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Badke K, Small SS, Pratt M, Lockington J, Gurney L, Kestler A, Moe J. Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study. BMC Health Serv Res 2024; 24:211. [PMID: 38360620 PMCID: PMC10870432 DOI: 10.1186/s12913-023-10271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective. METHODS In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation. DATA ANALYSIS We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively. RESULTS Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population. CONCLUSION Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.
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Affiliation(s)
- Katherin Badke
- Lower Mainland Pharmacy Services, Vancouver, BC, Canada.
- Pharmacy Department, Vancouver General Hospital, 899 W 12th avenue, Vancouver, BC, V5Z 1M9, Canada.
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Serena S Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Megan Pratt
- Social Work Department, Vancouver General Hospital, Vancouver, BC, Canada
| | - Julie Lockington
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Lara Gurney
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
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2
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Moe J, Badke K, Pratt M, Cho RY, Azar P, Flemming H, Sutherland KA, Harvey B, Gurney L, Lockington J, Brasher P, Gill S, Garrod E, Bath M, Kestler A. Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study. J Am Coll Emerg Physicians Open 2020; 1:1712-1722. [PMID: 33392580 PMCID: PMC7771760 DOI: 10.1002/emp2.12289] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Emergency department (ED)-initiated buprenorphine may prevent overdose. Microdosing is a novel approach that does not require withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention. METHODS We broadly screened patients ≥18 years old for opioid use disorder at a large, urban ED. In a first phase, we provided consecutive patients with 3-day standard-dosing packages, and then we provided a subsequent group with 6-day microdosing packages. In a second phase, we randomized patients to standard dosing or microdosing. We attempted 7-day telephone follow-ups and 30-day in-person community follow-ups. The primary feasibility outcome was number of patients enrolled and accepting randomization. Secondary outcomes were numbers screened, follow-up rates, and 30-day opioid agonist therapy retention. RESULTS We screened 3954 ED patients and identified 94 with opioid use disorders. Of the patients, 26 (27.7%) declined participation: 10 identified a negative prior experience with buprenorphine/naloxone as the reason, 5 specifically cited precipitated withdrawal, and none cited randomization. We enrolled 68 patients. A total of 14 left the ED against medical advice, 8 were excluded post-enrollment, 21 received standard dosing, and 25 received microdosing. The 7-day and 30-day follow-up rates were 9/46 (19.6%) and 15/46 (32.6%), respectively. At least 5/21 (23.8%) provided standard dosing and 8/25 (32.0%) provided microdosing remained on opioid agonist therapy at 30 days. CONCLUSIONS ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable to our target population.
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Affiliation(s)
- Jessica Moe
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Katherin Badke
- Department of Pharmaceutical SciencesVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Megan Pratt
- Social WorkVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Raymond Y Cho
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pouya Azar
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Complex Pain and Addiction ServicesVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Heather Flemming
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - K. Anne Sutherland
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Barbara Harvey
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Lara Gurney
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Julie Lockington
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Penny Brasher
- Centre for Clinical Epidemiology and EvaluationVancouverBritish ColumbiaCanada
| | - Sam Gill
- Rapid Access Addiction ClinicSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Emma Garrod
- Urban Health Program, Providence Health CareVancouverBritish ColumbiaCanada
| | - Misty Bath
- Regional PreventionVancouver Coastal Health AuthorityVancouverBritish ColumbiaCanada
| | - Andy Kestler
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineSt. Paul's HospitalVancouverBritish ColumbiaCanada
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Caton N, Campbell K, Brumwell T, Pratt M, Stewart L, Wong E, Zurberg T. Pups Assisting Wellness for Staff (P.A.W.S.): Evaluating the impact of canine-assisted interventions on critical care staff wellness. Healthc Manage Forum 2020; 34:119-122. [PMID: 32996336 DOI: 10.1177/0840470420960162] [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] [Indexed: 11/15/2022]
Abstract
Acute care settings can expose staff to job-related stressors. Pups Assisting Wellness for Staff (P.A.W.S.) has been designed as an innovative approach to support acute care staff in the emergency department and intensive care unit. Initially, P.A.W.S. was implemented as a Comfort Dog Pilot and then expanded into a Therapy Dog Model. The Therapy Dog Model incorporated learnings from the Comfort Dog Pilot to evaluate the impact of the following: more dogs, using certified therapy dogs, and visiting at different times of the day. Results throughout the project demonstrated a positive impact on staff morale, staff stress, overall and staff satisfaction, and a strong desire for the project to continue. As a result and with a collaborative effort between a multidisciplinary team, P.A.W.S. has now been operationalized as a permanent program to support staff in acute care.
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Affiliation(s)
- Natasha Caton
- Quality and Patient Safety, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
| | - Kerry Campbell
- Quality and Patient Safety, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
| | - Tammy Brumwell
- Emergency Department & Team Based Quality Improvement, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
| | - Megan Pratt
- Intensive Care Unit & Team Based Quality Improvement, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
| | - Lisa Stewart
- Quality and Patient Safety, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
| | - Eliza Wong
- Employee Safety, Health and Wellness, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
| | - Teresa Zurberg
- Canine Scent Detection Unit, 25469Vancouver Coastal Health (VCH), Vancouver, British Columbia, Canada
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Lancette GA, Harmon SM, Brooks D, Bryant R, Chiu J, Graham J, Guilfoyle D, Hill W, Latt T, Noah C, Placencia A, Pratt M, Radle D, Smith A, Solomon H, Staben D, Stern N, Thaker N. Enumeration and Confirmation of Bacillus cereus in Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/63.3.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study was conducted in 15 laboratories to evaluate 2 different techniques for enumerating Bacillus cereus in foods. A direct plating technique using mannitol-egg yolk-polymyxin agar and a most probable number (MPN) technique using trypticase-soy-polymyxin broth were compared for the enumeration of high and low populations of B. cereus in mashed potatoes. The collaborative results showed that the overall mean recovery obtained with the low population level was essentially the same by both techniques. However, the overall mean recovery was significantly higher by the direct plating technique at the high population level. A statistical evaluation of the data also showed that the direct plating technique had better repeatability and reproducibility than did the MFN technique at both the high and low population levels. These results suggest that the MPN technique is suitable for examining foods containing low populations of B. cereus, but that the direct plating technique is preferable for foods that contain a high population of this organism. The confirmatory technique used in the proposed method is reliable for presumptive identification of isolates as B. cereus. The method has been adopted as official first action.
