengthening of research centres, knowledge translation and new obesity prevention projects.
Collapse
Affiliation(s)
- J T Schultz
- National Food and Nutrition Centre, Suva, Fiji.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Fotu KF, Millar L, Mavoa H, Kremer P, Moodie M, Snowdon W, Utter J, Vivili P, Schultz JT, Malakellis M, McCabe MP, Roberts G, Swinburn BA. Outcome results for the Ma'alahi Youth Project, a Tongan community-based obesity prevention programme for adolescents. Obes Rev 2011; 12 Suppl 2:41-50. [PMID: 22008558 DOI: 10.1111/j.1467-789x.2011.00923.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tonga has a very high prevalence of obesity with steep increases during youth, making adolescence a critical time for obesity prevention. The Ma'alahi Youth Project, the Tongan arm of the Pacific Obesity Prevention in Communities project, was a 3-year, quasi-experimental study of community-based interventions among adolescents in three districts on Tonga's main island (Tongatapu) compared to the island of Vava'u. Interventions focused mainly on capacity building, social marketing, education and activities promoting physical activity and local fruit and vegetables. The evaluation used a longitudinal design (mean follow-up duration 2.4 years). Both intervention and comparison groups showed similar large increases in overweight and obesity prevalence (10.1% points, n = 815; 12.6% points, n = 897 respectively). Apart from a small relative decrease in percentage body fat in the intervention group (-1.5%, P < 0.0001), there were no differences in outcomes for any anthropometric variables between groups and behavioural changes did not follow a clear positive pattern. In conclusion, the Ma'alahi Youth Project had no impact on the large increase in prevalence of overweight and obesity among Tongan adolescents. Community-based interventions in such populations with high obesity prevalence may require more intensive or longer interventions, as well as specific strategies targeting the substantial socio-cultural barriers to achieving a healthy weight.
Collapse
Affiliation(s)
- K F Fotu
- Ministry of Health, Nuku'alofa, Tonga.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Swinburn BA, Millar L, Utter J, Kremer P, Moodie M, Mavoa H, Snowdon W, McCabe MP, Malakellis M, de Courten M, Waqa G, Fotu KF, Roberts G, Scragg R. The Pacific Obesity Prevention in Communities project: project overview and methods. Obes Rev 2011; 12 Suppl 2:3-11. [PMID: 22008554 DOI: 10.1111/j.1467-789x.2011.00921.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four-country project (Fiji, Tonga, New Zealand and Australia) designed to prevent adolescent obesity. This paper overviews the project and the methods common to the four countries. Each country implemented a community-based intervention programme promoting healthy eating, physical activity and healthy weight in adolescents. A community capacity-building approach was used, with common processes employed but with contextualized interventions within each country. Changes in anthropometric, behavioural and perception outcomes were evaluated at the individual level and school environments and community capacity at the settings level. The evaluation tools common to each are described. Additional analytical studies included economic, socio-cultural and policy studies. The project pioneered many areas of obesity prevention research: using multi-country collaboration to build research capacity; testing a capacity-building approach in ethnic groups with very high obesity prevalence; costing complex, long-term community intervention programmes; systematically studying the powerful socio-cultural influences on weight gain; and undertaking a participatory, national, priority-setting process for policy interventions using simulation modelling of cost-effectiveness of interventions.
Collapse
Affiliation(s)
- B A Swinburn
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
McGreevy A, Millar L, Murphy B, Davison GW, Brown R, O'Donnell ME. The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland. Int J Clin Pract 2010; 64:1563-1569. [PMID: 20846204 DOI: 10.1111/j.1742-1241.2010.02390.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision. METHODS A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24-h period following live and televised sporting activities was performed over a 5-year period. Data were compiled from the hospital's emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world-wide televised sporting broadcasts. RESULTS A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi-finals, 2 WC quarter-finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All-Ireland finals, 11 semi-finals, 11 quarter-finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi- and quarter-final games (p = 0.001-0.01). There was no difference identified in total attendance or non-admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r < 0.15, p > 0.07), multinomial logistic regression demonstrated that FA Cup final (p = 0.001), Rugby Six Nations (p = 0.019), Rugby WC games involving Ireland (p = 0.003), GAA All-Ireland semi- and quarter-finals (p = 0.016; p = 0.016) were predictors of patient admission rates. CONCLUSION This study suggests that live or televised sporting events do not significantly affect ED attendances to a DGH. However, some events appeared to be predictors of patient admission rates. Although it may be beneficial to consider the effect of sporting events on service stratification during these periods, the overall effect is probably minimal and should not create a major concern for future service provision despite the implementation of the European Working Time Directive.
