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Jones MP, Koloski NA, Walker MM, Holtmann GJ, Shah A, Eslick GD, Talley NJ. A Minority of Childhood Disorders of Gut-Brain Interaction Persist Into Adulthood: A Risk-Factor Analysis. Am J Gastroenterol 2024:00000434-990000000-01071. [PMID: 38483301 DOI: 10.14309/ajg.0000000000002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/06/2024] [Indexed: 04/24/2024]
Abstract
INTRODUCTION Disorders of gut-brain interaction (DGBIs) may originate in childhood. There are currently limited data on persistence of DGBI into adulthood and risk factors for persistence. Furthermore, there are no data on this question from general practice, where the majority of DGBIs are diagnosed and managed. This study documents the proportion of childhood-diagnosed DGBIs that persisted into adulthood and what factors were associated with persistence. METHODS General practice records were obtained for more than 60,000 patients whose medical record spanned both childhood and adulthood years. Patients with diagnosed organic gastrointestinal disorder were excluded. Medical records were also interrogated for potential risk factors. RESULTS Eleven percent of patients with irritable bowel syndrome (IBS) and 20% of patients with functional dyspepsia (FD) diagnosed in childhood had repeat diagnoses of the same condition in adulthood. Female sex (odds ratio [OR] 2.02) was associated with persistence for IBS, while a childhood diagnosis of gastritis (OR 0.46) was risk-protective. Childhood non-steroidal anti-inflammatory drug use (OR 1.31, 95% confidence interval [CI] 1.09-1.56) was a risk factor for persistence in IBS. For FD, a childhood diagnosis of asthma (OR 1.30, 95% CI 1.00-1.70) was a risk factor, as was anxiety for both IBS (OR 1.24, 95% CI 1.00-1.54) and FD (OR 1.48 95% CI 1.11-1.97) with a similar finding for depression for IBS (OR 1.34, 95% CI 1.11-1.62) and FD (OR 1.88 95% CI 1.47-2.42). DISCUSSION Childhood DGBIs persist into adulthood in 10%-20% of patients, suggesting that management monitoring should continue into adulthood. Those diagnosed with anxiety or mood disorders in childhood should receive particular attention, and prescription of non-steroidal anti-inflammatory drugs in children should be made judiciously.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Natasha A Koloski
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia
| | - Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia
| | - Guy D Eslick
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Tanaka T, Vander Weg M, Jones MP, Wehby G. Assessment of the 2021 AASLD Practice Guidance for Albumin Infusion in Elective Therapeutic Paracentesis: A Regression Discontinuity Design. Am J Gastroenterol 2024:00000434-990000000-01078. [PMID: 38501671 DOI: 10.14309/ajg.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The 2021 American Association for the Study of Liver Disease (AASLD) Practice Guidance recommends albumin infusion when removing ≥5 L of ascites to prevent post-paracentesis circulatory dysfunction. However, the optimal criteria and scenarios for initiating albumin infusion subsequent to therapeutic paracentesis (TP) have been subject to limited scientific inquiry. METHODS We conducted a retrospective cohort study at a US academic healthcare center. Participants received elective, outpatient TP between July 2019 and December 2022. Patients with spontaneous bacterial peritonitis, post-TP clinical adjustments, and/or hospitalization were excluded. The institution strictly followed the AASLD Guidance. We used a sharp regression discontinuity (RD) design to estimate the effect of albumin infusion at the AASLD Guidance-recommended cutoff of 5 L on serum creatinine and sodium trajectory after TP. RESULTS Over the study period, 1,457 elective TPs were performed on 235 unique patients. Albumin infusion at the threshold of 5 L of ascites removal reduced serum creatinine levels by 0.046 mg/dL/d (95% confidence interval 0.003-0.116, P = 0.037) and increased serum sodium levels by 0.35 mEq/L/d (95% confidence interval 0.15-0.55, P = 0.001) compared with those who did not receive albumin infusion. The RD plots indicated worsened serum creatine/sodium levels after draining 3 L of fluid, approaching levels similar to or worse than with albumin infusion at 5 L or more. DISCUSSION Our RD models supported the 2021 AASLD Guidance with robust estimation of causal effect sizes at the cutoff level of 5 L. Nevertheless, the findings also highlight the need to further evaluate the efficacy of albumin infusion in patients who undergo elective TP and have 3-5 L of ascites removed.
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Affiliation(s)
- Tomohiro Tanaka
- Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Mark Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Michael P Jones
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - George Wehby
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Department of Economics, University of Iowa, Iowa City, Iowa, USA
- National Bureau of Economic Research, Cambridge, Massachusetts, USA
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Gandy M, Coleman H, Cutler H, Jones MP, Karin E, Kwan P, Nikpour A, Parratt K, Rayner G, Titov N, Todd L, Seil E, Winton‐Brown T, Wu W, Dear BF. Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial. Epilepsia Open 2024; 9:808-818. [PMID: 38345357 PMCID: PMC10984311 DOI: 10.1002/epi4.12913] [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: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Mental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out-of-pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost-effectiveness, and long-term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy. METHOD Approximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10-week internet-delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment-as-usual waiting-list control group. Participants will complete online questionnaires at pre-, post-treatment, and 3- and 12-month follow-up and consent to have their data linked to their medical records to capture healthcare system resource use and costs. ANALYSIS Primary outcome measures will be symptoms of depression and anxiety. A cost-utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia. SIGNIFICANCE The results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer-reviewed publication(s). ANZCTR TRIAL REGISTRATION NUMBER ACTRN12623001327673. PLAIN LANGUAGE SUMMARY This study seeks to find out if a 10-week online psychological treatment can improve the mental health and well-being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.
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Affiliation(s)
- Milena Gandy
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Honor Coleman
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Henry Cutler
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Michael P. Jones
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eyal Karin
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Armin Nikpour
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kaitlyn Parratt
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The Epilepsy Society of AustraliaSouth AustraliaAustralia
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Nickolai Titov
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
| | - Lisa Todd
- Epilepsy Action AustraliaSydneyNew South WalesAustralia
| | - Elizabeth Seil
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Toby Winton‐Brown
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Wendy Wu
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Blake F. Dear
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
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Li SG, Mazor Y, Park CJ, Jones MP, Malcolm A. Faecal incontinence with concurrent disorders of gut-brain interaction: A worse outcome. United European Gastroenterol J 2024. [PMID: 38412024 DOI: 10.1002/ueg2.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/22/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Faecal incontinence is a common debilitating condition associated with poor quality of life that generates substantial economic strain on healthcare systems. OBJECTIVES We aimed to evaluate, in a tertiary referral population presenting with faecal incontinence, the impact of suffering additional disorders of gut-brain interaction (DGBI) on symptom severity, anxiety, depression and quality of life. METHODS Design: Retrospective cohort study. SETTING Tertiary referral Neurogastroenterology centre. PATIENTS All patients presenting with faecal incontinence from 2007 to 2020 were included. MAIN OUTCOME MEASURES The results from structured medical and surgical questionnaires including Rome III Integrative Questionnaire, Faecal Incontinence Severity Index, Hospital Anxiety and Depression Scale, SF-36, and anorectal physiology were analysed using Stata version 17. Patients were categorised into 3 groups: 0-1 additional DGBI, 2 DGBIs, and 3+ DGBI. Statistical significance was defined as p < 0.05 (two-tailed). KEY RESULTS Faecal incontinence patients (n = 249; mean age 63.4 ± 12.6 years; 93.6% female, 48.1% urge subtype) met diagnostic criteria for mean 2.2 additional DGBI each, mostly affecting bowel (n = 231, 42.4%) and anorectal (n = 150, 27.5%) regions. A greater number of DGBIs was associated with higher faecal incontinence symptom severity (p < 0.001), higher anxiety (p = 0.002) and depression (p = 0.003), and worse quality of life in areas of mental health (p = 0.037) and social effect (p < 0.001). Patients with a greater number of concurrent DGBI demonstrated a greater family history of gastrointestinal problems (p = 0.004). There were no associations found between a greater amount of DGBIs and anorectal physiology. CONCLUSIONS AND INFERENCES A greater number of additional DGBIs in faecal incontinence patients was associated with worse faecal incontinence symptoms, higher anxiety and depression scores, and worse quality of life but was unrelated to physiology. This highlights the need to proactively search for comorbid DGBI in patients presenting with faecal incontinence.
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Affiliation(s)
- Sarah G Li
- The University of Sydney, Sydney, New South Wales, Australia
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Hornsby Hospital, Sydney, New South Wales, Australia
| | - Yoav Mazor
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Calvin Joomann Park
- The University of Sydney, Sydney, New South Wales, Australia
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael P Jones
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Allison Malcolm
- The University of Sydney, Sydney, New South Wales, Australia
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Koloski N, Shah A, Kaan I, Ben Jacob R, Talley NJ, Jones MP, Holtmann G. Healthcare Utilization Patterns: Irritable Bowel Syndrome, Inflammatory Bowel Disease, and Gastroesophageal Reflux Disease. Dig Dis Sci 2024:10.1007/s10620-024-08297-w. [PMID: 38400884 DOI: 10.1007/s10620-024-08297-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/22/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Limited information is available about patterns of healthcare utilization for prevalent gastrointestinal conditions and their link to symptom burden. AIM To identify patterns of healthcare utilization among outpatients with highly prevalent gastrointestinal conditions and define the link between healthcare utilization, symptom burden, and disease group. METHODS We randomly selected patients from the gastroenterology outpatient clinic at Princess Alexandra Hospital who had chronic gastrointestinal conditions such as constipation-predominant irritable bowel syndrome (IBS-C, n = 101), diarrhea-predominant IBS (IBS-D, n = 101), mixed IBS (n = 103), inflammatory bowel disease with acute flare (n = 113), IBD in remission (n = 103), and gastroesophageal reflux disease (n = 102). All had presented at least 12 months before and had a 12-month follow-up after the index consultation. Healthcare utilization data were obtained from state-wide electronic medical records over a 24-month period. Intensity of gastrointestinal symptoms was measured using the validated Structured Assessment of Gastrointestinal Symptoms (SAGIS) Scale. Latent class analyses (LCA) based on healthcare utilization were used to identify distinct patterns of healthcare utilization among these patients. RESULTS LCA revealed four distinct healthcare utilization patterns across all diagnostic groups: Group A: Emergency department utilizers, Group B: Outpatient focused care utilizers, Group C: Inpatient care utilizers and Group D: Inpatient care and emergency department utilizers. LCA groups with high emergency utilization were characterized by high gastrointestinal symptom burden at index consultation regardless of condition (Mean (standard deviation)) SAGIS score Group A: 24.63 (± 14.11), Group B: 19.18 (± 15.77), Group C: 22.48 (± 17.42), and Group D: 17.59 (± 13.74, p < 0.05). CONCLUSION Distinct healthcare utilization patterns across highly prevalent gastrointestinal conditions exist. Symptom severity rather than diagnosis, likely reflecting unmet clinical need, defines healthcare utilization.
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Affiliation(s)
- Natasha Koloski
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ayesha Shah
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Iain Kaan
- Former Employee of AbbVie Australia, Sydney, NSW, Australia
| | - Ronen Ben Jacob
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Ryde, NSW, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia.
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
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McNaughton DT, Mara P, Jones MP. The impact of self-assessment and surveyor assessment on site visit performance under the National General Practice Accreditation scheme. AUST HEALTH REV 2024:AH23235. [PMID: 38369748 DOI: 10.1071/ah23235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
ObjectiveThere is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators.MethodsThe data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit.ResultsTwo hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14-0.72], P = 0.28). A small number of surveyors (N = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors.ConclusionsAttempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified.
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Ingemansson A, Walter SA, Jones MP, Sjödahl J. Defecation Symptoms in Relation to Stool Consistency Significantly Reflect the Dyssynergic Pattern in High-resolution Anorectal Manometry in Constipated Patients. J Clin Gastroenterol 2024; 58:57-63. [PMID: 36730549 DOI: 10.1097/mcg.0000000000001794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
GOALS To evaluate the usefulness of a 2-week patient-completed bowel habit and symptom diary as a screening tool for disordered rectoanal coordination (DRC). BACKGROUND DRC is an important subgroup of chronic constipation that benefits from biofeedback treatment. Diagnosis of DRC requires a dyssynergic pattern (DP) of attempted defecation in high-resolution anorectal manometry (HRAM) and at least 1 other positive standardized examination, such as the balloon expulsion test or defecography. However, HRAM is generally limited to tertiary gastroenterology centres and finding tools for selecting patients for referral for further investigations would be of clinical value. STUDY Retrospective data from HRAM and a 2-week patient-completed bowel habit and symptom diary from 99 chronically constipated patients were analyzed. RESULTS Fifty-seven percent of the patients had a DP pattern during HRAM. In the DP group, 76% of bowel movements with loose or normal stool resulted in a sense of incomplete evacuation compared with 55% of the non-DP group ( P =0.004). Straining and sensation of incomplete evacuation with the loose stool were significantly more common in the DP group ( P =0.032). Hard stool was a discriminator for non-DP ( P =0.044). Multiple logistic regression including incomplete evacuation and normal stool predicted DP with a sensitivity of 82% and a specificity of 50%. CONCLUSIONS The sensation of incomplete evacuation with loose or normal stool could be a potential discriminator in favor of DP in chronically constipated patients. The bowel habit and symptom diary may be a useful tool for stratifying constipated patients for further investigation of suspected DRC.