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Affiliation(s)
- Gayle A Lancette
- Food and Drug Administration, Minneapolis Center for Microbiological Investigations, Minneapolis, MN 55401
| | - Stanley M Harmon
- Food and Drug Administration, Minneapolis Center for Microbiological Investigations, Minneapolis, MN 55401
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5
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Higgins DL, Robison BJ, Bailey S, Hagen C, Higgins D, Jankow D, Jost K, Kallay K, Kulhanek C, Madden J, Matushek M, Okolo C, Pratt M, Sloan E, Stone J, Tuncan E, Weagent S, Weatherington J. Comparison of MICRO-ID Listeria Method with Conventional Biochemical Methods for Identification of Listeria Isolated From Food and Environmental Samples: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.4.831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Fourteen laboratories participated in a collaborative study to evaluate the ability of the MICRO-ID Listeria identification method to correctly identify Listeria isolated from food and environmental sources. Each collaborator received 60 isolates consisting of 51 Listeria and 9 non-Listeria cultures. All isolates were identified by conventional biochemical analyses in the principal laboratory. Cultures were checked for purity by Gram staining and examined for oxidase and catalase activities. Only Gram positive, oxidase negative, catalase positive cultures were tested with the method. Colonies from trypticase soy agar with 0.6% yeast extract were suspended in 4.6 ml_ physiological saline to a MacFarland No. 1 turbidity standard and used to inoculate the test strip. In addition, the hemolytic reaction of each isolate was determined by using the Christie-Atkins-Munch-Peterson (CAMP) test and by stabbing sheep blood agar. Identification of Listeria is based on the octal code obtained from the strip and the hemolytic reaction of the isolate. The MICRO-ID Listeria method agreed with conventional biochemical identification for 98.0% of L. monocytogenes, 77.1% of L. seeligeri, 98.0% of L ivanovii, 96.4% of L. grayi/L. murrayi, 73.9% of L. welshimeri, and 100% of L innocua isolates. A large percentage of errors in identification of the L. seeligeri and L ivanovii cultures was caused by inaccurate reading of the CAMP and hemolysis tests rather than errors in the test strip. The method was adopted first action by AOAC International.
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Affiliation(s)
- Don L Higgins
- Organon Teknika Corp., 100 Akzo Ave, Durham, NC 27704
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6
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Constantine R, Smith L, Lepore M, Le T, Cool A, Padgett C, McMullen T, Pratt M. THE SKILLED NURSING FACILITY QUALITY REPORTING PROGRAM: DATA SUBMISSION, CONFIDENTIAL FEEDBACK, AND REPORTING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Constantine
- RTI International, Waltham, Massachusetts, United States
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7
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Ptaszek A, Deutsch A, Li Q, Cool A, Smith L, McMullen T, Pratt M. POLICY AND QUALITY: THE IMPACT ACT OF 2014 AND DEVELOPMENT OF THE SKILLED NURSING FACILITY QUALITY REPORTING PROGRAM. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Ptaszek
- RTI International, Waltham, Massachusetts, United States
| | | | - Q Li
- RTI International, Waltham, MA, USA
| | - A Cool
- RTI International, Waltham, MA, USA
| | - L Smith
- RTI International, Waltham, MA, USA
| | - T McMullen
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - M Pratt
- Centers for Medicare & Medicaid Service, Division of Chronic and Post-Acute Care, Baltimore, MD, USA
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8
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Kline L, Jones-Smith J, Jaime Miranda J, Pratt M, Reis RS, Rivera JA, Sallis JF, Popkin BM. A research agenda to guide progress on childhood obesity prevention in Latin America. Obes Rev 2017; 18 Suppl 2:19-27. [PMID: 28741906 PMCID: PMC5560467 DOI: 10.1111/obr.12572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
Childhood obesity rates in Latin America are among the highest in the world. This paper examines and evaluates the many efforts underway in the region to reduce and prevent further increases in obesity, identifies and discusses unique research challenges and opportunities in Latin America, and proposes a research agenda in Latin America for the prevention of childhood obesity and concomitant non-communicable diseases. Identified research gaps include biological challenges to healthy growth across the life cycle, diet and physical activity dynamics, community interventions promoting healthy child growth, and rigorous evaluation of national food and activity programs and regulatory actions. Addressing these research gaps is critical to advance the evidence-based policy and practice in childhood obesity tailored to the Latin American context that will be effective in addressing obesity.
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Affiliation(s)
- L Kline
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - J Jones-Smith
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M Pratt
- University of California, San Diego School of Medicine, Institute for Public Health, La Jolla, CA, USA
| | - R S Reis
- George Warren Brown School of Social Work, Washington University in St. Louis, Saint Louis, MO, USA
| | - J A Rivera
- National Institute of Public Health, Cuernavaca, Mexico
| | - J F Sallis
- Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - B M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Li X, Kang Y, Roife D, Lee Y, Pratt M, Perez MR, Dai B, Koay EJ, Fleming JB. Prolonged exposure to extracellular lumican restrains pancreatic adenocarcinoma growth. Oncogene 2017; 36:5432-5438. [PMID: 28534517 DOI: 10.1038/onc.2017.125] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 12/22/2022]
Abstract
We previously demonstrated that pancreatic stellate cells within pancreatic ductal adenocarcinoma (PDAC) stroma secrete lumican and its presence is associated with prolonged survival of patients with localized PDAC. Here, we observed that extracellular lumican decreases PDAC tumour cell growth in xenograft and syngeneic orthotopic animal models, and induces growth inhibition of low-passage human PDAC cells in a species-specific manner. PDAC cells grown in variant culture conditions and exposed to extracellular lumican display typical characterizations of cancer cell in a quiescent state, such as growth inhibition, apoptosis, G0/G1 arrest and chemoresistance. Importantly, extracellular lumican is associated with diminished ERK1/2 phosphorylation and increased p38 phosphorylation within PDAC cells. We further demonstrated that extracellular lumican physically binds with EGFR to trigger EGFR internalization and downregulation of EGFR and its downstream signal molecule ERK. Lumican enhances casitas B-lineage lymphoma expression, which stabilized the TGFβ Type II receptor sensitizing PDAC cells to TGFβ-mediated activation of p38 and SMAD signals. These provide a mechanism for the shift in signalling and phenotypic changes we observed after prolonged exposure to lumican. Together, our findings demonstrate that stromal lumican restrains PDAC cell growth through mediating cell entry into a quiescent state.
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Affiliation(s)
- X Li
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y Kang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - D Roife
- Department of General Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Y Lee
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - M Pratt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - M R Perez
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Dai
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - E J Koay
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J B Fleming
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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10
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Fleming P, Bai J, Pratt M, Sibbald C, Lynde C, Gulliver W. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol 2016; 31:798-807. [DOI: 10.1111/jdv.13891] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Affiliation(s)
- P. Fleming
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - J.W. Bai
- MD Program; Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - M. Pratt
- Faculty of Medicine; Memorial University of Newfoundland; St. John's NF Canada
| | - C. Sibbald
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - C. Lynde
- Division of Dermatology; University of Toronto; Toronto ON Canada
- Lynde Dermatology (Private Practice); Markham ON Canada
| | - W.P. Gulliver
- Department of Medicine; Faculty of Medicine; Memorial University of Newfoundland; St. John's NF Canada
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11
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Fleming P, Bai J, Pratt M, Sibbald C, Lynde C, Gulliver W. 010 The prevalence of anxiety in patients with psoriasis: A systematic review of observational studies and clinical trials. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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VanDyke D, Kyriacopulos P, Yassini B, Wright A, Burkhart E, Jacek S, Pratt M, Peterson CR, Rai P. Nanoparticle Based Combination Treatments for Targeting Multiple Hallmarks of Cancer. ACTA ACUST UNITED AC 2016; Suppl 4:1-18. [PMID: 27547592 DOI: 10.19070/2167-8685-si04001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Treatment of cancer remains one of the most challenging tasks facing the healthcare system. Cancer affects the lives of millions of people and is often fatal. Current treatment methods include surgery, chemotherapy, radiation therapies or some combinations of these. However, recurrence is a major problem. These treatments can be invasive with severe side effects. Inefficacies in treatments are a result of the complex and variable biology of cancerous cells. Malignant tumor cells and normal functioning cells share many of the same biological characteristics but the main difference is that in cancer cells there is in an overuse and over expression of these biological characteristics. These pertinent characteristics can be grouped into eight hallmarks, as illustrated by Hanahan and Weinberg. These characteristics include sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, activating invasion and metastasis, reprogramming energy metabolism, and evading immune destruction. In order to provide a noninvasive, effective treatment, delivery methods must be explored in order to transport cytotoxic agents used for targeting the hallmarks of cancer in a safer and more effective fashion. The use of nanoparticles as drug delivery carriers provides an effective method in which multiple cytotoxic agents can be safely delivered to cancer tissue to simultaneously target multiple hallmarks. By targeting multiple hallmarks of cancer at once, the efficacy of cancer treatments could be improved drastically. This review explores the uses and efficacy of combination therapies using nanoparticles that can simultaneously target multiple hallmarks of cancer.