Collapse
Affiliation(s)
- A McGreevy
- Department of General Surgery, Daisy Hill Hospital, Newry, UKSport and Exercise Sciences Research Institute and University of Ulster, Newtownabbey, UKFaculty of Life and Health Sciences, University of Ulster, Newtownabbey, UK
| | - L Millar
- Department of General Surgery, Daisy Hill Hospital, Newry, UKSport and Exercise Sciences Research Institute and University of Ulster, Newtownabbey, UKFaculty of Life and Health Sciences, University of Ulster, Newtownabbey, UK
| | - B Murphy
- Department of General Surgery, Daisy Hill Hospital, Newry, UKSport and Exercise Sciences Research Institute and University of Ulster, Newtownabbey, UKFaculty of Life and Health Sciences, University of Ulster, Newtownabbey, UK
| | - G W Davison
- Department of General Surgery, Daisy Hill Hospital, Newry, UKSport and Exercise Sciences Research Institute and University of Ulster, Newtownabbey, UKFaculty of Life and Health Sciences, University of Ulster, Newtownabbey, UK
| | - R Brown
- Department of General Surgery, Daisy Hill Hospital, Newry, UKSport and Exercise Sciences Research Institute and University of Ulster, Newtownabbey, UKFaculty of Life and Health Sciences, University of Ulster, Newtownabbey, UK
| | - M E O'Donnell
- Department of General Surgery, Daisy Hill Hospital, Newry, UKSport and Exercise Sciences Research Institute and University of Ulster, Newtownabbey, UKFaculty of Life and Health Sciences, University of Ulster, Newtownabbey, UK
| |
Collapse
|
32
|
Valcour V, Yeh TM, Bartt R, Clifford D, Gerschenson M, Evans SR, Cohen BA, Ebenezer GJ, Hauer P, Millar L, Gould M, Tran P, Shikuma C, Souza S, McArthur JC. Acetyl-l-carnitine and nucleoside reverse transcriptase inhibitor-associated neuropathy in HIV infection. HIV Med 2009; 10:103-10. [PMID: 19200173 DOI: 10.1111/j.1468-1293.2008.00658.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Antiretroviral toxic neuropathy (ATN) is associated with dideoxynucleoside reverse transcriptase inhibitor use in patients infected with HIV, possibly as a result of mitochondrial toxicity. Acetyl-l-carnitine (ALC) has been linked to symptomatic improvement in ATN. We present an open-label single-arm pilot study to evaluate changes in intra-epidermal nerve fibre (IENF) density and mitochondrial DNA (mtDNA) copies/cell among subjects treated with 3000 mg ALC daily. METHODS Punch skin biopsies were examined at baseline and after 24 weeks of therapy. Participants reported neuropathic symptoms using the Gracely Pain Intensity Score. Neurological examinations were completed. RESULTS Twenty-one subjects completed the study. ALC was generally well tolerated. The IENF density did not change in cases completing 24 weeks of ALC therapy, with median (90% confidence interval) IENF changes of -1.70 (-3.50, infinity) (P=0.98) and 2.15 (-0.10, infinity) (P=0.11) for the distal leg and proximal thigh, respectively. Fat mtDNA copies/cell did not change with therapy. Improvements in neuropathic pain (P<0.01), paresthesias (P=0.01), and symptoms of numbness (P<0.01) were noted. Similarly, improvement was noted on the Gracely Pain Intensity Score. CONCLUSIONS ALC therapy coincided with improvements in subjective measures of pain in this open-label single-arm study. However, changes were not observed in objective measures of IENF density or mtDNA levels, providing little objective support for use of ALC in this setting.