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Affiliation(s)
- Anna Ingemansson
- Department of Gastroenterology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Susanna A Walter
- Department of Gastroenterology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michael P Jones
- Psychology Department, Macquarie University, North Ryde, NSW, Australia
| | - Jenny Sjödahl
- Department of Gastroenterology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Shah A, Jones MP, Callaghan G, Fairlie T, Ma X, Culver EL, Stuart K, De Cruz P, O’Beirne J, Tabibian JH, Dignass A, Canbay A, Gores GJ, Holtmann GJ. Efficacy and safety of biologics in primary sclerosing cholangitis with inflammatory bowel disease: A systematic review and meta-analysis. Hepatol Commun 2024; 8:e0347. [PMID: 38206197 PMCID: PMC10786591 DOI: 10.1097/hc9.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is an immune-mediated, chronic cholestatic liver disease. Currently, liver transplantation is the only established life-saving treatment. Several studies have evaluated the effect of different biologic therapies on PSC with inconclusive findings. We conducted a systematic review and meta-analysis to assess the effects of biologics in PSC and associated inflammatory bowel disease (IBD). METHODS MEDLINE, Scopus, and Embase were searched up to July 31, 2023, for studies reporting the effects of biologics in patients with PSC-IBD. Effects of biologic therapy on alkaline phosphatase, total bilirubin, ulcerative colitis response score, and adverse events were calculated and expressed as standardized difference of means (SMD), proportions, and 95% CI using a random-effects model. RESULTS Six studies, including 411 PSC-IBD patients who received biologics, were included. Biologic treatment was associated with no change in alkaline phosphatase (SMD: 0.1, 95% CI: -0.07 -0.17, p=0.43), but a small and statistically significant increase in total bilirubin (SMD: 0.2, 95% CI: 0.05-0.35, p<0.01). 31.2% (95% CI: 23.8-39.7) of patients with IBD achieved endoscopic response, and there was a significant improvement in ulcerative colitis response score (SMD: -0.6,95% CI: -0.88 to 0.36, p<0.01). Furthermore, 17.6% (95% CI: 13.0-23.5) of patients experienced adverse events severe enough to discontinue therapy, and 29.9% (95% CI: 25.2-34.8) had a loss of response to biologics. CONCLUSIONS Treatment of patients with PSC-IBD with biologics (vedolizumab, infliximab, and adalimumab) was not associated with improvement of biochemical markers of cholestasis. Biologics are effective in treating the colitis associated with PSC. Vedolizumab was associated with worsening liver enzymes in contrast to other biologics, a finding that warrants further study.
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Affiliation(s)
- Ayesha Shah
- The University of Queensland, Faculty of Medicine, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Translational Research Institute, Queensland, Australia
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health
| | - Michael P. Jones
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Gavin Callaghan
- The University of Queensland, Faculty of Medicine, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
| | - Thomas Fairlie
- The University of Queensland, Faculty of Medicine, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Translational Research Institute, Queensland, Australia
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health
| | - Xiaomin Ma
- The University of Queensland, Faculty of Medicine, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
| | - Emma L. Culver
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Katherine Stuart
- The University of Queensland, Faculty of Medicine, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - James O’Beirne
- University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - James H. Tabibian
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Ali Canbay
- Department of Medicine, University Hospital of the Ruhr-University Bochum, Germany
| | - Gregory J. Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerald J. Holtmann
- The University of Queensland, Faculty of Medicine, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Translational Research Institute, Queensland, Australia
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health
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Sjödahl J, Ingemansson A, Bureychak T, Norlin AK, Jones MP, Faresjö Å, Walter S. Defecation symptoms in primary health care patients with irritable bowel syndrome. Scand J Gastroenterol 2024; 59:16-24. [PMID: 37612888 DOI: 10.1080/00365521.2023.2248538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The objectives of the present study were to (a) measure the prevalence of defecation symptoms in IBS, (b) investigate the relationship between stool consistency and defecation symptoms in IBS, and (c) investigate the association of defecation symptoms with health-related quality of life (HRQL) and self-reported stress in patients with IBS cared for in a primary health care setting. METHODS Ten primary health care centres joined the study. 282 patients with IBS as well as 372 non-IBS controls filled in gastrointestinal symptom diaries prospectively for two weeks as well as the Perceived Stress Scale-14 (PSS14) and the EuroQol barometer to measure perceived stress and HRQL, respectively. RESULTS Incomplete evacuation was present in 51% vs. 21% of the stools among the IBS patients and the non-IBS controls, respectively. The need to strain during defecation was existing in 41% vs. 33% of the stools for the IBS patients and the non-IBS controls, respectively. Urgency was experienced in 37% of the stools in the IBS patients compared with 18% of the stools in the non-IBS controls. Patients with IBS experienced in a significant higher degree of overlapping symptoms per stool (p < 0.001 to p = 0.007). The occurrence of all defecation symptoms in the same patient was related to decreased HRQL, and increased stress (p = 0.001 to p < 0.001). CONCLUSIONS An overlap between IBS and symptoms from the anorectal region related to defecation was found in a primary health care population. Defecation symptoms are very common in primary care IBS-patients, it co-occurs with increased self-perceived stress, and decreased HRQL.
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Affiliation(s)
- Jenny Sjödahl
- Department of Gastroenterology, University Hospital Linköping, County Council of Östergötland, Linköping, Sweden
| | - Anna Ingemansson
- Department of Gastroenterology, University Hospital Linköping, County Council of Östergötland, Linköping, Sweden
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Tetyana Bureychak
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Anna-Karin Norlin
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Åshild Faresjö
- Department of Health, Medicine and Caring Sciences (HMV), Division of Society and Health/Public Health, Linköping University, Linköping, Sweden
| | - Susanna Walter
- Department of Gastroenterology, University Hospital Linköping, County Council of Östergötland, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences (HMV), Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden
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Jones MP, Browning K, Corsetti M, Keszthelyi D, Shin A, Singh R, Visaggi P, Zerbib F. Appropriate use of p-values. Neurogastroenterol Motil 2023; 35:e14664. [PMID: 37691548 DOI: 10.1111/nmo.14664] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Kirsteen Browning
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Maura Corsetti
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Andrea Shin
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rajan Singh
- Department of Physiology and Cell Biology, University of Nevada, Reno, Nevada, USA
- School of Medicine, Reno, Nevada, USA
| | - Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, Bordeaux, France
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Wuthrich VM, Zagic D, Dickson SJ, McLellan LF, Chen JTH, Jones MP, Rapee RM. Effectiveness of Psychotherapy for Internalising Symptoms in Children and Adolescents When Delivered in Routine Settings: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2023; 26:824-848. [PMID: 37059918 PMCID: PMC10465434 DOI: 10.1007/s10567-023-00433-8] [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] [Accepted: 03/24/2023] [Indexed: 04/16/2023]
Abstract
This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = - 0.24 to 0.50) and depression (SMD = - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.
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Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia.
| | - Dino Zagic
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Sophie J Dickson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Jessamine T-H Chen
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
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da Fonseca LA, Montiani-Ferreira F, Soto J, Jones MP, Zagaya N, Cray C. Comparison of agarose gel and capillary zone electrophoresis methods with preliminary reference interval generation using capillary zone electrophoresis in bald eagles (Haliaeetus leucocephalus). Vet Clin Pathol 2023; 52:452-460. [PMID: 36973576 DOI: 10.1111/vcp.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/27/2022] [Accepted: 10/22/2022] [Indexed: 03/29/2023]
Abstract
BACKGROUND Electrophoresis can be used to aid in the diagnosis of different diseases in avian species. Capillary zone electrophoresis (CZE) is an automated method that is proposed to be superior to the dye methods used in agarose gel electrophoresis (AGE). However, reference intervals (RIs) for CZE in avian species and comparison studies between electrophoretic methods are lacking. OBJECTIVES The goals of the current study were to compare AGE and CZE methods and determine reference intervals for CZE using plasma from bald eagles (Haliaeetus leucocephalus). METHODS Heparinized plasma samples from 44 bald eagles (mean age 18.7 years) under managed care were examined by AGE and CZE. Method comparison analyses were completed, as well as the generation of preliminary RIs using the CZE method and ASVCP guidelines. RESULTS Passing-Bablok regression and Bland-Altman plots demonstrate that these methods are not equivalent. All fractions were significantly correlated between the methods except for alpha 1 globulin. Inter-assay and intra-assay CVs for CZE were lower or comparable to AGE and ranged from 2.4% to 15.4%, and 0.8% to 8.3%, respectively. CZE resolved more fractions than AGE with two fractions observed in the beta and gamma region vs one for AGE in each region. CONCLUSIONS CZE provided improved resolution and reproducibility for the quantitation of protein fractions in the bald eagle. Although most fraction results correlated with AGE, these methods were judged as not equivalent, necessitating method-specific Rls. Reference intervals generated from a limited number of mostly aged individuals under managed care should be considered preliminary; additional studies will aid in the production of more robust intervals.
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Affiliation(s)
- Leandro Abreu da Fonseca
- Departamento de Veterinária, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fabiano Montiani-Ferreira
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Departamento de Medicina Veterinária, Universidade Federal do Paraná, Curitiba, Puerto Rico, Brazil
| | - Jeny Soto
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Nancy Zagaya
- The American Eagle Foundation, Pigeon Forge, Tennessee, USA
| | - Carolyn Cray
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Sadeghi H, Lynch CF, Field WR, Snetselaar LG, Jones MP, Sinha R, Torner JC. Dietary omega-6/omega-3 fatty acids and risk of prostate cancer; Is there any potential interaction by organophosphate insecticides among the agricultural health study population. Cancer Epidemiol 2023; 85:102410. [PMID: 37413804 PMCID: PMC10528409 DOI: 10.1016/j.canep.2023.102410] [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: 03/13/2023] [Revised: 06/10/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND In the United States (US), the average annual increase in the incidence of prostate cancer (PCa) has been 0.5% between 2013 and 2017. Although some modifiable factors have been identified as the risk factors for PCa, the effect of lower ratio of omega-6 to omega-3 fatty acids intake (N-6/N-3) remains unknown. Previous studies of the Agricultural Health Study (AHS) reported a significant positive association between PCa and selected organophosphate pesticides (OPs) including terbufos and fonofos. OBJECTIVE The aim of this study was to evaluate the association between N-6/N-3 and PCa and any interaction between N-6/N-3 and 2 selected OPs (i.e., terbufos and fonofos) exposure. DESIGN AND PARTICIPANTS This case-control study, nested within a prospective cohort study, was conducted on a subgroup of the AHS population (1193 PCa cases and 14,872 controls) who returned their dietary questionnaire between 1999 and 2003 MAIN OUTCOME MEASURES: PCa was coded based on the International Classification of Diseases of Oncology (ICD-O-3) definitions and obtained from the statewide cancer registries of Iowa (2003-2017) and North Carolina (2003-2014). STATISTICAL ANALYSIS Multivariate logistic regression analysis was applied to obtain the odds ratios adjusted (aORs) for age at dietary assessment (years), race/ethnicity (white, African American, other), physical activity (hours/week), smoking (yes/no), terbufos (yes/no), fonofos (yes/no), diabetes, lycopene intake (milligrams/day), family history of PCa, and the interaction of N-6/N-3 with age, terbufos and fonofos. Pesticide exposure was assessed by self-administrated questionnaires collecting data on ever/never use of mentioned pesticides during lifetime as a yes/no variable. Assessing the P value for the interaction between pesticides and N-6/N-3, we used the continuous variable of "intensity adjusted cumulative exposure" to terbufos and fonofos. This exposure score was based on duration, intensity and frequency of exposure. We also conducted a stratified regression analysis by quartiles of age. RESULTS Relative to the highest N-6/N-3 quartile, the lowest quartile was significantly associated with a decreased risk of PCa (aOR=0.61, 95% CI: 0.41-0.90), and quartile-specific aORs decreased toward the lowest quartile (Ptrend=<0.01). Based on the age-stratified analysis, the protective effect was only significant for the lowest quartile of N-6/N-3 among those aged between 48 and 55 years old (aORs=0.97, 95% CI, 0.45-0.55). Among those who were exposed to terbufos (ever exposure reported as yes in the self-report questionnaires), lower quartiles of N-6/N-3 were protective albeit nonsignificant (aORs: 0.86, 0.92, 0.91 in quartiles 1,2, and 3, respectively). No meaningful findings were observed for fonofos and N-6/N-3 interaction. CONCLUSION Findings showed that lower N-6/N-3 may decrease risk of PCa among farmers. However, no significant interaction was found between selected organophosphate pesticides and N-6/N-3.