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Affiliation(s)
- D VanDyke
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - P Kyriacopulos
- Biomedical Engineering and Biotechnology Program, University of Massachusetts, Lowell, MA, USA
| | - B Yassini
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - A Wright
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - E Burkhart
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - S Jacek
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - M Pratt
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - C R Peterson
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA
| | - P Rai
- Department of Chemical Engineering, University of Massachusetts, Lowell, MA, USA; Biomedical Engineering and Biotechnology Program, University of Massachusetts, Lowell, MA, USA
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13
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Li X, Roife D, Kang Y, Dai B, Pratt M, Fleming JB. Extracellular lumican augments cytotoxicity of chemotherapy in pancreatic ductal adenocarcinoma cells via autophagy inhibition. Oncogene 2016; 35:4881-90. [PMID: 26876211 DOI: 10.1038/onc.2016.20] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/27/2015] [Accepted: 12/04/2015] [Indexed: 12/17/2022]
Abstract
Lumican, an extracellular matrix proteoglycan overexpressed by pancreatic stellate cells (PSCs) and pancreatic ductal adenocarcinoma cells (PDACs), drives the formation of a tumor-specific microenvironment. We recently showed that extracellular lumican inhibits pancreatic cancer cell growth and is associated with prolonged survival after surgery. Here we investigated the role of extracellular lumican in chemotherapy-mediated cancer therapy. Lumican secretion was increased by chemotherapeutic agents in PDAC, and especially in PSCs, and appeared to be linked to the extent of cells' response to chemotherapy-induced growth inhibition. In multiple PDAC models, including cell lines, patient-derived xenografts and lumican knockout mice, lumican significantly increased antitumor effect of chemotherapy. This effect was associated with DNA damage, apoptosis and inhibition of cell viability, glucose consumption, lactate production and vascular endothelial growth factor secretion. In PDAC cells, chemotherapeutic agents triggered autophagosome formation and increased LC3 expression through the reactive oxygen species-mediated AMP-activated kinase (AMPK) signaling pathway. Inhibition of gemcitabine-induced autophagy in cancer cells by treatment with AMPK inhibitor compound C, lysosomal inhibitor chloroquine or autophagy inhibitor 3MA enhanced gemcitabine-induced apoptosis, suggesting that autophagy is a protective cellular response to gemcitabine treatment. Importantly, lumican dramatically decreased AMPK activity, inhibiting chemotherapy-induced autophagy in both in vitro and in vivo PDAC models. Co-treatment of PDAC cells with lumican and gemcitabine increased mitochondrial damage, reactive oxygen species (ROS) production and cytochrome c release, indicating that lumican-induced disruption of mitochondrial function may be the mechanism of sensitization to gemcitabine. Together, our findings demonstrate that extracellular lumican augments cytotoxicity of chemotherapy in PDAC cells through inhibition of chemotherapeutic agent-induced autophagy.
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Affiliation(s)
- X Li
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Roife
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Kang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Dai
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Pratt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J B Fleming
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fisberg M, Kovalskys I, Gómez G, Rigotti A, Cortés LY, Herrera-Cuenca M, Yépez MC, Pareja RG, Guajardo V, Zimberg IZ, Chiavegatto Filho ADP, Pratt M, Koletzko B, Tucker KL. Latin American Study of Nutrition and Health (ELANS): rationale and study design. BMC Public Health 2016; 16:93. [PMID: 26829928 PMCID: PMC4736497 DOI: 10.1186/s12889-016-2765-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/21/2016] [Indexed: 11/27/2022] Open
Abstract
Background Obesity is growing at an alarming rate in Latin America. Lifestyle behaviours such as physical activity and dietary intake have been largely associated with obesity in many countries; however studies that combine nutrition and physical activity assessment in representative samples of Latin American countries are lacking. The aim of this study is to present the design rationale of the Latin American Study of Nutrition and Health/Estudio Latinoamericano de Nutrición y Salud (ELANS) with a particular focus on its quality control procedures and recruitment processes. Methods/Design The ELANS is a multicenter cross-sectional nutrition and health surveillance study of a nationally representative sample of urban populations from eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Perú and Venezuela). A standard study protocol was designed to evaluate the nutritional intakes, physical activity levels, and anthropometric measurements of 9000 enrolled participants. The study was based on a complex, multistage sample design and the sample was stratified by gender, age (15 to 65 years old) and socioeconomic level. A small-scale pilot study was performed in each country to test the procedures and tools. Discussion This study will provide valuable information and a unique dataset regarding Latin America that will enable cross-country comparisons of nutritional statuses that focus on energy and macro- and micronutrient intakes, food patterns, and energy expenditure. Trial Registration Clinical Trials NCT02226627
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Affiliation(s)
- M Fisberg
- Instituto Pensi, Fundação Jose Luiz Egydio Setubal, Hospital Infantil Sabara, São Paulo, 01239-040, Brazil. .,Universidade Federal de São Paulo, São Paulo, 04023-062, Brazil. .,, Rua Borges Lagoa, 1080, Vila Clementino, São Paulo, CEP 04038-002, Brazil.