Collapse
Affiliation(s)
- V Valcour
- Hawaii AIDS Clinical Research Program, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Zhou L, Kitch DW, Evans SR, Hauer P, Raman S, Ebenezer GJ, Gerschenson M, Marra CM, Valcour V, Diaz-Arrastia R, Goodkin K, Millar L, Shriver S, Asmuth DM, Clifford DB, Simpson DM, McArthur JC. Correlates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy. Neurology 2007; 68:2113-9. [PMID: 17562831 DOI: 10.1212/01.wnl.0000264888.87918.a1] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate the relationship between epidermal nerve fiber density (ENFD) in the leg and the phenotype of HIV-associated distal sensory polyneuropathy (HIV-DSP) in a multicenter prospective study (ACTG A5117). METHODS A total of 101 HIV-infected adults, with CD4 cell count <300 cells/mm(3) and who had received antiretroviral therapy (ART) for at least 15 consecutive weeks, underwent standardized clinical and electrophysiologic assessment. All 101 subjects were biopsied at the distal leg (DL) and 99 at the proximal thigh (PT) at baseline. ENFD was assessed by skin biopsy using PGP9.5 immunostaining. Associations of ENFD with demographics, ART treatment, Total Neuropathy Score (TNS), sural sensory nerve action potential (SNAP) amplitude and conduction velocity, quantitative sensory testing (QST) measures, and neuropathic pain were explored. RESULTS ENFD at the DL site correlated with neuropathy severity as gauged by TNS (p < 0.01), the level of neuropathic pain quantified by the Gracely Pain Scale (GPS) (p = 0.01) and Visual Analogue Scale (VAS) (p = 0.01), sural SNAP amplitude (p < 0.01), and toe cooling (p < 0.01) and vibration (p = 0.02) detection thresholds. ENFD did not correlate with neurotoxic ART exposure, CD4 cell count, or plasma HIV-1 viral load. CONCLUSIONS In subjects with advanced HIV-1 infection, epidermal nerve fiber density (ENFD) assessment correlates with the clinical and electrophysiologic severity of distal sensory polyneuropathy (DSP). ENFD did not correlate with previously established risk factors for HIV-DSP, including CD4 cell count, plasma HIV-1 viral load, and neurotoxic antiretroviral therapy exposure.
Collapse
Affiliation(s)
- L Zhou
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287-7609, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Simpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B, Goodkin K, Gerschenson M, So Y, Marra CM, Diaz-Arrastia R, Shriver S, Millar L, Clifford DB. HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology 2006; 66:1679-87. [PMID: 16769940 DOI: 10.1212/01.wnl.0000218303.48113.5d] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy. METHODS The authors evaluated 101 subjects with advanced HIV infection over 48 weeks. Assessments included a brief peripheral neuropathy (PN) screen (BPNS), neurologic examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsies with quantitation of epidermal nerve fiber density. Data were summed into a Total Neuropathy Score (TNS). The presence, severity, and progression of DSP were related to clinical and laboratory results. RESULTS The mean TNS (range 0 to 36) was 8.9, with 38% of subjects classified as PN-free, 10% classified as having asymptomatic DSP, and 52% classified as having symptomatic DSP. Progression in TNS from baseline to week 48 occurred only in the PN-free group at baseline (mean TNS change = 1.16 +/- 2.76, p = 0.03). Factors associated with progression in TNS were lower current TNS, distal epidermal denervation, and white race. As compared with the TNS diagnosis of PN at baseline, the BPNS had a sensitivity of 34.9% and a specificity of 89.5%. CONCLUSIONS In this cohort of advanced human immunodeficiency virus (HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy (DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.
Collapse
|
35
|
Schifitto G, Yiannoutsos C, Simpson DM, Adornato BT, Singer EJ, Hollander H, Marra CM, Rubin M, Cohen BA, Tucker T, Koralnik IJ, Katzenstein D, Haidich B, Smith ME, Shriver S, Millar L, Clifford DB, McArthur JC. Long-term treatment with recombinant nerve growth factor for HIV-associated sensory neuropathy. Neurology 2001; 57:1313-6. [PMID: 11591856 DOI: 10.1212/wnl.57.7.1313] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
HIV-associated distal sensory polyneuropathy (DSP) is a common complication of AIDS. No effective treatment is available. The authors investigated the long-term effect (48 weeks) of the neurotrophin nerve growth factor (NGF) in an open-label study of 200 subjects with HIV-associated DSP. Similar to their previously reported double-blind study, the authors showed that NGF was safe and well tolerated and significantly improved pain symptoms. However, there was no improvement of neuropathy severity as assessed by neurologic examination, quantitative sensory testing, and epidermal nerve fiber density.