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Affiliation(s)
- Homa Sadeghi
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - William R Field
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Michael P Jones
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James C Torner
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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14
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Fairlie T, Shah A, Talley NJ, Chey WD, Koloski N, Yeh Lee Y, Gwee KA, Jones MP, Holtmann G. Overlap of disorders of gut-brain interaction: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023:S2468-1253(23)00102-4. [PMID: 37211024 DOI: 10.1016/s2468-1253(23)00102-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/10/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Rome criteria differentiate distinct types of disorders of gut-brain interaction (DGBI); also known as functional gastrointestinal disorders. Overlap of symptom categories frequently occurs. This systematic review and meta-analysis aimed to define the prevalence of DGBI overlap and compare overlap in population-based, primary care or tertiary care health settings. Furthermore, we aimed to compare symptom severity of psychological comorbidities in DGBI with and without overlap. METHODS For this systematic review and meta-analysis we searched MEDLINE (PubMed) and Embase electronic databases from inception until March 1, 2022, for original articles and conference abstracts of observational cross-sectional, case-controlled, or cohort design studies that reported the prevalence of DGBI overlap in adult participants (aged ≥18 years). We included only those studies where the diagnosis of DGBI was based on clinical assessment, questionnaire data, or specific symptom-based criteria. Studies were excluded if reporting on mixed populations of DGBI and organic diseases. Aggregate patient data were extracted from eligible published studies. The prevalence of DGBI overlap in all studies was pooled using the DerSimonian and Laird random effects model, and further analysis stratified by subgroups (care setting, diagnostic criteria, geographic region, and gross domestic product per capita). We also assessed the relationship between DGBI overlap with anxiety, depression, and quality of life symptom scores. This study was registered with PROSPERO (CRD42022311101). FINDINGS 46 of 1268 screened studies, reporting on 75 682 adult DGBI participants, were eligible for inclusion in this systematic review and meta-analysis. Overall, 24 424 (pooled prevalence 36·5% [95% CI 30·7 to 42·6]) participants had a DGBI overlap, with considerable between-study heterogeneity (I2=99·51, p=0·0001). In the tertiary health-care setting, overlap among participants with DGBI was more prevalent (8373 of 22 617, pooled prevalence 47·3% [95% CI 33·2 to 61·7]) compared with population-based cohorts (11 332 of 39 749, pooled prevalence 26·5% [95% CI 20·5 to 33·4]; odds ratio 2·50 [95% CI 1·28 to 4·87]; p=0·0084). Quality of life physical component scores were significantly lower in participants with DGBI overlap compared with participants without overlap (standardised mean difference -0·47 [95% CI -0·80 to -0·14]; p=0·025). Participants with DGBI overlap had both increased symptom scores for anxiety (0·39 [95% CI 0·24 to 0·54]; p=0·0001) and depression (0·41 [0·30 to 0·51]; p=0·0001). INTERPRETATION Overlap of DGBI subtypes is frequent, and is more prevalent in tertiary care settings and associated with more severe symptom manifestations or psychological comorbidities. Despite the large sample size, the comparative analyses revealed substantial heterogeneity, and the results should be interpreted with caution. FUNDING National Health and Medical Research Council and Centre for Research Excellence.
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Affiliation(s)
- Thomas Fairlie
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ayesha Shah
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - William D Chey
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Natasha Koloski
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; School of Medicine and Public Health, and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Kok-Ann Gwee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
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Ejova A, Jones MP, Beath AP, McKerchar SL, Okifuji A. Moment-to-moment relationships between pain, fatigue, and distress as a function of GI symptoms in fibromyalgia. J Psychosom Res 2023; 170:111348. [PMID: 37210772 DOI: 10.1016/j.jpsychores.2023.111348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/23/2023] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE There is emerging evidence that people with both fibromyalgia and functional gastrointestinal (GI) disorders report more severe psychological symptoms than people with only fibromyalgia or a functional GI disorder. We use Ecological Momentary Assessment (EMA) to examine whether, for people with fibromyalgia, accompanying GI symptoms result in stronger bidirectional relationships between distress and bodily pain or fatigue. METHODS Participants were 67 women with fibromyalgia from a study by Okifuji et al. (2011; 13), in which EMA data on pain, fatigue, and distress was collected over 30 days. Thirty-three participants reported GI symptoms at baseline, and 34 participants reported no GI symptoms but at least one other bodily symptom. Using multilevel linear regressions with interaction terms, we compared the two groups on the strength of reciprocal within-day and day-to-day relationships between pain, fatigue, and distress. RESULTS GI symptom status did not moderate relationships between distress and pain. However, participants with GI symptoms uniquely reported more distress following increased fatigue within days (b = 0.120, 95%CI: 0.041,0.198), and sharper distress escalations across days (b = 0.078 95%CI: 0.007, 0.149). CONCLUSION We do not find evidence of stronger bidirectional within-day and day-to-day relationships between distress and bodily symptoms in this patient group. We do, however, find evidence of heightened fatigue-related distress and escalating distress. These cyclical processes can become a focus for cognitive behavioural therapy, patient education, and physical (exercise/sleep) therapy aimed at addressing fatigue.
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Affiliation(s)
- Anastasia Ejova
- School of Psychology, The University of Adelaide, Australia; School of Psychological Sciences, Macquarie University, Australia.
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Australia; Centre for Emotional Health (CEH), Macquarie University, Australia.
| | - Alissa P Beath
- School of Psychological Sciences, Macquarie University, Australia.
| | | | - Akiko Okifuji
- Pain Research & Management Center, Department of Anesthesiology, University of Utah, USA.
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Tanaka T, Jones MP. Letter: deciphering the complexities of chronic liver disease epidemiology through a directed acyclic graph (DAG). Aliment Pharmacol Ther 2023; 57:1207-1209. [PMID: 37094313 DOI: 10.1111/apt.17427] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Tomohiro Tanaka
- Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael P Jones
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
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Kutyla MJ, McMaster JJ, Haig A, Koloski N, Hourigan L, Meeusen V, Shah A, Talley NJ, Jones MP, Holtmann GJ. Development and Validation of a Patient-Reported Experience Measure for Gastrointestinal Endoscopy: The Comprehensive Endoscopy Satisfaction Tool (CEST). J Clin Gastroenterol 2023; 57:472-478. [PMID: 37022206 DOI: 10.1097/mcg.0000000000001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/13/2022] [Indexed: 04/07/2023]
Abstract
GOALS We aimed to develop and validate a patient-reported experience measure for gastrointestinal (GI) endoscopy, the Comprehensive Endoscopy Satisfaction Tool that captures relevant domains that influence the patient's experience and identify factors that shape satisfaction. BACKGROUND Patient-reported experience measures are used to capture specific quality aspects of health care services. GI endoscopic services are high-volume services, and there is a lack of specific, validated instruments to capture various domains that shape the patients' experience with routine clinical endoscopic services. STUDY After an environmental scan and structured literature review, focus groups with patients were conducted to identify relevant factors influencing the patient experience with GI endoscopic services. After an initial validation in 101 patients undergoing routine GI endoscopies, the instrument was tested in 7800 patients. In addition, the influence of sociodemographic factors on global satisfaction was explored. RESULTS The final version included 26 specific items plus 4 global ratings for preprocedure, experience on day of procedure, postprocedure care, and infrastructure. In addition, a global rating of the overall experience was included. Patient satisfaction was significantly higher in older patients (P<0.001) but not influenced by gender, nationality, marital status, education, or employment status. Interestingly, during periods of coronavirus disease-19-related service interruptions, the Net Promoter Score was significantly reduced (P<0.0001) providing evidence for the responsiveness of the instrument. CONCLUSIONS The Comprehensive Endoscopy Satisfaction Tool is a valid measure for the patient experience with the various components of endoscopic services, allows for the identification of domains that impact on the patient experience and is a practical tool to compare patient satisfaction over time and across facilities.
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Affiliation(s)
- Marguerite J Kutyla
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
- Translational Research Institute
| | - Jessica J McMaster
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
- Translational Research Institute
| | - Adam Haig
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
| | - Natasha Koloski
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
- Translational Research Institute
- Australian Gastrointestinal Research Alliance (AGIRA) and the NHMRC Centre for Research Excellence in Digestive Health, Brisbane, QLD
- Faculty of Health & Medicine, University of Newcastle, Newcastle
| | - Luke Hourigan
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
| | - Vera Meeusen
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Nursing and Midwifery
| | - Ayesha Shah
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
- Translational Research Institute
- Australian Gastrointestinal Research Alliance (AGIRA) and the NHMRC Centre for Research Excellence in Digestive Health, Brisbane, QLD
| | - Nicholas J Talley
- Australian Gastrointestinal Research Alliance (AGIRA) and the NHMRC Centre for Research Excellence in Digestive Health, Brisbane, QLD
- School of Medicine and Public Health, University of Newcastle, Callaghan
| | - Michael P Jones
- Australian Gastrointestinal Research Alliance (AGIRA) and the NHMRC Centre for Research Excellence in Digestive Health, Brisbane, QLD
- School of Psychological Sciences, Macquarie University, Ryde, NSW, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital
- Faculty of Medicine
- Faculty of Health and Behavioural Sciences, University of Queensland
- Translational Research Institute
- Australian Gastrointestinal Research Alliance (AGIRA) and the NHMRC Centre for Research Excellence in Digestive Health, Brisbane, QLD
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Shah A, Pakeerathan V, Jones MP, Kashyap PC, Virgo K, Fairlie T, Morrison M, Ghoshal UC, Holtmann GJ. Small Intestinal Bacterial Overgrowth Complicating Gastrointestinal Manifestations of Systemic Sclerosis: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil 2023; 29:132-144. [PMID: 37019859 PMCID: PMC10083111 DOI: 10.5056/jnm22168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/12/2022] [Accepted: 01/25/2023] [Indexed: 04/07/2023] Open
Abstract
Background/Aims Systemic sclerosis (SSc) often is complicated by small intestinal bacterial overgrowth (SIBO). A systematic review and meta-analysis thus examined the prevalence of SIBO in SSc (SSc-subtypes), identify risk factors for SIBO in SSc and the effects of concomitant SIBO on gastrointestinal symptoms in SSc. Methods We searched electronic databases until January-2022 for studies providing prevalence rates of SIBO in SSc. The prevalence rates, odds ratio (OR) and 95% confidence intervals (CI) of SIBO in SSc and controls were calculated. Results The final dataset comprised 28 studies with 1112 SSc-patients and 335 controls. SIBO prevalence in SSc-patients was 39.9% (95% CI, 33.1-47.1; P = 0.006), with considerable heterogeneity, (I2 = 76.00%, P < 0.001). As compared to controls, there was a 10-fold increased SIBO prevalence in SSc-patients (OR, 9.6; 95% CI, 5.6-16.5; P < 0.001). The prevalence of SIBO was not different in limited cutaneous SSc as compared to diffuse cutaneous SSc (OR, 1.01; 95% CI, 0.46-2.20; P = 0.978). Diarrhea (OR, 5.9; 95% CI, 2.9-16.0; P = 0.001) and the association between SIBO in SSc and proton pump inhibitor use (OR, 2.3; 95% CI, 0.8-6.4; P = 0.105) failed statistical significance. Rifaximin was significantly more effective as compared to rotating antibiotic in eradicating SIBO in SSc-patients (77.8% [95% CI, 64.4-87.9]) vs 44.8% [95% CI, 31.7-58.4]; P < 0.05). Conclusions There is a 10-fold increased prevalence of SIBO in SSc, with similar SIBO prevalence rates in SSc-subtypes. Antimicrobial therapy of SIBO-positive SSc-patients with diarrhea should be considered. However, the results must be interpreted with caution due to substantial unexplained heterogeneity in the prevalence studies, and the low sensitivity and specificity of the diagnostic tests suggesting that the reliability of the evidence may be low.