| | - I Kovalskys
- Commitee of Nutrition and Wellbeing, International Life Science Institute (ILSI-Argentina), Buenos Aires, C1059ABF, Argentina.,Departamento Nutricion, Facultad de Ciencias Medicas, Universidad Favaloro, Buenos Aires, C1078AAI, Argentina
| | - G Gómez
- Departamento de Bioquímica, Escuela de Medicina, Universidad de Costa Rica, San José, 11501, Costa Rica
| | - A Rigotti
- Departamento de Nutrición, Diabetes y Metabolismo, Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, 833-0024, Chile
| | - L Y Cortés
- Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - M Herrera-Cuenca
- Centro de Estudios del Desarrollo, Universidad Central de Venezuela (CENDES-UCV)/Fundación Bengoa, Caracas, 1010, Venezuela
| | - M C Yépez
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, 17-1200-841, Ecuador
| | - R G Pareja
- Instituto de Investigación Nutricional, Lima, 15026, Peru
| | - V Guajardo
- Commitee of Nutrition and Wellbeing, International Life Science Institute (ILSI-Argentina), Buenos Aires, C1059ABF, Argentina
| | - I Z Zimberg
- Universidade Federal de São Paulo, São Paulo, 04023-062, Brazil
| | - A D P Chiavegatto Filho
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, 01255-000, Brazil
| | - M Pratt
- Nutrition and Health Sciences Program, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, 30322, USA
| | - B Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, D-80337, Munich, Germany
| | - K L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, 01854, USA
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Davila EP, Quintero MA, Orrego ML, Ford ES, Walke H, Arenas MM, Pratt M. Prevalence and risk factors for metabolic syndrome in Medellin and surrounding municipalities, Colombia, 2008-2010. Prev Med 2013; 56:30-4. [PMID: 23142534 DOI: 10.1016/j.ypmed.2012.10.027] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/22/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We assessed the prevalence of and risk factors for metabolic syndrome (MetS) among adults 25-64 years of age from Medellin and surrounding municipalities, Colombia. METHOD We used 2008-2010 data from the Antioquia STEPwise approach to Surveillance (STEPS), a multi-stage complex cross-sectional survey designed according to World Health Organization guidelines. The revised 2005 International Diabetes Federation definition of MetS was used. RESULTS There were a total of 3000 participants. Of these, 21.4% had high blood pressure (HBP) and 64% had abdominal obesity (AO). In the subsample with serum data (n = 943), 19.8% had high fasting serum glucose, 43.9% had high triglycerides (HTG), and 56.6% had low HDL cholesterol (L-HDL). Among those with data to define MetS (n = 901), 41% had MetS. Older age was associated with MetS and all components except L-HDL. Female sex [odds ratio (OR) = 2.85, 95% confidence interval (CI): 2.20-3.70], being married (OR = 1.40, CI: 1.09-1.82), and high physical activity (OR = 0.59, CI: 0.39-0.91) were associated with AO, smoking with HTG (OR = 1.76, CI: 1.16-2.67) and L-HDL (OR = 1.67, CI: 1.10-2.51) and rural residence with HBP (OR = 3.42, CI: 1.83-6.37) and L-HDL (OR = 1.18, CI: 1.10-2.51). CONCLUSION The prevalence of MetS and AO was high in this Colombian region. Targeted strategies for promoting healthy behaviors are needed.
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Affiliation(s)
- E P Davila
- Division of Public Health Systems and Workforce Development, Center for Global Health, Atlanta, GA 30333, USA.
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Parra D, Dauti M, Harris J, Brownson R, Reyes L, Malta D, Quintero M, Pratt M. How does network structure relate to the likelihood of inter-organizational collaboration for promoting physical activity? Evidence from Brazil and Colombia. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.783] [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: 10/27/2022]
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17
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Ramos L, Florindo A, Gomes G, Mieke G, Pratt M, Parra D, Simões E, Moura L, Bracco M, Hallal P. Prevalence of health promotion programs in primary health care units in Brazil. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Paez D, Parra D, Sarmiento O, Hallal P, Reis R, Simoes E, Hoehner C, Arango C, Pratt M, Brownson R. Physical activity classes in community settings: Interventions to promote healthy lifestyles. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.767] [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: 10/27/2022]
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19
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Monteiro S, Barboza C, Barradas S, Pratt M, Rios P, Sarmiento O. Behaviour change theory based research in the promotion of healthy diets and physical activity in Latin America. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.782] [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: 11/16/2022]
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20
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Gonzalez-Casanova I, Stein A, Sarmiento O, Pratt M. Familial determinants of sedentary behaviour in children 5 to 18 years from Colombia*. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.272] [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: 10/27/2022]
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21
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Salvo D, Torres C, Rivera J, Pratt M. Objectively measured physical activity in adults from Cuernavaca, Mexico. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Gomes G, Mieke G, Ramos L, Pratt M, Parra D, Simões E, Florindo A, Bracco M, Lobelo F, Hallal P. Characteristics of physical activity interventions in primary health care settings in Brazil. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.853] [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: 10/27/2022]
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23
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Cislak A, Safron M, Pratt M, Gaspar T, Luszczynska A. Family-related predictors of body weight and weight-related behaviours among children and adolescents: a systematic umbrella review. Child Care Health Dev 2012; 38:321-31. [PMID: 21752064 DOI: 10.1111/j.1365-2214.2011.01285.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This umbrella review analysed the relationships between family variables and child/adolescent body weight, diet and physical activity. In line with theories of health behaviour change, it was assumed that behaviour-specific family variables (i.e. beliefs, perceptions and practices referring to food intake or physical activity) would have stronger support than more general family variables (i.e. socio-economic status or general parental practices). Data obtained from 18 systematic reviews (examining 375 quantitative studies) were analysed. Reviews of experimental trials generally supported the effectiveness of reward/positive reinforcement parental strategies, parental involvement in treatment or prevention programmes, and cognitive-behavioural treatment in reducing child/adolescent body mass and/or obesity. Results across reviews of correlational studies indicated that healthy nutrition of children/adolescents was related to only one parental practice (parental monitoring), but was associated with several behaviour-specific family variables (e.g. a lack of restrictive control over food choices, high intake of healthy foods and low intake of unhealthy foods by parents and siblings, low pressure to consume foods). With regard to adolescent physical activity, stronger support was also found for behaviour-specific variables (e.g. physical activity of siblings), and for certain socio-economic variables (e.g. parental education). Child and adolescent obesity prevention programmes should account for behaviour-specific family variables.
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Affiliation(s)
- A Cislak
- Warsaw School of Social Sciences and Humanities, Warsaw, Poland
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24
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Regenold WT, Pratt M, Nekkalapu S, Shapiro PS, Kristian T, Fiskum G. Mitochondrial detachment of hexokinase 1 in mood and psychotic disorders: implications for brain energy metabolism and neurotrophic signaling. J Psychiatr Res 2012; 46:95-104. [PMID: 22018957 DOI: 10.1016/j.jpsychires.2011.09.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [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: 06/21/2011] [Revised: 09/12/2011] [Accepted: 09/29/2011] [Indexed: 01/08/2023]
Abstract
The pathophysiology of mood and psychotic disorders, including unipolar depression (UPD), bipolar disorder (BPD) and schizophrenia (SCHZ), is largely unknown. Numerous studies, from molecular to neuroimaging, indicate that some individuals with these disorders have impaired brain energy metabolism evidenced by abnormal glucose metabolism and mitochondrial dysfunction. However, underlying mechanisms are unclear. A critical feature of brain energy metabolism is attachment to the outer mitochondrial membrane (OMM) of hexokinase 1 (HK1), an initial and rate-limiting enzyme of glycolysis. HK1 attachment to the OMM greatly enhances HK1 enzyme activity and couples cytosolic glycolysis to mitochondrial oxidative phosphorylation, through which the cell produces most of its adenosine triphosphate (ATP). HK1 mitochondrial attachment is also important to the survival of neurons and other cells through prevention of apoptosis and oxidative damage. Here we show, for the first time, a decrease in HK1 attachment to the OMM in postmortem parietal cortex brain tissue of individuals with UPD, BPD and SCHZ compared to tissue from controls without psychiatric illness. Furthermore, we show that HK1 mitochondrial detachment is associated with increased activity of the polyol pathway, an alternative, anaerobic pathway of glucose metabolism. These findings were observed in samples from both medicated and medication-free individuals. We propose that HK1 mitochondrial detachment could be linked to these disorders through impaired energy metabolism, increased vulnerability to oxidative stress, and impaired brain growth and development.