Collapse
Affiliation(s)
- G Schifitto
- Department of Neurology, University of Rochester, NY 14642, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Beattie GC, Millar L, Nawroz IM, Browning GG. A case of sacro-coccygeal chordoma masquerading as pilonidal sinus. J R Coll Surg Edinb 2000; 45:254-5. [PMID: 11130026] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Chordoma is a rare, slow-growing, but locally aggressive malignant tumour derived from the primitive notochord. Pilonidal sinus disease, characterised by communicating granulating natal cleft tracts and abscesses, is a common condition. We report a case of a sacro-coccygeal chordoma diagnosed incidentally on surgical exploration of a case of presumed pilonidal disease.
Collapse
Affiliation(s)
- G C Beattie
- Department of Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, U.K
| | | | | | | |
Collapse
|
37
|
Valenzuela GJ, Sanchez-Ramos L, Romero R, Silver HM, Koltun WD, Millar L, Hobbins J, Rayburn W, Shangold G, Wang J, Smith J, Creasy GW. Maintenance treatment of preterm labor with the oxytocin antagonist atosiban. The Atosiban PTL-098 Study Group. Am J Obstet Gynecol 2000; 182:1184-90. [PMID: 10819856 DOI: 10.1067/mob.2000.105816] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Patients admitted with an acute episode of preterm labor who respond to early intravenously administered tocolysis remain at risk of having subsequent episodes of preterm labor and preterm delivery. Several pharmacologic agents have been used in an attempt to reduce subsequent episodes of preterm labor, and all are associated with significant side effects. Atosiban, an oxytocin receptor antagonist, is effective in the treatment of an acute episode of preterm labor. This study was designed to compare the efficacy and safety of atosiban with those of placebo maintenance therapy in women with preterm labor who achieved uterine quiescence with intravenous atosiban. STUDY DESIGN A multicenter, double-blind, placebo-controlled trial was designed for patients in preterm labor who responded to early intravenous treatment with atosiban. Five hundred thirteen patients were randomly assigned to receive maintenance therapy, 252 to receive atosiban, and 251 to receive matching placebo. Maintenance therapy was administered as a continuous subcutaneous infusion, via pump, of 30 microg/min to the end of 36 weeks' gestation. The primary end point was the number of days from the start of maintenance therapy until the first recurrence of labor. A secondary end point was the percentage of patients receiving subsequent intravenous atosiban therapy. RESULTS The time (median) from the start of maintenance treatment to the first recurrence of labor was 32.6 days with atosiban and 27.6 days with placebo (P =.02). At least one subsequent intravenous atosiban treatment was needed by 61 atosiban patients (23%) and 77 placebo patients (31%). Except for injection site reactions, adverse event profiles of atosiban and placebo were comparable. There were 4 neonatal deaths reported in the atosiban group and 5 in the placebo group after the start of maintenance therapy. Infant outcomes (including birth weight) were comparable between maintenance and treatment groups. CONCLUSIONS Maintenance therapy with the oxytocin receptor antagonist atosiban can prolong uterine quiescence after successful treatment of an acute episode of preterm labor with atosiban. Treatment was well tolerated.
Collapse
Affiliation(s)
- G J Valenzuela
- Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVE To determine the sensitivity, specificity, and positive and negative predictive values of an enzymatic urine screening test for diagnosing bacteriuria in pregnancy. METHODS Clean-catch midstream urine samples were collected from 383 women who had routine prenatal screening for bacteriuria. Sensitivity, specificity, and positive and negative predictive values for each screening test (enzyme activity, nitrites or leukocytes on dipstick, and bacteria or pyuria on microscopic examination) were estimated using urine culture as the criterion standard. Urine cultures were considered positive if they grew 10(4) colony-forming units of a single uropathogen. Standard deviations used to calculate 95% confidence intervals were based on binomial distribution. A sample of 30 urine specimens was selected to evaluate interrater agreement using Cohen's kappa statistic. RESULTS Five of 383 samples were contaminated, leaving 378 samples for evaluation. Thirty of 43 specimens with positive urine culture had positive enzyme activity. Of 335 samples with no growth, 150 had negative enzyme activity. Sensitivity, specificity, and positive and negative predictive values for the Uriscreen enzymatic screening test (Bard Patient Care Division, Murray Hill, NJ) were 70%, 45%, 14%, and 92%, respectively. Sensitivity of the Uriscreen was lower than that of bacteria alone. Interrater agreement for Uriscreen testing was high among the three testers (kappa =.86). CONCLUSION The Uriscreen enzymatic screening test had inadequate sensitivity for rapid screening for bacteriuria in pregnancy.