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Affiliation(s)
- Ayesha Shah
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Translational Research Institute, Woollongabba, QLD, Australia
| | - Veenaa Pakeerathan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Purna C Kashyap
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kate Virgo
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Translational Research Institute, Woollongabba, QLD, Australia
| | - Thomas Fairlie
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Translational Research Institute, Woollongabba, QLD, Australia
| | - Mark Morrison
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- The University of Queensland Frazer Institute, Brisbane, QLD, Australia
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gerald J Holtmann
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Translational Research Institute, Woollongabba, QLD, Australia
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White PA, Faresjö T, Jones MP, Ludvigsson J. Low maternal education increases the risk of Type 1 Diabetes, but not other autoimmune diseases: a mediating role of childhood BMI and exposure to serious life events. Sci Rep 2023; 13:6166. [PMID: 37061552 PMCID: PMC10105777 DOI: 10.1038/s41598-023-32869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 04/17/2023] Open
Abstract
The objective of this paper was to investigate if socioeconomic status (SES), measured by maternal education and household income, influenced the risk of developing autoimmune disease (Type 1 Diabetes, Celiac disease, Juvenile Idiopathic Arthritis, Crohn's disease, Ulcerative colitis, and autoimmune thyroid disease), or age at diagnosis, and to analyse pathways between SES and autoimmune disease. We used data from the All Babies in Southeast Sweden (ABIS) study, a population-based prospective birth cohort, which included children born 1997-1999. Diagnoses of autoimmune disease was collected from the Swedish National Patient Register Dec 2020. In 16,365 individuals, low maternal education, but not household income, was associated with increased risk of Type 1 Diabetes; middle education RR 1.54, 95% CI 1.06, 2.23; P 0.02, low education RR 1.81, 95% CI 1.04, 3.18; P 0.04. Maternal education and household income was not associated with any other autoimmune disease and did not influence the age at diagnosis. Part of the increased risk of Type 1 Diabetes by lower maternal education was mediated by the indirect pathway of higher BMI and higher risk of Serious Life Events (SLE) at 5 years of age. The risk of developing Type 1 Diabetes associated to low maternal education might be reduced by decreasing BMI and SLE during childhood.
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Affiliation(s)
- Pär Andersson White
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, 581 83, Sweden.
- Crown Princess Victoria Children's Hospital, Linköping University, Linköping, 581 85, Sweden.
| | - Tomas Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, 581 83, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Linköping University, Linköping, 581 85, Sweden
- Department of Biomedical and Clinical Sciences, Division of Pediatrics, Linköping University, Linköping, 581 83, Sweden
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20
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Mathew S, Fitts MS, Liddle Z, Bourke L, Campbell N, Murakami-Gold L, Russell DJ, Humphreys JS, Mullholand E, Zhao Y, Jones MP, Boffa J, Ramjan M, Tangey A, Schultz R, Wakerman J. Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations? BMC Health Serv Res 2023; 23:341. [PMID: 37020234 PMCID: PMC10074370 DOI: 10.1186/s12913-023-09265-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic increased the use of telehealth consultations by telephone and video around the world. While telehealth can improve access to primary health care, there are significant gaps in our understanding about how, when and to what extent telehealth should be used. This paper explores the perspectives of health care staff on the key elements relating to the effective use of telehealth for patients living in remote Australia. METHODS Between February 2020 and October 2021, interviews and discussion groups were conducted with 248 clinic staff from 20 different remote communities across northern Australia. Interview coding followed an inductive approach. Thematic analysis was used to group codes into common themes. RESULTS Reduced need to travel for telehealth consultations was perceived to benefit both health providers and patients. Telehealth functioned best when there was a pre-established relationship between the patient and the health care provider and with patients who had good knowledge of their personal health, spoke English and had access to and familiarity with digital technology. On the other hand, telehealth was thought to be resource intensive, increasing remote clinic staff workload as most patients needed clinic staff to facilitate the telehealth session and complete background administrative work to support the consultation and an interpreter for translation services. Clinic staff universally emphasised that telehealth is a useful supplementary tool, and not a stand-alone service model replacing face-to-face interactions. CONCLUSION Telehealth has the potential to improve access to healthcare in remote areas if complemented with adequate face-to-face services. Careful workforce planning is required while introducing telehealth into clinics that already face high staff shortages. Digital infrastructure with reliable internet connections with sufficient speed and latency need to be available at affordable prices in remote communities to make full use of telehealth consultations. Training and employment of local Aboriginal staff as digital navigators could ensure a culturally safe clinical environment for telehealth consultations and promote the effective use of telehealth services among community members.
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Affiliation(s)
- Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, Australia.
| | - Michelle S Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, Australia
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, VIC, Australia
| | - Narelle Campbell
- Flinders Rural and Remote Health Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | | | - Deborah J Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, Australia
| | - John S Humphreys
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | | | - Yuejen Zhao
- Northern Territory Department of Health, Darwin, NT, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, NSW, Australia
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Mark Ramjan
- Top End Population and Primary Health Care, Northern Territory Government, Casuarina, NT, Australia
| | - Annie Tangey
- Ngaanyatjarra Health Service, Alice Springs, NT, Australia
| | | | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, Australia
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21
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Kaplan AI, Mazor Y, Prott GM, Sequeira C, Jones MP, Malcolm A. Experiencing multiple concurrent functional gastrointestinal disorders is associated with greater symptom severity and worse quality of life in chronic constipation and defecation disorders. Neurogastroenterol Motil 2023; 35:e14524. [PMID: 36578247 DOI: 10.1111/nmo.14524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/18/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent community-based studies have demonstrated that experiencing multiple concurrent functional gastrointestinal disorders (FGIDs) is associated with increased somatization, worse quality of life (QoL), and greater health care utilization. However, the presence of multiple overlapping FGIDs is unstudied specifically in chronic constipation and functional defecation disorders (FDD). We investigated the prevalence and impact of additional nonconstipation FGIDs on constipation severity, anorectal physiology, anxiety and depression, and QoL, in patients with chronic constipation and FDD. METHODS One-hundred and forty-six consecutive patients with functional constipation or irritable bowel syndrome (IBS-C/IBS-M) presenting to a tertiary referral Neurogastroenterology Clinic were studied. In addition, 90/146 (62%) qualified for FDD due to abnormal defecatory physiology. Patients underwent comprehensive baseline assessment comprising anorectal physiology, Bristol Stool Chart, Rome questionnaire, Knowles-Eccersley-Scott-Symptom (KESS) constipation score, Hospital Anxiety, and Depression Scale, and modified 36-Item Short Form Health Survey (SF-36) for QoL. Additional FGIDs were diagnosed using Rome III criteria. KEY RESULTS Additional nonconstipation FGIDs occurred in 85% of patients, with a mean of 2.1 (SD 1.6) additional FGIDs. Patients with four or more additional FGIDs experienced greater constipation severity compared to those with no additional FGIDs (p = 0.004). Comorbid FGIDs were associated with worse SF-36 scores for physical functioning (p < 0.001), role-physical (p = 0.005), bodily pain (p < 0.001), vitality (p = 0.008), social functioning (p = 0.004), and mental health index (p = 0.031). CONCLUSIONS AND INFERENCES Functional gastrointestinal disorders comorbidity is highly prevalent in chronic constipation and defecatory disorders, and this is associated with greater symptom severity and worse QoL. Multimodal treatments targeting comorbid FGIDs may lead to superior outcomes.
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Affiliation(s)
- Adam I Kaplan
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Yoav Mazor
- Neurogastroenterology Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Department of Medical Neurobiology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gillian M Prott
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Carol Sequeira
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael P Jones
- Deputy Head of Psychology Department, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Allison Malcolm
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, Sydney, New South Wales, Australia
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22
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Mouat JS, Li X, Neier K, Zhu Y, Mordaunt CE, La Merrill MA, Lehmler HJ, Jones MP, Lein PJ, Schmidt RJ, LaSalle JM. Networks of placental DNA methylation correlate with maternal serum PCB concentrations and child neurodevelopment. Environ Res 2023; 220:115227. [PMID: 36608759 PMCID: PMC10518186 DOI: 10.1016/j.envres.2023.115227] [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] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Gestational exposure to polychlorinated biphenyls (PCBs) has been associated with elevated risk for neurodevelopmental disorders. Placental epigenetics may serve as a potential mechanism of risk or marker of altered placental function. Prior studies have associated differential placental DNA methylation with maternal PCB exposure or with increased risk of autism spectrum disorder (ASD). However, sequencing-based placental methylomes have not previously been tested for simultaneous associations with maternal PCB levels and child neurodevelopmental outcomes. OBJECTIVES We aimed to identify placental DNA methylation patterns associated with maternal PCB levels and child neurodevelopmental outcomes in the high-risk ASD MARBLES cohort. METHODS We measured 209 PCB congeners in 104 maternal serum samples collected at delivery. We identified networks of DNA methylation from 147 placenta samples using the Comethyl R package, which performs weighted gene correlation network analysis for whole genome bisulfite sequencing data. We tested placental DNA methylation modules for association with maternal serum PCB levels, child neurodevelopment, and other participant traits. RESULTS PCBs 153 + 168, 170, 180 + 193, and 187 were detected in over 50% of maternal serum samples and were highly correlated with one another. Consistent with previous findings, maternal age was the strongest predictor of serum PCB levels, alongside year of sample collection, pre-pregnancy BMI, and polyunsaturated fatty acid levels. Twenty seven modules of placental DNA methylation were identified, including five which significantly correlated with one or more PCBs, and four which correlated with child neurodevelopment. Two modules associated with maternal PCB levels as well as child neurodevelopment, and mapped to CSMD1 and AUTS2, genes previously implicated in ASD and identified as differentially methylated regions in mouse brain and placenta following gestational PCB exposure. CONCLUSIONS Placental DNA co-methylation modules were associated with maternal PCBs and child neurodevelopment. Methylation of CSMD1 and AUTS2 could be markers of altered placental function and/or ASD risk following maternal PCB exposure.
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Affiliation(s)
- Julia S Mouat
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA; Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; Genome Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA
| | - Xueshu Li
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Kari Neier
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA; Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; Genome Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA
| | - Yihui Zhu
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA; Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; Genome Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA
| | - Charles E Mordaunt
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA; Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; Genome Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA
| | - Michele A La Merrill
- Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; Department of Environmental Toxicology, University of California, Davis, CA, USA
| | - Hans-Joachim Lehmler
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Michael P Jones
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Pamela J Lein
- Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA; Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Rebecca J Schmidt
- Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA; Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, USA; Perinatal Origins of Disparities Center, University of California, Davis, CA, USA; Genome Center, University of California, Davis, CA, USA; MIND Institute, University of California, Davis, CA, USA.
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23
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Jones MP, Holtmann G. Placebo effects in functional dyspepsia: Causes and implications for clinical trials. Neurogastroenterol Motil 2023; 35:e14527. [PMID: 36592054 PMCID: PMC10078415 DOI: 10.1111/nmo.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
Placebo responses to an apparently inactive intervention are of interest from a scientific perspective as they suggest possible mechanism(s) at work beyond the intervention itself. They are also of interest from a clinical trials perspective since high rates of placebo response limit the potential to demonstrate worthwhile efficacy of a new intervention. This mini-review was motivated by the work of Bosman and colleagues(Neurogastroenterol Motil, 2022, and e14474) that is published in this issue of the journal in which they report on a systematic review and meta-analysis of placebo response in functional dyspepsia clinical trials. The review sets the scene for their work by putting it in the context of other disorders of brain-gut interaction and extra-gastrointestinal disorders. The review canvasses potential mechanisms of placebo response.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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24
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Vuong KS, Sheley W, Liu M, Carlson AK, Jones MP. Chromatophoromas on the tail of a pet axolotl (Ambystoma mexicanum) with presumptive metastasis. J Exot Pet Med 2023. [DOI: 10.1053/j.jepm.2023.02.002] [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: 02/11/2023]
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25
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Mohr NM, Okoro U, Harland KK, Fuller BM, Campbell K, Swanson MB, Wymore C, Faine B, Zepeski A, Parker EA, Mack L, Bell A, DeJong K, Mueller K, Chrischilles E, Carpenter CR, Wallace K, Jones MP, Ward MM. Outcomes Associated With Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care: A Multicenter Cohort Study. Ann Emerg Med 2023; 81:1-13. [PMID: 36253295 PMCID: PMC9780149 DOI: 10.1016/j.annemergmed.2022.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To test the hypothesis that provider-to-provider tele-emergency department care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). METHODS Multicenter (n=23), propensity-matched, cohort study using medical records of patients with sepsis from rural hospitals in an established, on-demand, rural video tele-ED network in the upper Midwest between August 2016 and June 2019. The primary outcome was 28-day hospital-free days, with secondary outcomes of 28-day inhospital mortality and SSC guideline adherence. RESULTS A total of 1,191 patients were included in the analysis, with tele-ED used for 326 (27%). Tele-ED cases were more likely to be transferred to another hospital (88% versus 8%, difference 79%, 95% confidence interval [CI] 75% to 83%). After matching and regression adjustment, tele-ED cases did not have more 28-day hospital-free days (difference 0.07 days more for tele-ED, 95% CI -0.04 to 0.17) or 28-day inhospital mortality (adjusted odds ratio [aOR] 0.51, 95% CI 0.16 to 1.60). Adherence with both the SSC 3-hour bundle (aOR 0.59, 95% CI 0.28 to 1.22) and complete bundle (aOR 0.45, 95% CI 0.02 to 11.60) were similar. An a priori-defined subgroup of patients treated by advanced practice providers suggested that the mortality was lower in the cohort with tele-ED use (aOR 0.11, 95% CI 0.02 to 0.73) despite no significant difference in complete SSC bundle adherence (aOR 2.88, 95% CI 0.52 to 15.86). CONCLUSION Rural emergency department patients treated with provider-to-provider tele-ED care in a mature network appear to have similar clinical outcomes to those treated without.