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Affiliation(s)
- W T Regenold
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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25
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Chillo S, Ranawana DV, Pratt M, Henry CJK. Glycemic response and glycemic index of semolina spaghetti enriched with barley β-glucan. Nutrition 2011; 27:653-8. [DOI: 10.1016/j.nut.2010.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 01/01/2023]
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Pratt M, Lightowler H, Henry CJ, Thabuis C, Wils D, Guérin-Deremaux L. No observable differences in glycemic response to maltitol in human subjects from 3 ethnically diverse groups. Nutr Res 2011; 31:223-8. [PMID: 21481716 DOI: 10.1016/j.nutres.2011.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 02/04/2011] [Accepted: 02/07/2011] [Indexed: 11/28/2022]
Abstract
Consumption of a low glycemic index (GI) diet may be helpful in the management and prevention of diabetes and cardiovascular disease. The investigation of GI has been predominantly confined to white subjects. We hypothesized that differences in glycemic response (GR) may be observable in subjects of different ethnic origin. The objective of the present study was to determine GR to a high GI (glucose) and low GI (maltitol) test drink in subjects of different ethnic origin. In a randomized, single-blind crossover trial, 10 whites, 10 South Indians and 10 Chinese subjects consumed either glucose or maltitol test drink containing 50 g of one of the test products on different occasions. Capillary blood glucose samples were taken at 15 and 10 minutes before and 0, 15, 30, 45, 60, 90, 120, 150, and 180 minutes after consumption of the test drink. The incremental area under the curve of glucose and maltitol were not significantly different between the 3 groups. The mean GR for maltitol was 33.5% in whites, 32.9% in Chinese, and 23.1% in South Indians. The results presented here confirmed that there are no observable differences noted in GR to a high-GI or low-GI test drink between the 3 ethnically diverse groups. We conclude that different ethnic groups exhibit similar GR to low- and high-GI drinks, and GR to maltitol is similar irrespective of ethnic background.
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Affiliation(s)
- Megan Pratt
- Functional Food Centre, School of Life Sciences, Oxford Brookes University, Gypsy Lane Campus, Headington, OX3 0BP Oxford, UK
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Ranawana V, Henry CJK, Pratt M. Degree of habitual mastication seems to contribute to interindividual variations in the glycemic response to rice but not to spaghetti. Nutr Res 2010; 30:382-91. [PMID: 20650345 DOI: 10.1016/j.nutres.2010.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/04/2010] [Accepted: 06/07/2010] [Indexed: 02/07/2023]
Abstract
Previous work by our group showed that the degree of particle breakdown of rice during mastication affects in vitro glycemic potency. The objective of this study was to confirm these in vitro findings in an in vivo model. We hypothesized that the degree of habitual mastication will influence individuals' in vivo blood glucose response (glycemic response, or GR) to carbohydrate foods. Eleven participants came in on six nonconsecutive days to the laboratory and evaluated 2 test foods (rice and spaghetti). Their GR was measured for the subsequent 120 minutes. Mastication parameters were determined using surface electrode electromyography. The particle size distribution of individuals' masticated food was also determined. The intraindividual number of chews per mouthful did not significantly differ for rice and spaghetti (29.9 and 33, respectively), although masticated particle size distribution did (P < .001). Significant correlations between the degree of breakdown during mastication and the GR were observed for rice, but none for spaghetti. Individuals' peak GR (at 45 minutes) correlated significantly with the particles size distribution of their masticated rice (P = .002), and also with the total incremental area under the curve for the GR (r = -0.72; P = .012) and the incremental area under the curve for the first 45 (r = -0.74; P = .010) and 60 minutes (r = 0.73; P = .010) postconsumption. The results suggest that individual differences in mastication may be one of the causes for interindividual differences in the GR to rice but not spaghetti.
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Affiliation(s)
- Viren Ranawana
- Functional Food Centre, School of Life Sciences, Oxford Brookes University, Gipsy Lane Campus, Headington, Oxford OX3 0BP, UK
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Lee KK, Carlson S, Pratt M, Kohl H. 018: Prevalence of Meeting Physical Activity Recommendations as a Predictor of State Obesity Prevalence - United States, 2003. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K K Lee
- Centers for Disease Control and Prevention - CDC, Atlanta, GA, 30341
| | - S Carlson
- Centers for Disease Control and Prevention - CDC, Atlanta, GA, 30341
| | - M Pratt
- Centers for Disease Control and Prevention - CDC, Atlanta, GA, 30341
| | - H Kohl
- Centers for Disease Control and Prevention - CDC, Atlanta, GA, 30341
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Saap L, Fahim S, Arsenault E, Pratt M, Pierscianowski T, Falanga V, Pedvis‐Leftick A. 021 Contact Sensitivity in Patients with Leg Ulcerations: A North American Study. Wound Repair Regen 2004. [DOI: 10.1111/j.1067-1927.2004.0abstractxv.x] [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: 12/01/2022]
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Brown DR, Pate RR, Pratt M, Wheeler F, Buchner D, Ainsworth B, Macera C. Physical activity and public health: training courses for researchers and practitioners. Public Health Rep 2002. [PMID: 12034908 DOI: 10.1016/s0033-3549(04)50034-1] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The authors explore development of courses in continuing education intended to provide additional research and practice capacity for addressing the growing burden of chronic disease and disability from physical inactivity. Two annual training courses on physical activity and public health are described. The courses are developed with funding from the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. The University of South Carolina, School of Public Health, Prevention Research Center has been an active collaborator and was responsible for developing and implementing the courses. An eight-day "Course on Research Directions and Strategies," is offered to postdoctoral researchers, and practitioners may take a six-day "Practitioners' Course on Community Interventions." Both courses are designed to increase the number of professionals qualified to implement physical activity community interventions and conduct physical activity and public health research.
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Affiliation(s)
- D R Brown
- Physical Activity and Health Branch, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
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31
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Affiliation(s)
- D Cohen
- Department of Dermatology, New York University, New York, NY, USA
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Jefferson T, Demicheli V, Deeks J, MacMillan A, Sassi F, Pratt M. Vaccines for preventing hepatitis B in health care workers. Nurs Times 2001; 97:39. [PMID: 11966050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Abstract
OBJECTIVE To analyze direct medical costs among US adults with arthritis and estimate the proportion associated with inactivity. METHODS In the 1987 National Medical Expenditure Survey, arthritis was defined using questions on self-reported, doctor-diagnosed arthritis or rheumatism. Physical activity was defined using a self-report question on level of activity. Inactivity-associated medical costs were derived by subtracting costs for active adults from costs for inactive adults after controlling for functional limitation. RESULTS Among 5,486 adults with arthritis, inactive persons had higher medical costs than did active persons in all demographic groups examined. In multivariate models adjusting for key covariates, the proportion of costs associated with inactivity averaged 12.4% ($1,250 in 2000 dollars) and ranged from 7.8% to 14.3% among various demographic groups. CONCLUSION Inactivity-associated medical costs among persons with arthritis are considerable. Physical activity interventions may be a cost-effective strategy for reducing the burden of arthritis.