Collapse
Affiliation(s)
- L Millar
- Kapiolani Medical Center for Women and Children and University of Hawaii-John A. Burns School of Medicine, Honolulu, HI 96826, USA.
| | | | | | | | | |
Collapse
|
39
|
McArthur JC, Yiannoutsos C, Simpson DM, Adornato BT, Singer EJ, Hollander H, Marra C, Rubin M, Cohen BA, Tucker T, Navia BA, Schifitto G, Katzenstein D, Rask C, Zaborski L, Smith ME, Shriver S, Millar L, Clifford DB, Karalnik IJ. A phase II trial of nerve growth factor for sensory neuropathy associated with HIV infection. AIDS Clinical Trials Group Team 291. Neurology 2000; 54:1080-8. [PMID: 10720278 DOI: 10.1212/wnl.54.5.1080] [Citation(s) in RCA: 205] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of recombinant human nerve growth factor (rhNGF) in HIV-associated sensory neuropathy (SN) within a multicenter, placebo-controlled, randomized trial (ACTG 291). BACKGROUND SN affects 30% of individuals with AIDS, is worsened by neurotoxic antiretrovirals, and its treatment is often ineffective. NGF is trophic for small sensory neurons and stimulates the regeneration of damaged nerve fibers. METHODS A total of 270 patients with HIV-associated SN were randomized to receive placebo, 0.1 microg/kg rhNGF, or 0.3 microg/kg rhNGF by double-blinded subcutaneous injection twice weekly for 18 weeks. The primary outcome was change in self-reported neuropathic pain intensity (Gracely Pain Scale). Secondary outcomes included an assessment of global improvement in neuropathy by patients and investigators, neurologic examination, use of prescription analgesics, and quantitative sensory testing. In a subset, epidermal nerve fiber densities were determined in punch skin biopsies. RESULTS Both doses of NGF produced significant improvements in average and maximum daily pain compared with placebo. Positive treatment effects were also observed for global pain assessments (p = 0.001) and for pin sensitivity (p = 0.019). No treatment differences were found with respect to mood, analgesic use, or epidermal nerve fiber densities. Injection site pain was the most frequent adverse event, and resulted in unblinding in 39% of subjects. Severe transient myalgic pain occurred in eight patients, usually from accidental overdosing. There were no changes in HIV RNA levels or other laboratory indices. CONCLUSIONS We found a positive effect of recombinant human nerve growth factor on neuropathic pain and pin sensitivity in HIV-associated sensory neuropathy. rhNGF was safe and well tolerated, but injection site pain was frequent.
Collapse
Affiliation(s)
- J C McArthur
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Hall CD, Dafni U, Simpson D, Clifford D, Wetherill PE, Cohen B, McArthur J, Hollander H, Yainnoutsos C, Major E, Millar L, Timpone J. Failure of cytarabine in progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection. AIDS Clinical Trials Group 243 Team. N Engl J Med 1998; 338:1345-51. [PMID: 9571254 DOI: 10.1056/nejm199805073381903] [Citation(s) in RCA: 245] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy affects about 4 percent of patients with the acquired immunodeficiency syndrome (AIDS), and survival after the diagnosis of leukoencephalopathy averages only about three months. There have been anecdotal reports of improvement but no controlled trials of therapy with antiretroviral treatment plus intravenous or intrathecal cytarabine. METHODS In this multicenter trial, 57 patients with human immunodeficiency virus (HIV) infection and biopsy-confirmed progressive multifocal leukoencephalopathy were randomly assigned to receive one of three treatments: antiretroviral therapy alone, antiretroviral therapy plus intravenous cytarabine, or antiretroviral therapy plus intrathecal cytarabine. After a lead-in period of 1 to 2 weeks, active treatment was given for 24 weeks. For most patients, antiretroviral therapy consisted of zidovudine plus either didanosine or stavudine. RESULTS At the time of the last analysis, 14 patients in each treatment group had died, and there were no significant differences in survival among the three groups (P=0.85 by the log-rank test). The median survival times (11, 8, and 15 weeks, respectively) were similar to those in previous studies. Only seven patients completed the 24 weeks of treatment. Anemia and thrombocytopenia were more frequent in patients who received antiretroviral therapy in combination with intravenous cytarabine than in the other groups. CONCLUSIONS Cytarabine administered either intravenously or intrathecally does not improve the prognosis of HIV-infected patients with progressive multifocal leukoencephalopathy who are treated with the antiretroviral agents we used, nor does high-dose antiretroviral therapy alone appear to improve survival over that reported in untreated patients.