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Affiliation(s)
- Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.
| | - Uche Okoro
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brian M Fuller
- Division of Critical Care, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO; Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kalyn Campbell
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Surgery, Hennepin County Medical Center, Minneapolis, MN
| | - Morgan B Swanson
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Cole Wymore
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brett Faine
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Pharmaceutical Practice, College of Pharmacy, University of Iowa, Iowa City, IA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Edith A Parker
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA
| | - Luke Mack
- Avel eCare, Sioux Falls, SD; Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | | | | | - Keith Mueller
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA
| | | | | | - Kelli Wallace
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Michael P Jones
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA
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Shah A, Kang S, Talley NJ, Do A, Walker MM, Shanahan ER, Koloski NA, Jones MP, Keely S, Morrison M, Holtmann GJ. The duodenal mucosa associated microbiome, visceral sensory function, immune activation and psychological comorbidities in functional gastrointestinal disorders with and without self-reported non-celiac wheat sensitivity. Gut Microbes 2022; 14:2132078. [PMID: 36303431 PMCID: PMC9621048 DOI: 10.1080/19490976.2022.2132078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Frequently, patients with functional gastrointestinal disorders (FGIDs) report intolerance of wheat products. We compared gastrointestinal symptoms, sensory function, psychiatric comorbidities, gut-homing immune cells, and duodenal mucosa-associated microbiome (d-MAM) in FGID patients and controls with and without self-reported wheat sensitivity (SR-NCWS). We recruited 40 FGID patients and 20 controls referred by GPs for treatment. Gastrointestinal/extraintestinal symptoms, visceral sensory function, psychological comorbidities, and SR-NCWS were assessed in a standardized approach. Peripheral gut homing T-cells (CD4+α4+β7+CCR9+/CD8+α4+β7+CCR9+) were quantified, and the d-MAM was assessed by DNA sequencing for 46 subjects. Factors of bacterial genera were extracted utilizing factor analysis with varimax rotation and factors univariately associated with FGID or SR-NCWS included in a subsequent multivariate analysis of variance to identify statistically independent discriminators. Anxiety scores (p < .05) and increased symptom responses to a nutrient challenge (p < .05) were univariately associated with FGID. Gut homing T-cells were increased in FGID patients with SR-NCWS compared to other groups (p all <0.05). MANOVA revealed that anxiety (p = .03), visceral sensory function (p = 0.007), and a d-MAM factor comprise members of the Alloprevotella, Prevotella, Peptostreptococcus, Leptotrichia, and Veillonella lineages were significantly (p = .001) associated with FGID, while gut homing CD4+α4+ β7+CCR9+ T-cells were associated (p = .002) with SR-NCWS. Compared to controls, patients with and without SR-NCWS show that there are shifts in the amplicon sequence variants within specific bacterial genera between the FGID subgroups (particularly Prevotella and Streptococcus) as well as distinct bacterial taxa discriminatory for the two different FGID subtypes. Compared to controls, both FGID patients with and without SR-NCWS have an increased symptom response to a standardized nutrient challenge and increased anxiety scores. The FGID patients with SR-NCWS - as compared to FGID without SR-NCWS (and controls without SR-NCWS) - have increased gut homing T-cells. The d-MAM profiles suggest species and strain-based variations between the two FGID subtypes and in comparison to controls.
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Affiliation(s)
- Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Seungha Kang
- Faculty of Medicine, University of Queensland, Brisbane, Australia,University of Queensland Diamantina Institute, Woolloongabba, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Anh Do
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Marjorie M Walker
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Erin R Shanahan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia
| | - Natasha A Koloski
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Michael P Jones
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Mark Morrison
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia,University of Queensland Diamantina Institute, Woolloongabba, Australia,CONTACT Mark Morrison
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia,Gerald J Holtmann Princess Alexandra Hospital, Brisbane Department of Gastroenterology and Hepatology & University of Queensland 199 Ipswich Road, Woolloongabba, Queensland, Australia
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Shah A, Thite P, Hansen T, Kendall BJ, Sanders DS, Morrison M, Jones MP, Holtmann G. Links between celiac disease and small intestinal bacterial overgrowth: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:1844-1852. [PMID: 35734803 PMCID: PMC9795979 DOI: 10.1111/jgh.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Symptoms of small intestinal bacterial overgrowth (SIBO) and celiac disease (CeD) often overlap, and studies suggest a link between SIBO and CeD. We thus conducted a systematic review and meta-analysis to compare SIBO prevalence in CeD patients and controls and assessed effects of antimicrobial therapy on gastrointestinal symptoms in SIBO positive CeD patients. METHODS Electronic databases were searched until February 2022 for studies reporting SIBO prevalence in CeD. Prevalence rates, odds ratio (OR), and 95% confidence intervals (CI) of SIBO in CeD and controls were calculated. RESULTS We included 14 studies, with 742 CeD patients and 178 controls. The pooled prevalence of SIBO in CeD was 18.3% (95% CI: 11.4-28.1), with substantial heterogeneity. Including case-control studies with healthy controls, SIBO prevalence in CeD patients was significantly increased (OR 5.1, 95% CI: 2.1-12.4, P = 0.0001), with minimal heterogeneity. Utilizing breath tests, SIBO prevalence in CeD patients was 20.8% (95% CI: 11.9-33.7), almost two-fold higher compared with culture-based methods at 12.6% (95% CI: 5.1-28.0), with substantial heterogeneity in both analyses. SIBO prevalence in CeD patients nonresponsive to a gluten free diet (GFD) was not statistically higher as compared with those responsive to GFD (OR 1.5, 95% CI: 0.4-5.0, P = 0.511). Antibiotic therapy of SIBO positive CeD patients resulted in improvement in gastrointestinal symptoms in 95.6% (95% CI: 78.0-99.9) and normalization of breath tests. CONCLUSIONS This study suggests a link between SIBO and CeD. While SIBO could explain nonresponse to a GFD in CeD, SIBO prevalence is not statistically higher in CeD patients non-responsive to GFD. The overall quality of the evidence is low, mainly due to substantial "clinical heterogeneity" and the limited sensitivity/specificity of the available diagnostic tests.
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Affiliation(s)
- Ayesha Shah
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Department of Gastroenterology and HepatologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia,Translational Research InstituteWoolloongabbaQueenslandAustralia
| | - Parag Thite
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Department of Gastroenterology and HepatologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Teressa Hansen
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Department of Gastroenterology and HepatologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia,Translational Research InstituteWoolloongabbaQueenslandAustralia
| | - Bradley J Kendall
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Department of Gastroenterology and HepatologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - David S Sanders
- Academic Unit of GastroenterologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Mark Morrison
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Department of Gastroenterology and HepatologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia,Diamantina InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| | - Michael P Jones
- Department of PsychologyMacquarie UniversitySydneyNew South WalesAustralia
| | - Gerald Holtmann
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Department of Gastroenterology and HepatologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia,Translational Research InstituteWoolloongabbaQueenslandAustralia
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28
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Ramachandran A, Montenegro M, Singh M, Dixon T, Kayani W, Liang T, Yu N, Reddy S, Liveris A, Manyapu M, McEwan AA, Nguyen VT, Sonenthal NV, Corbo J, Friedman BW, Sperling J, Jones MP, Halperin M. “Diffusion of innovations”: a feasibility study on the pericapsular nerve group block in the emergency department for hip fractures. Clin Exp Emerg Med 2022; 9:198-206. [PMID: 36111356 PMCID: PMC9561200 DOI: 10.15441/ceem.22.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
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29
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Suzuki H, Goto M, Nair R, Livorsi DJ, Sekar P, Ohl ME, Diekema DJ, Perencevich EN, Alexander B, Jones MP, McDaniel JS, Schweizer ML. Effectiveness and Optimal Duration of Adjunctive Rifampin Treatment in the Management of Staphylococcus Aureus Prosthetic Joint Infections after Debridement, Antibiotics and Implant Retention. Open Forum Infect Dis 2022; 9:ofac473. [PMID: 36196299 PMCID: PMC9522668 DOI: 10.1093/ofid/ofac473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Rifampin is recommended as adjunctive therapy for patients with a Staphylococcus aureus prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) with no solid consensus on the optimal duration of therapy. Our study assessed the effectiveness and optimal duration of rifampin for S. aureus PJI using Veterans Health Administration (VHA) data.
Methods
We conducted a retrospective cohort study of patients with S. aureus PJI managed with DAIR between 2003 and 2019 in VHA hospitals. Patients who died within 14 days after DAIR were excluded. The primary outcome was a time to microbiological recurrence from 15 days up to two years after DAIR. Rifampin use was analyzed as a time-varying exposure, and time-dependent hazard ratios (HRs) for recurrence were calculated according to the duration of rifampin treatment.
Results
Among 4,624 patients, 842 (18.2%) received at least one dose of rifampin. 1785 (38.6%) experienced recurrence within two years. Rifampin treatment was associated with significantly lower HRs for recurrence during the first 90 days of treatment (HR 0.60; 95%CI 0.45-0.79) and between days 91 and 180 (HR 0.16; 95%CI 0.04-0.66) but no statistically significant protective effect was observed with longer than 180 days (HR 0.57; 95%CI 0.18-1.81). The benefit of rifampin was observed for subgroups including knee PJI, MSSA or MRSA infection, and early or late PJI.
Conclusions
This study supports current guidelines which recommend adjunctive rifampin use for up to six months among patients with S. aureus PJI treated with DAIR.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Michihiko Goto
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Rajeshwari Nair
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Daniel J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Poorani Sekar
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Michael E Ohl
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Eli N Perencevich
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Bruce Alexander
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
| | - Michael P Jones
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Biostatistics, University of Iowa College of Public Health , Iowa City, IA , USA
| | - Jennifer S McDaniel
- Department of Epidemiology, University of Iowa College of Public Health , Iowa City, IA , USA
| | - Marin L Schweizer
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
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Jones MP, Shah A, Walker MM, Koloski NA, Holtmann G, Talley NJ. Overlap of heartburn, functional dyspepsia, and irritable bowel syndrome in a population sample: Prevalence, temporal stability, and associated comorbidities. Neurogastroenterol Motil 2022; 34:e14349. [PMID: 35293084 DOI: 10.1111/nmo.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/02/2022] [Accepted: 02/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Co-occurring (overlapping) irritable bowel syndrome (IBS), functional dyspepsia (FD), and heartburn has been observed. However, whether it is a distinct entity has not been established, nor what clinical, demographic, lifestyle, and psychological traits are associated with it. This study sought to estimate the prevalence and temporal stability of this overlap and to identify features specific to it in order to gain some insights into the potential etiopathogenesis. METHODS Two waves of a survey to a population-representative sample were conducted 3 years apart, recruiting 1312 individuals for this study. The chance-expected probability of complete overlap (CO) was calculated and compared with the observed CO. A range of demographic, lifestyle factors, medical diagnoses, sleep quality, and psychological distress were tested to identify predictors of overlap using logistic regression. KEY RESULTS CO was observed in 2.1% (95% confidence interval 1.9, 3.7) of the sample and was closely replicated in wave 2 at 2.0%. The observed CO was greater than expected by chance (0.2%) to a statistically significant extent (p < 0.001). Overlap between IBS subtypes, FD subtypes, and heartburn was also elevated above chance expectation. Individuals with CO were separately differentiated from others with respect to elevated rates of self-reported medically diagnosed asthma, elevated psychological distress score, and elevated impact on sleep quality. The discrimination provided by these factors was further independent of age and sex. CONCLUSIONS AND INFERENCES Overlap between IBS, FD, and heartburn (GERD) appears to be a distinct entity that has a profile including psychological morbidity, sleep disturbance, and elevated rates of atopy.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Marjorie M Walker
- College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natasha A Koloski
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
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Rapee RM, McLellan LF, Carl T, Trompeter N, Hudson JL, Jones MP, Wuthrich VM. Comparison of Transdiagnostic Treatment and Specialized Social Anxiety Treatment for Children and Adolescents With Social Anxiety Disorder: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2022; 62:646-655. [PMID: 35987298 DOI: 10.1016/j.jaac.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic cognitive-behavioral therapy (CBT) treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes. METHOD A total of 200 children and adolescents (mean age = 9.5 years, SD = 2.2 years; 47% boys) diagnosed with social anxiety disorder as either their principal or additional disorder were randomly allocated to either the generic or the modified treatment. Both treatments were based on a manualized, empirically validated program (Cool Kids) and comprised 10 sessions over 12 weeks. Assessments comprised structured diagnostic interview and parent and youth reports, and covered diagnoses, symptoms, life impairment, and assessment of maintaining processes at post-treatment and 6-month follow-up. RESULTS The treatments did not differ significantly on the primary outcome (remission of social anxiety disorder) at either post-treatment (remission in generic = 41%; modified = 44%) or follow-up (remission in generic = 51%; modified = 69%), although the latter approached significance (p = .08). They also did not differ at either time point on most secondary measures of outcome. The only maintaining process that changed more under modified treatment was attention to the current task. CONCLUSION Despite some positive hints in the data, there was little evidence that the modified intervention significantly improved treatment of pediatric social anxiety disorder, despite incorporating strategies to address putative maintaining mechanisms. The similar improvement between treatments on most maintaining processes suggests that new and innovative strategies may be needed to better target these processes. CLINICAL TRIAL REGISTRATION INFORMATION Efficacy of Cognitive Behavioural Treatment for Socially Anxious Youth; https://www.anzctr.org.au/; 12616001065482.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Talia Carl
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia; Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
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32
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Hill CM, Jones MP, Chi DL. Effects of Adult Medicaid Dental Benefits Elimination on Child Dental Care Use. Med Care 2022; 60:579-587. [PMID: 35616495 DOI: 10.1097/mlr.0000000000001739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the effect of adult dental benefit cuts on child dental use in Washington state Medicaid and determine if cuts affect child demographic subgroups differentially. RESEARCH DESIGN The study used an interrupted time-series methodology to measure differences in child dental use after adult dental benefit elimination and reinstatement. Monthly data came from Washington state Medicaid enrollee and dental claim files from January 2008 to December 2015. SUBJECTS Medicaid-enrolled children with at least one Medicaid-enrolled adult in the same household were the intervention group, and Medicaid-enrolled children without a Medicaid-enrolled adult in the same household were the control group. MEASURES The outcome was the monthly proportion of Medicaid-enrolled children with a dental examination per 10,000 Medicaid-enrolled children. RESULTS After adult dental benefits elimination, dental examinations among children with Medicaid-enrolled adults in the same household gradually decreased, corresponding to 65 fewer dental examinations per 10,000 children per year (5.4 fewer dental examinations per 10,000 children per month; 95% confidence interval: -7.7, -3.1; P =0.006). Adult dental benefits had no effect on dental examination for children without a Medicaid-enrolled adult in the same household. Dental examinations for children with a Medicaid-enrolled adult in the same household continued to gradually decrease after adult benefits reinstatement. Children younger than age 6 were the most adversely impacted by changes to adult Medicaid dental benefits. CONCLUSION Policymakers should consider the spillover effects and ethical considerations of eliminating adult Medicaid dental benefits on children's access to dental care.