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Affiliation(s)
- G Wang
- Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
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Rietschel RL, Mathias CG, Taylor JS, Storrs FJ, Sherertz EF, Pratt M, Marks JG, Maibach HI, Fransway AF, Fowler JF, DeLeo VA, Belsito DV. A preliminary report of the occupation of patients evaluated in patch test clinics. Am J Contact Dermat 2001; 12:72-6. [PMID: 11381341 DOI: 10.1053/ajcd.2001.19630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. OBJECTIVE The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. RESULTS Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. CONCLUSION Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.
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Affiliation(s)
- R L Rietschel
- North American Contact Dermatitis Group and Ochsner Clinic, New Orleans, LA 70121, USA
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Fowler J, Taylor J, Storrs F, Sherertz E, Rietschel R, Pratt M, Mathias CG, Marks J, Maibach H, Fransway A, DeLeo V, Belsito D. Gold allergy in North America. Am J Contact Dermat 2001; 12:3-5. [PMID: 11244133] [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: 02/19/2023]
Abstract
OBJECTIVE To determine the prevalence of allergic reactions to gold among patients tested by the North American Contact Dermatitis Group (NACDG) from 1996 to 1998. METHODS This is a prospective analysis of patch test results from the 12 centers that comprise the NACDG. Gold was tested as gold sodium thiosulfate (0.5% in petrolatum [pet]), along with 49 other screening allergens, in patients presenting with possible contact dermatitis. RESULTS Of 4,101 patients tested, 388 (9.5%) had a positive patch test result to gold. Women accounted for 62.8% of the subjects tested and 90.2% of patients positive to gold (P < .0001). The most common sites of dermatitis in gold-allergic patients were the hands (29.6%), face (19.3%), and eyelids (7.5%). Nickel and cobalt allergies, respectively, also were present in 33.5% and 18.3% of gold allergic individuals, as compared with 14.2% and 9.0% of the total population. Gold was the only positive reaction in 15.2% of the 388 patients. CONCLUSION Gold is a more common allergen than previously reported and might cause facial and eyelid dermatitis. Hypersensitivity to gold is statistically linked to female gender and to allergic reactions to nickel and cobalt.
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Affiliation(s)
- J Fowler
- North American Contact Dermatitis Group
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36
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Brown DR, Pate RR, Pratt M, Wheeler F, Buchner D, Ainsworth B, Macera C. Physical activity and public health: training courses for researchers and practitioners. Public Health Rep 2001; 116:197-202. [PMID: 12034908 PMCID: PMC1497315 DOI: 10.1093/phr/116.3.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The authors explore development of courses in continuing education intended to provide additional research and practice capacity for addressing the growing burden of chronic disease and disability from physical inactivity. Two annual training courses on physical activity and public health are described. The courses are developed with funding from the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. The University of South Carolina, School of Public Health, Prevention Research Center has been an active collaborator and was responsible for developing and implementing the courses. An eight-day "Course on Research Directions and Strategies," is offered to postdoctoral researchers, and practitioners may take a six-day "Practitioners' Course on Community Interventions." Both courses are designed to increase the number of professionals qualified to implement physical activity community interventions and conduct physical activity and public health research.
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Affiliation(s)
- D R Brown
- Physical Activity and Health Branch, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
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Delmore-Ko P, Pancer SM, Hunsberger B, Pratt M. Becoming a parent: the relation between prenatal expectations and postnatal experience. J Fam Psychol 2000; 14:625-640. [PMID: 11132485 DOI: 10.1037/0893-3200.14.4.625] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The relationship between individuals' prenatal expectations about parenthood and their postnatal experience of parenthood was examined. Seventy-three primiparous couples were interviewed during the 3rd trimester of pregnancy and asked open-ended questions regarding their expectations. A content analysis of these expectations identified several themes. A cluster analysis, using these themes as variables, identified 3 clusters of women labeled prepared, fearful, and complacent and 4 clusters of men labeled prepared, fearful, complacent, and mixed. Postnatal comparisons indicated that women and men in the prepared cluster generally demonstrated better adjustment than did individuals in the other clusters. Results are discussed in terms of the content of expectations about parenthood, gender differences in these expectations, and the association between prenatal expectations and postnatal experiences.
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Affiliation(s)
- P Delmore-Ko
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
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38
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Abstract
PURPOSE AND METHODS Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity. RESULTS Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)). CONCLUSIONS Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.
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Affiliation(s)
- R C Brownson
- Department of Community Health and Prevention Research Center, School of Public Health, Saint Louis University, MO 63108-3342, USA.
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39
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Abstract
The benefits of physical activity in reducing morbidity and mortality are well-established, but the effect of physical inactivity on direct medical costs is less clear.
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Affiliation(s)
- M Pratt
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
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40
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41
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Macera CA, Pratt M. Public health surveillance of physical activity. Res Q Exerc Sport 2000; 71:S97-S103. [PMID: 10925831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
There is a clear public health need to measure and track physical activity behavior. Surveillance systems should be flexible enough to keep up with scientific advances in identifying dose-response relationships and in developing new assessment techniques, and new ways to assess community indicators associated with physical activity. Having a strong public health surveillance system that produces data that can be used to plan, guide, and evaluate programs is essential for increasing the prevalence of an important health-related behavior: physical activity.
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42
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Abstract
BACKGROUND Few primary care physicians routinely counsel for exercise, despite the benefits of physical activity and the high prevalence of inactivity. The objective of this study is to assess the effectiveness of Physician-Based Assessment and Counseling for Exercise (PACE), a brief, behavior-based tool for primary care providers counseling healthy adults. METHODS This study is a randomized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician offices at a staff model health maintenance organization. Intervention physicians were trained to deliver PACE exercise counseling protocols at the index visit, and one reminder telephone call occurred at 1 month. An enhanced intervention group received additional activity reminders. RESULTS At the 6-month follow-up, the control group did not differ significantly from the intervention group for energy expended (2,048 kcal/week versus 2,108 kcal/ week, P = 0.77), time spent in walking or other moderate to vigorous activities (202 min/week versus 187 min/ week, P = 0.99), mental health, physical function, or behaviors previously shown to predict activity change. Among the intervention patients, the stages-of-change score for Contemplators increased significantly compared with controls (P = 0.03), but without a significant change in energy expended. Baseline levels of physical activity counseling were high (50%), as were baseline patient physical activity levels (61% exercised at least three times a week). CONCLUSIONS These results suggest that a one-time PACE counseling session with minimal reinforcement, in a setting with high baseline levels of activity, does not further increase activity. The finding that Contemplators advanced in stage of behavior change suggests that further studies are needed to examine long-term, repeated counseling interventions.