Collapse
Affiliation(s)
- C D Hall
- University of North Carolina at Chapel Hill School of Medicine, 27599-7025, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Fernhall B, McCubbin JA, Rintala P, Rimmer JA, Pitetti K, Millar L, Brett M, Teo-Koh SM, de Silva AC. PREDICTING MAXIMAL HEART RATE IN INDIVIDUALS WITH MENTAL RETARDATION, INCLUDING DOWN SYNDROME. Med Sci Sports Exerc 1998. [DOI: 10.1097/00005768-199805001-00899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Mullaney PB, Weatherhead R, Millar L, Ayyash II, Ayberk H, Cai F, Risco JM. Keratoconjunctivitis sicca associated with achalasia of the cardia, adrenocortical insufficiency, and lacrimal gland degeneration: Keratoconjunctivitis sicca secondary to lacrimal gland degeneration may parallel degenerative changes in esophageal and adrenocortical function. Ophthalmology 1998; 105:643-50. [PMID: 9544638 DOI: 10.1016/s0161-6420(98)94018-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE/DESIGN This study aimed to examine and describe three siblings with alacrima, the eldest of whom had associated achalasia and adrenocortical insufficiency. PARTICIPANTS Three affected siblings and four age-matched control subjects participated. INTERVENTION/MAIN OUTCOME MEASURES: The three children underwent complete ophthalmologic examinations; computed tomographic scanning of brain, orbit, chest, and abdomen; and measurement of serum cortisol. All three were subjected to a short synacthen challenge. Lacrimal gland biopsies were performed on the two younger subjects, and specimens were studied by light and electron microscopy. RESULTS All three children showed virtually absent tear secretion as tested by the Schirmer test. The resulting keratopathy was most severe in the oldest child, who developed bilateral corneal melting. The two younger children showed interpalpebral corneal staining with rose bengal. All three children improved after punctal occlusion. Addison's disease was present in the oldest child. Computed tomographic scanning showed absent lacrimal and shrunken adrenal glands in association with achalasia of the cardia in the oldest child. The lacrimal glands were found to be reduced in size in the next eldest child. When evaluated by electron microscopy, the lacrimal gland biopsy specimens from the two younger children showed neuronal degeneration associated with depletion of secretory granules in the acinar cells. CONCLUSION In this disease, radiologic evidence of reducing lacrimal gland size with increasing age could represent a degenerative process. This may be paralleled by other signs and the possibility of adrenocortical insufficiency and achalasia of the cardia should be investigated in all children presenting with dry eyes. These children appear to have a progressive neuronal disease.