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Affiliation(s)
- Courtney M Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA
| | - Michael P Jones
- Department of Biostatistics, University of Iowa, Iowa City, IA
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA
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33
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Dear BF, Scott AJ, Fogliati R, Gandy M, Karin E, Dudeney J, Nielssen O, McDonald S, Heriseanu AI, Bisby MA, Sharpe L, Jones MP, Ali S, Titov N. The Chronic Conditions Course: A Randomised Controlled Trial of an Internet-Delivered Transdiagnostic Psychological Intervention for People with Chronic Health Conditions. Psychother Psychosom 2022; 91:265-276. [PMID: 35367986 DOI: 10.1159/000522530] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/06/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Psychological adjustment to chronic health conditions is important, as poor adjustment predicts a range of adverse medical and psychosocial outcomes. Psychological treatments demonstrate efficacy for people with chronic health conditions, but existing research takes a disorder-specific approach and they are predominately delivered in face-to-face contexts. The internet and remotely delivered treatments have the potential to overcome barriers to accessing traditional face-to-face treatment. OBJECTIVE The current study examined the efficacy and acceptability of an internet-delivered transdiagnostic psychological intervention to promote adjustment to illness, based on cognitive behaviour therapy principles. METHODS In a two-arm randomised controlled trial, participants (n = 676) were randomly allocated to the 8-week intervention or a waitlist control. Treatment included five core lessons, homework tasks, additional resources, and weekly contact with a psychologist. Primary outcomes included depression, anxiety, and disability, assessed at pre-treatment, post-treatment, 3-month follow-up, and 12-month follow-up. RESULTS The treatment group reported significantly greater improvements in depression (between-groups d = 0.47), anxiety (d = 0.32), and disability (d = 0.17) at post-treatment (all ps <0.001). Improvements were sustained over the 3-month and 12-month follow-ups. High treatment completion rates (69%) and levels of satisfaction (86%) were reported by participants in treatment. The intervention required a mean clinician time of 56.70 min per participant. CONCLUSIONS The findings provide preliminary and tentative support for the potential of internet-delivered transdiagnostic interventions to promote adjustment to chronic health conditions. Further research using robust control groups, and exploring the generalisability of findings, is needed before firm conclusions can be drawn.
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Affiliation(s)
- Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Rhiannon Fogliati
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Milena Gandy
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joanne Dudeney
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Olav Nielssen
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah McDonald
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Andreea I Heriseanu
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Shehzad Ali
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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Jones MP, Yun G, Wass F, Rixon H, Shah A, Walker MM, Koloski NA, Holtmann G, Talley NJ, Beath AP. The role of mood state and emotion regulation in the discrepancy between gastrointestinal symptom burden recorded prospectively and via recall questionnaire. Neurogastroenterol Motil 2022; 34:e14304. [PMID: 34854512 DOI: 10.1111/nmo.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy. METHODS One hundred and forty nine subjects (mean age 20 years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7-day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7 days. KEY RESULTS Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d = 0.52), abdominal pain (d = 0.61) and indigestion (d = 0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d = 0.87 for overall score and d = 0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy (r = 0.23, p = 0.004) and visceral-specific anxiety with abdominal pain discrepancy (r = -0.18, p = 0.03). There was no evidence of recency or Hawthorne (observer) effects. CONCLUSIONS AND INFERENCES Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Grace Yun
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Fiona Wass
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Hayley Rixon
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Marjorie M Walker
- College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natasha A Koloski
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alissa P Beath
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
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35
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Martinez A, Awad AM, Jones MP, Hornbuckle KC. Intracity occurrence and distribution of airborne PCB congeners in Chicago. Sci Total Environ 2022; 812:151505. [PMID: 34762940 PMCID: PMC8810667 DOI: 10.1016/j.scitotenv.2021.151505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 06/03/2023]
Abstract
To evaluate the magnitude and extent of airborne PCBs in an urban area, we measured and investigated the temporal and spatial behavior of atmospheric concentrations of individual polychlorinated biphenyl (PCB) congeners as well as the sum of all congeners (ΣPCB) in both gas and particle phases at 27 locations across the City of Chicago in a single year (2009). In total, 141 gas-phase air samples were collected, including 22 pairs (44 samples) deployed at the same time but at two different locations, and 46 particle-phase samples. ΣPCB in the gas-phase ranged from 80 to 3000 pg/m3, with a geometric mean (GM) of 530 pg/m3, whereas particle-phase ranged from 8 to 160 pg/m3, with a GM of 28 pg/m3. We found the temporal variability to be about three times larger than the variability over space for all gas-phase congeners and ΣPCB. Around 50% of the sample PCB profiles resembled a mixture of a 1:1 vapor Aroclor mixture of 1016 + 1254, with most of the rest (30%) showing enrichment of PCB 3 (>0.1), which did not match any Aroclor profiles. PCB 11 contributed to ~5% in all samples. The fractions of PCB congeners bound to particles ranged from 0.001 to 0.97. Our analysis shows that airborne PCBs are widely distributed across Chicago and confirms that most locations have a similar PCB distribution, but differ in the concentration levels. Volatilization continues to be the main release process of PCBs into the atmosphere, including both Aroclor and non-Aroclor congeners.
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Affiliation(s)
- Andres Martinez
- Department of Civil & Environmental Engineering, IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA, USA.
| | - Andrew M Awad
- Department of Civil & Environmental Engineering, IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA, USA
| | - Michael P Jones
- Department of Biostatistics, The University of Iowa, Iowa City, IA 52242, USA
| | - Keri C Hornbuckle
- Department of Civil & Environmental Engineering, IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA, USA
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Honap S, Meade S, Ibraheim H, Irving PM, Jones MP, Samaan MA. Effectiveness and Safety of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci 2022; 67:1018-1035. [PMID: 33723700 DOI: 10.1007/s10620-021-06932-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Ustekinumab, an interleukin-12 and interleukin-23 antagonist, is licensed for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) after the phase III trial programs demonstrated efficacy over placebo. However, these findings may not be directly transferable to the real-world due to the stringent inclusion criteria of clinical trials. METHODS We conducted a systematic review and meta-analysis of the safety and effectiveness of ustekinumab in inflammatory bowel disease (IBD). A systematic literature search was conducted via Medline and Embase from inception to April 21, 2020. Observational studies assessing ustekinumab's safety and effectiveness by reporting response, remission and/or adverse events (AE) in either CD or UC were included. Two reviewers independently assessed risk of bias and extracted study data. Random-effects meta-analysis was performed to pool rates of clinical response, remission, and safety data. RESULTS Following deduplication, 2147 records were identified of which 41 studies (38 CD, 3 UC) comprising 4400 patients were included for quantitative analysis. Pooled clinical remission rates for CD were 34% (95% CI, 26%-42%) following induction and 31% (95% CI, 25%-38%) at one year. For UC, post-induction clinical remission rates were 39% (95% CI, 23%-56%). Serious AEs were reported in 5.6% of patients. Pregnancy outcomes were similar to the general population. One-third of patients with active baseline perianal disease responded or had fistula healing with ustekinumab. CONCLUSIONS In the most comprehensive systematic review and meta-analysis to date, and the first to include UC, ustekinumab was shown to be effective and safe in the real-world treatment of IBD.
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Affiliation(s)
- Sailish Honap
- IBD Centre, 1st Floor IBD Centre, Westminster Bridge Road, St Thomas Hospital, Guys and St Thomas NHS Foundation Trust, London, SE1 7EH, UK. .,School of Immunology and Microbial Sciences, Kings College London, London, UK.
| | - Susanna Meade
- IBD Centre, 1st Floor IBD Centre, Westminster Bridge Road, St Thomas Hospital, Guys and St Thomas NHS Foundation Trust, London, SE1 7EH, UK
| | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Norfolk Place, St Marys Campus, Imperial College London, London, W2 1PG, UK
| | - Peter M Irving
- IBD Centre, 1st Floor IBD Centre, Westminster Bridge Road, St Thomas Hospital, Guys and St Thomas NHS Foundation Trust, London, SE1 7EH, UK.,School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Michael P Jones
- Center for Emotional Health, Department of Psychology, Macquarie University, New South Wales, NSW, 2109, Australia
| | - Mark A Samaan
- IBD Centre, 1st Floor IBD Centre, Westminster Bridge Road, St Thomas Hospital, Guys and St Thomas NHS Foundation Trust, London, SE1 7EH, UK
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McNaughton DT, Andreasson A, Ljótsson B, Beath AP, Hush JM, Ljunggren G, Schmidt PT, Talley NJ, Agréus L, Jones MP. Limited evidence of moderation of the association between gastrointestinal symptoms and prospective healthcare utilisation by quality of life. Aliment Pharmacol Ther 2022; 55:311-317. [PMID: 34664298 DOI: 10.1111/apt.16651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/01/2021] [Accepted: 10/04/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND An individual's drive to seek medical help remains a complex behavioural process, incorporating psychological, social and symptom-specific factors. Within irritable bowel syndrome (IBS), gastrointestinal symptoms only predict a small portion of the high healthcare-seeking experienced. AIM To examine the moderating role of quality of life (QoL) domains on this relationship to help explain the variance observed. METHODS This is an analysis of a Swedish population-based prospective study of healthcare use over a 12-year period. At baseline, gastrointestinal symptoms were measured with the valid Gastrointestinal Symptom Rating Scale, and QoL via the SF-36. 1159 subjects (57% female; mean age 48.6 years) had their health records matched with the initial survey. 164 were classified as IBS by Rome II criteria. Negative binomial or logistic models were fit to evaluate the moderating effect of particular QoL domains on the relationship between gastrointestinal symptoms and prospective healthcare utilisation. RESULTS Gastrointestinal symptoms were associated with prospective healthcare use, but moderation in this relationship by particular QoL domains was not supported; most models did not reach statistical significance. Furthermore, the impact of IBS status did not alter the moderation hypotheses. CONCLUSIONS Particular QoL domains did not impact the relationship between gastrointestinal symptoms on prospective healthcare seeking. Future research should continue to examine other psychological, social and symptom variables to identify predictors of high healthcare consumers in IBS.