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Affiliation(s)
- S L Norris
- Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, USA
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43
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Abstract
This study examined the integrative complexity of thinking in individuals making the transition to parenthood, and the relationship between complexity and adjustment during this period. Sixty-nine couples were interviewed 3 months before their babies were born, and 6 months after the birth. The prenatal interview focussed on individuals' expectations about what it would be like being a parent; the postnatal interview focussed on individuals' actual experiences as parents. In addition, participants completed measures of depression, self-esteem, and marital satisfaction after each interview, and a measure of stress after the 6-month postnatal interview. Both men and women demonstrated a significant increase in the complexity of their thinking from the prenatal to the postnatal interview, with women demonstrating higher levels of complexity at both times. In addition, women with more complex expectations demonstrated better adjustment after their babies were born than did women with simpler expectations; these results were not obtained for men. Results are discussed with regard to the way in which thinking about the self changes as one negotiates major life transitions, and the way in which complex thinking can help counter some of the stresses that individuals may experience at these times.
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Affiliation(s)
- S M Pancer
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada.
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Pratt M, Taraska V. Disperse blue dyes 106 and 124 are common causes of textile dermatitis and should serve as screening allergens for this condition. Am J Contact Dermat 2000; 11:30-41. [PMID: 10684387 DOI: 10.1016/s1046-199x(00)90030-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Textile dye dermatitis is frequently undiagnosed because clinical awareness is low and because of the absence of good screening allergens in standard patch test series for this type of contact dermatitis. OBJECTIVES To determine the incidence of textile dye allergy in patients with problematic eczemas evaluated at a contact dermatitis clinic, and to determine the incidence of allergic contact dermatitis to diperse blue dyes in these patients. METHODS We conducted a retrospective study of 788 patients who were patch tested to either the North American Contact Dermatitis Group (NACDG) Standard Series or the European Standard Series, in addition to other relevant series. The Chemotechnique textile series was utilized in 271 patients (28%). RESULTS Forty patients reacted positively to 1 or more textile dyes, the majority reacting positively to Disperse Blue 106 (33 of 40; 82.5%) and to Disperse Blue 124 (32 of 40; 80%). Ten of 11 tested patients reacted to their own clothing, 9 of whom reacted to the blue/black 100% acetate or 100% polyester liners in their garments. CONCLUSIONS Textile dye allergy is more common than previously reported. It can cause marked dermatitis and widespread autoeczematization reactions. The most frequent allergens are Disperse Blue 106 and 124, which are frequently found in the 100% acetate and 100% polyester liners of women's clothing. We recommend that Disperse Blue 106 or 124 serve as the screening allergen for textile dye dermatitis.
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Affiliation(s)
- M Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
BACKGROUND Plague is endemic in China, Mongolia, Burma, Vietnam, Indonesia, India, large parts of Southern Africa, the United States and South America. There are three types of vaccines (live attenuated, killed and F1 fraction) with varying means of administration. OBJECTIVES The objective of this review was to assess the effects of vaccines to prevent plague. SEARCH STRATEGY We searched Medline, Embase, the Cochrane Controlled Trials Register and reference lists of articles. We handsearched the journal 'Vaccine' and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing live and killed plague vaccines against no intervention, placebo, other plague vaccines or vaccines against other disease (control vaccines). DATA COLLECTION AND ANALYSIS Three reviewers assessed the eligibility of trials. MAIN RESULTS No trials were included. REVIEWER'S CONCLUSIONS There is not enough evidence to evaluate the effectiveness of any plague vaccine, or the relative effectiveness between vaccines and their tolerability. Circumstantial data from observational studies suggest that killed types may be more effective and have fewer adverse effects than attenuated types of vaccine. No evidence appears to exist on the long-term effects of any plague vaccine.
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Affiliation(s)
- T Jefferson
- Army Medical Directorate 5, Ministry of Defence, Building 21a, Keogh Barracks, Ash Vale, HANTS, UK, GU12 5RR.
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Abstract
BACKGROUND Anthrax is an acute bacterial skin disease which may be fatal. Three anthrax vaccines are commercially available but their comparative effectiveness and safety is not clear. OBJECTIVES The objective of this review was to assess the effects of human anthrax vaccines in healthy adults and children. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register, Medline, Embase and the reference lists of articles. We handsearched the journal Vaccine and contacted researchers in the field. SELECTION CRITERIA Randomised and quasi-randomised trials comparing anthrax vaccines with placebo, vaccines for other diseases or no intervention. DATA COLLECTION AND ANALYSIS Trial quality assessment and data extraction was conducted independently by the six authors. MAIN RESULTS Two trials involving 16,052 people were included. Both trials had methodological limitations. Compared to placebo, vaccination was associated with a reduced risk of contracting anthrax (relative risk 0.16, 95% confidence interval 0.07 to 0.35). Compared to placebo, the killed vaccine was associated with a higher incidence and severity of adverse effects (odds ratio 5.15, 95% confidence interval 2.28 to 11.61). Just over 5% of participants in the vaccine group reported adverse effects. The effectiveness of the vaccine does not appear to be influenced by the route of inoculation. REVIEWER'S CONCLUSIONS Killed anthrax vaccines appear to be effective in reducing the risk of contracting anthrax with a relatively low rate of adverse effects. Further research should be restricted to testing new vaccines only.
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Affiliation(s)
- T Jefferson
- Army Medical Directorate 5, Ministry of Defence, Building 21a, Keogh Barracks, Ash Vale, HANTS, UK, GU12 5RR.
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Abstract
BACKGROUND Oral cholera vaccines (either killed whole cell or live recombinant vaccines) are newer alternatives to the parenteral vaccines which have been thought to confer only moderate and short-term immunity. OBJECTIVES The objective of this review was to assess the effect of cholera vaccines in preventing cases of cholera and preventing deaths. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase and reference lists of articles. We handsearched the journal Vaccine, contacted researchers in the field and manufacturers. SELECTION CRITERIA Randomised and quasi-randomised studies comparing cholera vaccines (killed or live) with placebo, control vaccines or no intervention, or comparing types, doses or schedules of cholera vaccine. We included adults and children irrespective of immune status or special risk category. DATA COLLECTION AND ANALYSIS Data extraction and assessment of trial quality was done independently by two reviewers. MAIN RESULTS Thirty-two trials were included. Seventeen efficacy trials of relatively good quality, testing parenteral and oral killed whole cell vaccines and involving over 2. 6 million adults, children and infants were included. Nineteen safety trials have been conducted for both types of killed whole cell vaccines and for live vaccines and have involved 11,459 people. For all types of vaccines compared to placebo, the relative risk of contracting cholera at 12 months was 0.49, 95% confidence interval 0. 41 to 0.59 (random effects model). This translates to an efficacy of 51%, 95% confidence interval 41% to 59%. Both parenteral and oral administration were relatively efficacious, but significant protection extended into the third year for oral killed whole cell vaccines. Children under 5 were only protected for up to a year, while older children or adults were protected for up to three years. Parenteral killed whole cell vaccines were associated with increased systemic and local adverse effects compared to placebo. Oral killed whole cell vaccines or oral live vaccines were not. REVIEWER'S CONCLUSIONS Cholera killed whole cell vaccines appear to be relatively effective and safe. Live oral recombinant vaccines appear to be safe, but efficacy data are not available. Protection against cholera appears to persist for up to two years following a single dose of vaccine, and for three to four years with an annual booster.