Collapse
Affiliation(s)
- P B Mullaney
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | | | | | | | | | | |
Collapse
|
43
|
Sanchez-Ramos L, Valenzuela G, Romero R, Silver H, Koltun W, Millar L, Wang J, Smith J, Creasy G. A double-blind placebo-controlled trial of oxytocin receptor antagonist (Antocin) maintenance therapy in patients with preterm labor. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80139-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
44
|
Affiliation(s)
- P Mullaney
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | |
Collapse
|
45
|
Goodwin TM, Millar L, North L, Abrams LS, Weglein RC, Holland ML. The pharmacokinetics of the oxytocin antagonist atosiban in pregnant women with preterm uterine contractions. Am J Obstet Gynecol 1995; 173:913-7. [PMID: 7573268 DOI: 10.1016/0002-9378(95)90365-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Our purpose was to evaluate the pharmacokinetics of atosiban, an oxytocin antagonist, during and after intravenous infusion in pregnant patients having at least six contractions per hour. The relationship between atosiban infusion and uterine activity was also assessed. STUDY DESIGN Plasma samples from eight pregnant patients treated with intravenous atosiban (300 micrograms/min for 6 to 12 hours) were analyzed for atosiban concentration by a specific radioimmunoassay procedure. Contraction rate data were obtained by external tocodynamometry for 1 hour before the infusion and during the subsequent infusion. RESULTS The average steady-state plasma concentrations of patients receiving intravenous atosiban were 442 +/- 73 ng/ml (mean +/- SD), with steady state achieved by 1 hour after the start of the infusion. After the completion of the infusion, plasma concentrations declined rapidly in a biexponential manner with initial and terminal half-life estimates of 13 +/- 3 and 102 +/- 18 minutes, respectively. The effective half-life was 18 +/- 3 minutes. The plasma clearance of atosiban was relatively high (42 L/hr) and the volume of distribution (approximately 18 L) was consistent with distribution into extracellular fluid. Of the seven patients evaluated for uterine activity, the mean contraction rate decreased by 75% during the third hour of treatment and remained low until treatment termination. CONCLUSION On the basis of earlier published reports, the pharmacokinetics of atosiban in pregnant patients are similar to those in nonpregnant women. Although the patient population was small, a consistent reduction in uterine activity was observed during atosiban infusion.
Collapse
Affiliation(s)
- T M Goodwin
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- J M Risco
- King Khaled Eye specialist Hospital, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Three children, ranging in age from 2 to 6 months, had diffuse and homogeneously opaque corneas, clinically consistent with congenital hereditary endothelial dystrophy. Bilateral elevated intraocular pressure (IOP) was a feature in all three children. METHODS Initially, all patients underwent glaucoma surgery to reduce IOP. Subsequently, a penetrating keratoplasty was performed in one eye of each patient to clear the visual axis. The excised corneal button was examined by light microscopy and by transmission and scanning electron microscopy. RESULTS Postoperatively, all patients maintained clear corneal grafts. Results of histopathologic examination showed an absence of the endothelial cell layer in all patients. The presence of a variably thick collagenous layer posterior to the anterior banded zone of Descemet's membrane and the absence of endothelial cells were noted on transmission electron microscopy. Scanning electron microscopy confirmed absent, or scanty, and abnormal endothelial cells. CONCLUSION The authors describe three patients with a clear association between congenital glaucoma and congenital hereditary endothelial dystrophy. This combination should be suspected where persistent and total corneal opacification fails to resolve after normalization of IOP.
Collapse
Affiliation(s)
- P B Mullaney
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | |
Collapse
|
48
|
Risco JM, Mullaney P, Millar L. Congenital absence of Descemet's membrane. Arch Ophthalmol 1995; 113:243-4. [PMID: 7864760 DOI: 10.1001/archopht.1995.01100020127044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J M Risco
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
49
|
Fernhall B, Pitetti K, Rimmer J, Kittredge J, Millar L, Burkett L. 432 CARDIORESPIRATORY DIFFERENCES BETWEEN INDIVIDUALS WITH MENTAL RETARDATION WITH AND WITHOUT DOWN SYNDROME. Med Sci Sports Exerc 1994. [DOI: 10.1249/00005768-199405001-00433] [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: 11/21/2022]
|
50
|
Abstract
In the past decade, physical health fitness has become increasingly more important in the lives of women of child-bearing age. Many have made regular, and sometimes vigorous commitments to exercise programs. In 1985, the American College of Obstetricians and Gynecologists (ACOG) developed a set of guidelines for women who plan to exercise during pregnancy. Recommendations were based on available, but somewhat limited, scientific data and common sense. Since that time, researchers have learned a significant amount of new information about how a pregnant woman and her fetus respond to aerobic activity. The objective of this communication is to review recent investigations in this area. Specific topics include a) maternal responses to exercise, b) fetal responses to maternal exercise, c) animal research models, and d) pregnancy and physical conditioning. Our objectives are to present information that will a) stimulate new and innovative research designs for exercise and pregnancy studies, and b) add significantly to our knowledge and ability to develop safe and effective exercise programs for women who wish to remain physically active throughout a normal-term pregnancy.
Collapse
Affiliation(s)
- R G McMurray
- Department of Physical Education and Exercise and Sport Science, University of North Carolina
| | | | | | | | | | | |
Collapse
|