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Affiliation(s)
- David T McNaughton
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Anna Andreasson
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.,Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alissa P Beath
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Julia M Hush
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Gunnar Ljunggren
- Academic Primary Health Care Centre, Stockholm, Sweden.,Public Healthcare Services Committee Administration, Stockholm, Sweden
| | - Peter T Schmidt
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Lars Agréus
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
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38
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Gandhi A, Shah A, Jones MP, Koloski N, Talley NJ, Morrison M, Holtmann G. Methane positive small intestinal bacterial overgrowth in inflammatory bowel disease and irritable bowel syndrome: A systematic review and meta-analysis. Gut Microbes 2022; 13:1933313. [PMID: 34190027 PMCID: PMC8253120 DOI: 10.1080/19490976.2021.1933313] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Several studies reported a potential role of methane producing archaea in the pathophysiology of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). We conducted a systematic review and meta-analysis to assess the prevalence of methane positive small intestinal bacterial overgrowth (SIBO) in IBS and IBD compared with controls. MEDLINE (PubMed) and Embase electronic databases were searched from inception until March 2021 for case-control and prevalence studies reporting SIBO in IBS and IBD. We extracted data from published studies and calculated pooled prevalence of SIBO in IBS or IBD, odds ratios (OR), and 95% CIs, utilizing a random effects model. The final dataset included 17 independent studies assessing the prevalence of methane positive SIBO in 1,653 IBS-patients and 713 controls, and 7 studies assessing the prevalence of methane positive SIBO in 626 IBD-patients and 497 controls, all utilizing breath test for SIBO diagnosis. Prevalence of methane positive SIBO in IBS and IBD was 25.0% (95% CI 18.8-32.4) and 5.6% (95% CI 2.6-11.8), respectively. Methane positive SIBO in IBS was not increased compared to controls (OR = 1.2, 95% CI 0.8-1.7, P = .37) but was significantly more prevalent in IBS-C as compared to IBS-D (OR = 3.1, 95% CI 1.7-5.6, P = .0001). The prevalence of methane-positive SIBO in patients with IBD was 3-fold lower at 7.4% (95% CI 5.4-9.8) compared to 23.5% (95% CI 19.8-27.5) in controls. The prevalence of methane positive SIBO was significantly lower in Crohn's disease as compared to ulcerative colitis, (5.3%, 95% CI 3.0-8.5 vs. 20.2%, 95% CI 12.8-29.4). This systematic review and meta-analysis suggests methane positivity on breath testing is positively associated with IBS-C and inversely with IBD. However, the quality of evidence is low largely due to clinical heterogeneity of the studies. Thus, causality is uncertain and further studies are required.
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Affiliation(s)
- Arjun Gandhi
- Faculty of Medicine, The University of Queensland, Queensland, Australia,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ayesha Shah
- Faculty of Medicine, The University of Queensland, Queensland, Australia,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,Translational Research Institute, Brisbane, Queensland, Australia
| | - Michael P. Jones
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Natasha Koloski
- Faculty of Medicine, The University of Queensland, Queensland, Australia,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,Translational Research Institute, Brisbane, Queensland, Australia
| | - Nicholas J. Talley
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Mark Morrison
- Faculty of Medicine, The University of Queensland, Queensland, Australia,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,University of Queensland, Diamantina Institute, Brisbane, Queensland, Australia
| | - Gerald Holtmann
- Faculty of Medicine, The University of Queensland, Queensland, Australia,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,Translational Research Institute, Brisbane, Queensland, Australia,CONTACT Gerald Holtmann Brisbane Department of Gastroenterology and Hepatology & University of Queensland Ipswich Road, Woolloongabba, Queensland, Australia
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Prasad SS, Walker MM, Talley NJ, Keely S, Kairuz T, Jones MP, Duncanson K. Healthcare Needs and Perceptions of People Living With Inflammatory Bowel Disease in Australia: A Mixed-Methods Study. Crohns Colitis 360 2022; 4:otab084. [PMID: 36777548 PMCID: PMC9802190 DOI: 10.1093/crocol/otab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis are inflammatory bowel diseases (IBDs) that adversely affect the healthcare needs and quality of life (QoL) of people with IBD. The aim of this study was to explore the needs and perceptions of people with IBD in a primary care setting. Methods This sequential explanatory mixed-methods study consisted of a cross-sectional survey (included validated tools), followed by semistructured interviews on participants' perceptions: IBD management, healthcare professionals, IBD care, flare management, and pharmacist's IBD roles. Results Sixty-seven participants completed the survey, and 8 completed interviews. Quantitative findings: Age at diagnosis had significant association with medication nonadherence (P = .04), QoL (P = .04), and disease control (P = .01) among the respondents. The odds of medication nonadherence were 8 times (adjusted odds ratio [AOR] = 8.04, 95% confidence interval [CI] = 1.08, 60.10) higher among younger participants aged <30 years. Those diagnosed with CD (P = .02) reported more likely to have unfavorable perceptions of pharmacists' role in managing their IBD (AOR = 9.45, 95% CI = 1.57, 56.62) than those with UC and indeterminate colitis. Qualitative findings: General practitioners were considered the most important care provider and the first point of contact for patients in managing all aspects of IBD. Participants identified their key need to be timely access to specialized IBD care and found that other primary healthcare professionals lacked disease-specific knowledge for managing IBD. Conclusions Primary healthcare professionals are well positioned but need targeted training to influence the needs of IBD patients. The specialty role of an IBD educator could complement existing services to deliver and address patient-specific care.
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Affiliation(s)
- Sharmila S Prasad
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia,NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,Address correspondence to: Sharmila S. Prasad, MPharm, Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia ()
| | - Marjorie M Walker
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Nicholas J Talley
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia,NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Therése Kairuz
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales, Australia
| | - Kerith Duncanson
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
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Bray NA, Koloski NA, Jones MP, Do A, Pang S, Coombes JS, McAllister S, Campos J, Arthur L, Stanley P, DeMaria K, Chao CY, Catague R, Whaley A, Talley NJ, Holtmann GJ. Evaluation of a Multidisciplinary Integrated Treatment Approach Versus Standard Model of Care for Functional Gastrointestinal Disorders (FGIDS): A Matched Cohort Study. Dig Dis Sci 2022; 67:5593-5601. [PMID: 35362835 PMCID: PMC9652261 DOI: 10.1007/s10620-022-07464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGID) are linked to a variety of potential causes, and treatments include reassurance, life-style (including diet), psychological, or pharmacologic interventions. AIMS To assess whether a multidisciplinary integrated treatment approach delivered in a dedicated integrated care clinic (ICC) was superior to the standard model of care in relation to the gastrointestinal symptom burden. METHODS A matched cohort of 52 consecutive patients with severe manifestation of FGID were matched with 104 control patients based upon diagnosis, gender, age, and symptom severity. Patients in the ICC received structured assessment and 12-weeks integrated treatment sessions provided as required by gastroenterologist and allied health team. Control patients received standard medical care at the same tertiary center with access to allied health services as required but no standardized interprofessional team approach. Primary outcome was reduction in gastrointestinal symptom burden as measured by the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). Secondary outcome was reduction in anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS Mixed models estimated the within ICC change in SAGIS total as -9.7 (95% CI -13.6, -5.8; p < 0.0001), compared with -1.7 (95% CI -4.0, 0.6; p = 0.15) for controls. The difference between groups reached statistical significance, -7.6 (95% CI -11.4, -3.8; p < 0.0001). Total HADS scores in ICC patients were 3.4 points lower post-intervention and reached statistical significance (p = 0.001). CONCLUSION This matched cohort study demonstrates superior short-term outcomes of FGID patients in a structured multidisciplinary care setting as compared to standard care.
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Affiliation(s)
- Nicola A. Bray
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia
| | - Natasha A. Koloski
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia ,College of Health Medicine and Wellbeing, University of Newcastle/AGIRA, Callaghan, NSW Australia
| | - Michael P. Jones
- grid.1004.50000 0001 2158 5405School of Psychological Sciences, Macquarie University, Ryde, NSW Australia
| | - Anh Do
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Siong Pang
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jeff S. Coombes
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia
| | - Sarah McAllister
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jane Campos
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Leela Arthur
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Paul Stanley
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Katherine DeMaria
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Che-yung Chao
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Rachel Catague
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Amanda Whaley
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Nicholas J. Talley
- College of Health Medicine and Wellbeing, University of Newcastle/AGIRA, Callaghan, NSW Australia
| | - Gerald J. Holtmann
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia ,grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
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Shah A, Pakneeshan S, Jones MP, Koloski N, Callaghan G, Morrison M, Holtmann G. How frequent are vancomycin-resistant enterococci in patients with primary sclerosing cholangitis and ulcerative colitis treated with oral vancomycin? Indian J Gastroenterol 2022; 41:519-524. [PMID: 36217097 PMCID: PMC9715441 DOI: 10.1007/s12664-022-01286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
In patients with primary sclerosing cholangitis (PSC), antimicrobial therapy with oral vancomycin (OV) is increasingly used to prevent progression of the liver disease and control concomitant ulcerative colitis (UC); however, there are concerns regarding the risk of development of vancomycin-resistant enterococci (VRE). Thus, we aimed to determine the incidence of VRE in PSC-UC patients. We conducted a retrospective study of PSC-UC patients, treated with OV at the Department of Gastroenterology at the Princess Alexandra Hospital. VRE testing was performed utilizing rectal swabs. We included 7 PSC-UC patients (age 22-53 years, 2 females) treated with OV with daily dose ranging from 250 to 1500 mg. All patients were treated for at least 6 months with OV (range 9-31 months, mean 32.1 months). All patients achieved complete clinical remission of the UC, with mean reduction of fecal calprotectin by 634 μg/mg (87.3%), mean reduction in the C-reactive protein by 21.9 mg/L (74.2%), and mean reduction in the total Mayo score by 9.3 (93.3%). With regard to the liver parameters, mean improvement in alkaline phosphatase enzyme and total bilirubin was -48.7 U/L (-19.7%) and -2.7 mg/dL (-19.6%), respectively. No patient treated with OV developed VRE or reported any adverse events. This cohort study including PSC-UC patients did not provide evidence for development of VRE, while treatment with vancomycin was associated with clinical and endoscopic remission of the UC. Larger, prospective trials are required to define the efficacy and safety of antimicrobial therapy in PSC-UC, while the risk of VRE appears small.
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Affiliation(s)
- Ayesha Shah
- Faculty of Medicine and Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health, Brisbane, Australia
| | - Sahar Pakneeshan
- Faculty of Medicine and Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
| | - Michael P Jones
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health, Brisbane, Australia
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Natasha Koloski
- Faculty of Medicine and Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health, Brisbane, Australia
| | - Gavin Callaghan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
| | - Mark Morrison
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health, Brisbane, Australia
- University of Queensland Diamantina Institute, Woolloongabba, QLD, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia.
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia.
- AGIRA (Australian Gastrointestinal Research Alliance) and the NHMRC Centre of Research Excellence in Digestive Health, Brisbane, Australia.
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Walter S, Jones MP, Sjödahl J, Stjernman H, Hjortswang H, Andreasson A. Measuring the impact of gastrointestinal inconvenience and symptoms on perceived health in the general population - validation of the Short Health Scale for gastrointestinal symptoms (SHS-GI). Scand J Gastroenterol 2021; 56:1406-1413. [PMID: 34521305 DOI: 10.1080/00365521.2021.1974087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) symptoms are intimately related to our wellbeing. The Short Health Scale for GI symptoms (SHS-GI) is a simple questionnaire to measure the impact of GI inconvenience and symptoms on quality of life. The aim was to validate the SHS-GI in a general population sample and to compare it with SHS-data across different patient groups. METHOD A subsample of 170 participants from a population-based colonoscopy study completed the Rome II questionnaire, GI diaries, psychological questionnaire (hospital anxiety and depression scale) and SHS-GI at follow-up investigation. Psychometric properties of SHS-GI as an overall score were determined by performing a confirmatory factor analysis (CFA). Spearman correlation between SHS total score and symptoms was calculated in the general population sample. SHS-GI data was compared with SHS data from patients with inflammatory bowel disease (IBD) and fecal incontinence (FI). RESULTS As expected, the general population rated their impact of GI inconvenience on quality of life as better than the patient populations in terms of all aspects of the SHS-GI. The CFA showed a good model fit meeting all fit criteria in the general population. Cronbach's alpha for the total scale was 0.80 in the general population sample and ranged from 0.72 in the FI sample to 0.88 and 0.89 in the IBD samples. CONCLUSIONS SHS-GI demonstrated appropriate psychometric properties in a sample of the normal population. We suggest that SHS-GI is a valid simple questionnaire suitable for measuring the impact of GI symptoms and inconvenience on quality of life in both general and patient populations.