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Affiliation(s)
- P Graves
- SPC Pacific Regional Vector-Borne Diseases Project, PO Box R272, Honiara, Solomon Islands.
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Abstract
BACKGROUND Hepatitis B causes acute and chronic liver disease and may be prevented by vaccination. OBJECTIVES To assess the effectiveness and safety of plasma-derived vaccines against acute and chronic hepatitis B in health-care workers in protecting them from hepatitis B infection and its consequences. SEARCH STRATEGY MEDLINE and Excerpta Medica Database (EMBASE) search using standard Cochrane strategy, Cochrane Library, full text searching of the journal "Vaccine", bibliography of retrieved studies and correspondence with authors, researchers and manufacturers. SELECTION CRITERIA All original prospective randomised comparisons of yeast-derived vaccines and plasma-derived vaccines against no intervention, placebo, or vaccines against other disease (control vaccines). Assessment of trial quality was made according to: 1. generation of allocation schedule 2. measure(s) taken to conceal treatment allocation 3. drop-out of allocated health-care worker participants from the analysis of trial results 4. measures taken to implement double blinding Trial reports were blinded by removal of authors and their affiliation, journal reference, introduction, results, and discussion. DATA COLLECTION AND ANALYSIS To assess efficacy the incidence rates of acute hepatitis B were observed in the surveillance of the vaccinated and control groups of the trials included in the review. Safety was assessed from side-effect rates, classified as systemic (malaise, nausea, fever, arthralgias, rash, headache) or local (induration and soreness at the site of the inoculation). MAIN RESULTS Four trials fulfilling the criteria were identified and the data synthesised. All trials compared plasma-derived vaccines versus placebo. Differences in the settings (and level of incidence) between three of the trial settings and Dienstag's led us to stratify our comparison grouping the three trials performed in dialysis units together. After our stratification, the Desmyter, Smuzness and Crosnier group appears to be homogeneous (Chi-square = 0.11, degrees of freedom = 2). Our estimates of effectiveness and safety in the high risk group favour treatment, the OR for cases of HB being 0.34; 95% CI (0.21, 0.55). The analysis also revealed a non-significant trend towards benefit in the lower risk health-care workers (Dienstag trial, OR 0.26 (0.05, 1.30). Overall the evidence strongly favours vaccination (OR=0.33; 95% CI (0.21, 0.53)). There was no difference in the incidence and severity of side-effects between the two arms of the trials. We calculated that it was necessary to vaccinate between 145 (assuming a baseline rate of 10 cases/1000/year) and 7 (for a baseline rate of 200/1000/year) health-care workers with plasma-derived vaccines to avoid one case of hepatitis B. Completeness of trial reporting was not good with all four trials failing to report titre results on antibodies against hepatitis B surface antigen and hepatitis B core antigen in the placebo arms (correspondence with two of the four authors failed to shed light on the reasons for such an omission). All four trials achieved low scores in the four quality dimensions assessed (generation of allocation schedule, measure(s) taken to conceal treatment allocation, exclusion of allocated participants from the analysis of the trial and measures taken to implement and protect double blinding). Mean length of follow-up was 14.5 months. REVIEWER'S CONCLUSIONS Plasma-derived vaccines appear to be efficacious and safe for use in high risk health-care workers, such as staff of renal dialysis and transplant units. There is some uncertainty concerning the effectiveness of the vaccine in lower risk health-care workers, although the trend is towards benefit. We found no evidence of a long-term protective effect due to the short follow-up time of the four trials included in this review. We found relatively poor standard of trial reporting, possibly related to the age of the trials.
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Affiliation(s)
- T Jefferson
- Cochrane Vaccines Field, UK Cochrane Centre NHS R&D Programme, Summertown Pavillion, Middle Way, Oxford, UK, OX2 7RG.
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Abstract
BACKGROUND Tick-borne encephalitis is a disease of the central nervous system caused by a virus. Other than the vaccine, there is no treatment for the disease. OBJECTIVES The objective of this review was to assess the effects of vaccines to prevent tick-borne encephalitis. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Vaccine Fields Trials Register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles. We also handsearched the journal Vaccine. SELECTION CRITERIA Randomised and quasi-randomised trials comparing tick-borne encephalitis vaccines against placebo, control vaccines or comparisons of different doses or schedules of tick-borne encephalitis vaccines. DATA COLLECTION AND ANALYSIS Two reviewers independently applied inclusion criteria. A panel of six assessors examined trial quality. MAIN RESULTS Five trials were included. They could not be combined for meta-analysis because of differences in comparisons and outcomes. Four types of tick-borne encephalitis vaccines were used. All the vaccines gave seroconversion rates of over 87%. There were frequent reports of systemic and local adverse effects. REVIEWER'S CONCLUSIONS Tick-borne encephalitis vaccines appear to be highly immunogenic, but the relationship between seroconversion and clinical protection has not been established. Although adverse effects were commonly reported, none were severe or life threatening.
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Affiliation(s)
- V Demicheli
- Dept of Preventive Medicine & Biometrics, University of Colorado Health Sciences Center, Box C 245, 4200 E Ninth Ave, Denver, CO 80262, USA.
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Pratt M, Macera CA, Blanton C. Levels of physical activity and inactivity in children and adults in the United States: current evidence and research issues. Med Sci Sports Exerc 1999; 31:S526-33. [PMID: 10593523 DOI: 10.1097/00005768-199911001-00007] [Citation(s) in RCA: 204] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose was to describe current levels of physical activity and inactivity among adults and young people in the United States. METHODS Estimates of participation in regular physical activity were derived from three national surveys for adults (National Health Interview Survey, National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Surveillance System) and from the Youth Risk Behavior Survey for high school students. RESULTS Overall, 63.8% of high school students surveyed on the 1997 YRBS reported participating in vigorous physical activity for at least 20 min on 3 or more days per week. Participation in vigorous activity was higher for boys (72.3%) than girls (53.5%), whites (66.8%) compared with blacks (53.9%) and Hispanics (60.4%), and decreased with advancing grade. Among adults, 27.7% meet recommended levels of either moderate or vigorous physical activity, whereas 29.2% report no regular physical activity outside of their work. Gender differences in participation in physical activity are less pronounced than in youth, and age-related patterns were complex. Whites are more active than blacks and Hispanics, and persons with higher family incomes and more education report being more physically active. There have been only minor changes in reported participation in leisure time physical activity over the past 15 yr. CONCLUSION National estimates of physical activity appear to be reliable and valid for adults but may be less so for adolescents and are poor measures for children. Research is needed to determine the role that objective monitoring with accelerometers may play in surveillance. Reliable and valid measures of occupational, household, and transportation-related physical activity and sedentary behaviors are needed to better characterize the range of activity that is associated with health.
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Affiliation(s)
- M Pratt
- Physical Activity and Health Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA.
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