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Affiliation(s)
- Susanna Walter
- Department of Biomedical and Clinical Sciences (BKV), Division of Inflammation and Infection, Linkoping University, Linkoping, Sweden.,Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, Australia
| | - Jenny Sjödahl
- Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Henrik Stjernman
- Department of Internal Medicine, Ryhov Hospital Jönköping, Jönköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Anna Andreasson
- School of Psychological Sciences, Macquarie University, North Ryde, Australia.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Irani MZ, Jones MP, Halland M, Herrick L, Choung RS, Loftus YAS, Walker MM, Murray JA, Talley NJ. Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population-based study. Aliment Pharmacol Ther 2021; 54:1416-1431. [PMID: 34626489 PMCID: PMC10835603 DOI: 10.1111/apt.16630] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rumination syndrome is a functional gastroduodenal disorder characterised by effortless regurgitation of recently ingested food. Emerging evidence reports duodenal eosinophilic inflammation in a subset, suggesting a shared pathophysiology with functional dyspepsia (FD). AIM To assess the clinical features of rumination syndrome and FD in a community-based study. METHODS We mailed a survey assessing gastrointestinal symptoms, diet and psychological symptoms to 9835 residents of Olmsted County, MN, USA in 2017-2018; diagnostic codes were obtained from linked clinical records. The two disorders were assessed as mutually exclusive in 'pure' forms with a separate overlap group, all compared to a control group not meeting criteria for either. Prevalence of associations, and univariate and independent associations with predictors were assessed by logistic regression. RESULTS Prevalence of rumination syndrome and FD were 5.8% and 7.1%, respectively; the overlap was 3.83-times more likely than expected by chance. Independent predictors for rumination (odds ratio (OR), 95% confidence interval (CI)) were female gender (1.79, 1.21-2.63), smoking (1.89, 1.28-2.78), gluten-free diet (1.58, 1.14-2.19), allergic rhinitis (1.45, 1.01-2.08) and depression (1.10, 1.05-1.16). FD was independently associated with female gender, depression, non-coeliac wheat sensitivity, migraine, irritable bowel syndrome and somatic symptoms. A similar reported efficacy (≥54%) of low fat or dairy-free diets was found with both disorders (P = 0.53 and P = 1.00, respectively). The strongest independent associations with overlapping FD and rumination syndrome were a history of rheumatoid arthritis (3.93, 1.28-12.06) and asthma (3.02, 1.44-6.34). CONCLUSION Rumination syndrome overlaps with FD with a shared risk factor profile, suggesting a common pathophysiology.
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Affiliation(s)
- Mudar Zand Irani
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Michael P. Jones
- NHMRC Centre of Research Excellence in Digestive Health
- School of Psychological Sciences, Macquarie University, North Ryde, Australia
| | - Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Linda Herrick
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Marjorie M. Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health
| | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas J. Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health
- Hunter Medical Research Institute, New Lambton Heights, Australia
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44
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Meira de-Faria F, Casado-Bedmar M, Mårten Lindqvist C, Jones MP, Walter SA, Keita ÅV. Altered interaction between enteric glial cells and mast cells in the colon of women with irritable bowel syndrome. Neurogastroenterol Motil 2021; 33:e14130. [PMID: 33797165 DOI: 10.1111/nmo.14130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/22/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Enteric glial cells (EGC) and mast cells (MC) are intimately associated with gastrointestinal physiological functions. We aimed to investigate EGC-MC interaction in irritable bowel syndrome (IBS), a gut-brain disorder linked to increased intestinal permeability, and MC. METHODS Parallel approaches were used to quantify EGC markers in colonic biopsies from healthy controls (HC) and patients with IBS. Data were correlated with MC, vasoactive intestinal polypeptide (VIP) and VIP receptors (VPAC1/VPAC2) expressions, and bacterial translocation through biopsies mounted in Ussing chambers. In addition, we investigated the effects of EGC mediators on colonic permeability and the pharmacological-induced responses of EGC and MC cell lines. KEY RESULTS Immunofluorescence of IBS colonic mucosa, as well as Western blotting and ELISA of IBS biopsy lysates, revealed increased glial fibrillary intermediate filament (GFAP) expression, indicating EGC activation. Mucosal GFAP correlated with increased MC and VPAC1+ MC numbers and decreased VIP+ MC, which seemed to control bacterial translocation in HC. In the contrary, EGC activation in IBS correlated with less MC and VPAC1+ MC numbers, and more VIP+ MC. In vitro, MC and EGC cell lines showed intracellular calcium responses to each other's mediators. Furthermore, EGC mediators prevented VIP-induced MC degranulation, while MC mediators induced a reactive EGC phenotype. In Ussing chambers, EGC mediators decreased paracellular passage through healthy colonic biopsies. CONCLUSIONS & INFERENCES Findings suggest the involvement of EGC and MC in the control of barrier function in the human colon and indicate a potential EGC-MC interaction that seems altered in IBS, with detrimental consequences to colonic permeability. Altogether, results suggest that imbalanced EGC-MC communication contributes to the pathophysiology of IBS.
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Affiliation(s)
- Felipe Meira de-Faria
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maite Casado-Bedmar
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carl Mårten Lindqvist
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Susanna A Walter
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Gastroenterology, Linköping University, Linköping, Sweden
| | - Åsa V Keita
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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45
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Jones MP, Shah A, Walker MM, Koloski NA, Holtmann G, Talley NJ. Antibiotic use but not gastrointestinal infection frequently precedes first diagnosis of functional gastrointestinal disorders. United European Gastroenterol J 2021; 9:1074-1080. [PMID: 34653313 PMCID: PMC8598965 DOI: 10.1002/ueg2.12164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION While the etiopathogenesis of functional gastrointestinal disorders (FGIDs) is not completely understood, alterations of the intestinal microbiome have been observed. Antibiotics can induce dysbiosis, but whether antibiotics are a risk factor for the onset of FGIDs is uncertain. Antibiotics have been reported as both a risk factor for new onset FGID but also as a therapy for existing FGID. This study aimed to estimate the fraction of cases where antibiotics provoked the onset of FGID. METHOD Electronic medical records were obtained from general practices (primary care) in the United Kingdom. Dates of antibiotic prescription (AP) were compared with first date of FGID diagnosis and contrasted across three prevalent FGIDs and controls without gastrointestinal disorders. RESULTS There were 10,926 GI healthy controls, 4326 IBS alone, 3477 FD alone, 340 chronic constipation and 4402 with overlap of multiple conditions. Both the prevalence of AP and rate were higher in FGID patients and increased with diagnosis of multiple FGIDs. 7%-14% of FGID patients were prescribed their first recorded antibiotic in the 12 months prior to their first FGID diagnosis and 20%-33% were prescribed an antibiotic in the same period. Differences between FGID groups were not accounted for by social deprivation and only rate of AP was moderated by social deprivation. In contrast, only 5%-10% of patients ever had a gastrointestinal infection recorded and only 1.5%-3.5% prior to their first FGID diagnosis. CONCLUSION These data indicate that antibiotics are prescribed prior to FGID diagnosis in a significant minority of care-seeking FGID patients, opening the potential for this medication to contribute to the pathophysiology. APs appears to mostly be for non-gastrointestinal conditions.
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Affiliation(s)
- Michael P. Jones
- School of Psychological SciencesMacquarie UniversityNorth RydeNew South WalesAustralia
| | - Ayesha Shah
- Department of Gastroenterology and HepatologyPrincess Alexandra Hospital and Translational Research Institute (TRI)WoolloongabbaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Marjorie M. Walker
- College of Health, Medicine and Well BeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Natasha A. Koloski
- Department of Gastroenterology and HepatologyPrincess Alexandra Hospital and Translational Research Institute (TRI)WoolloongabbaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- College of Health, Medicine and Well BeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Gerald Holtmann
- Department of Gastroenterology and HepatologyPrincess Alexandra Hospital and Translational Research Institute (TRI)WoolloongabbaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Nicholas J. Talley
- College of Health, Medicine and Well BeingUniversity of NewcastleNewcastleNew South WalesAustralia
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46
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Sadar MJ, Cox SK, Duvall A, Jones MP. Pharmacokinetics of a Single Intramuscular Injection of Ceftiofur Crystalline Free Acid in Bald Eagles ( Haliaeetus leucocephalus). J Avian Med Surg 2021; 35:290-294. [PMID: 34677027 DOI: 10.1647/20-00038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to evaluate the pharmacokinetic properties of ceftiofur crystalline free acid (CCFA) administered intramuscularly at dosages of 10 and 20 mg/kg in bald eagles (BAEAs) (Haliaeetus leucocephalus). Ceftiofur crystalline free acid is a long-acting, injectable, third-generation cephalosporin antibiotic drug. A prospective, randomized, complete crossover design was used for this pharmacokinetic investigation. CCFA (10 or 20 mg/kg) was administered intramuscularly, and blood samples were obtained from 6 adult, nonreleasable, healthy BAEAs at predetermined sampling times. After a 4-week washout period, the protocol was repeated with each bird receiving the dose not given during the initial sample collection according to the randomized crossover design. Plasma ceftiofur free acid equivalents were quantified and data were analyzed by a noncompartmental pharmacokinetic approach. The mean observed peak plasma concentrations were 9.23 µg/mL and 15.08 µg/mL for 10 and 20 mg/kg CCFA IM administration, respectively. The mean observed time to maximum plasma concentration was 18 and 17.6 hours, and the mean terminal elimination half-life was 32.38 and 38.08 hours for intramuscular administration of 10 and 20 mg/kg CCFA, respectively, in the BAEAs. Reported minimum inhibitory concentrations of raptor bacterial isolates from a prior study was used to determine the target minimum inhibitory concentration of 1 µg/mL selected for this investigation. From the previously published information, a target plasma concentration of 4 µg/mL was determined for the CCFA in the BAEAs. From the results of this study, CCFA may be dosed every 60 and 110 hours at 10 mg/kg IM, and every 80 and 160 hours at 20 mg/kg IM in BAEAs.
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Affiliation(s)
- Miranda J Sadar
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO 80523, USA,
| | - Sherry K Cox
- Department of Biomedical and Diagnostic Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996, USA
| | - Abigail Duvall
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996, USA
| | - Michael P Jones
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996, USA
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47
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Jones MP, Zhao Y, Guthridge S, Russell DJ, Ramjan M, Humphreys JS, Wakerman J. Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study. BMJ Open 2021; 11:e055635. [PMID: 34667018 PMCID: PMC8527144 DOI: 10.1136/bmjopen-2021-055635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff. DESIGN Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems). SETTING All 48 government primary healthcare clinics in remote communities in NT, Australia (2011-2015). PARTICIPANTS 25 413 patients drawn from participating clinics during the study period. OUTCOME MEASURES Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity. RESULTS The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction. CONCLUSIONS Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.
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Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Yuejen Zhao
- Population and Digital Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Deborah J Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Mark Ramjan
- Clinical Governance, Darwin Region & Strategic Primary Health Care, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - John S Humphreys
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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48
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Ejova A, Badcock NA, McKerchar S, Beath AP, Swift C, Talley NJ, Holtmann G, Walker MM, Jones MP. Electroencephalographic evidence of unconscious and conscious attentional bias in people with functional gastrointestinal disorders: A pilot study. Int J Psychophysiol 2021; 170:30-42. [PMID: 34560170 DOI: 10.1016/j.ijpsycho.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through psychological therapy. We compared the amplitudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN amplitudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 amplitudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.
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Affiliation(s)
- Anastasia Ejova
- Department of Psychology, Macquarie University, Sydney, Australia; School of Psychology, University of Adelaide, Adelaide, Australia.
| | - Nicholas A Badcock
- School of Psychological Science, University of Western Australia, Perth, Australia; Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Sarah McKerchar
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Alissa P Beath
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Claire Swift
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia; NHMRC Centre of Research Excellence in Digestive Health, Newcastle, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia; NHMRC Centre of Research Excellence in Digestive Health, Newcastle, Australia
| | - Michael P Jones
- Department of Psychology, Macquarie University, Sydney, Australia
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49
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Schweizer ML, Richardson K, Jones MP, Vaughan Sarrazin MS, Perencevich EN. Reply to Authors. Clin Infect Dis 2021; 73:1129-1130. [PMID: 33738493 DOI: 10.1093/cid/ciab249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marin L Schweizer
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Kelly Richardson
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa USA
| | - Michael P Jones
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa USA.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa USA
| | - Mary S Vaughan Sarrazin
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
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50
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Fitts MS, Humphreys J, Dunbar T, Bourke L, Mulholland E, Guthridge S, Zhao Y, Jones MP, Boffa J, Ramjan M, Murakami-Gold L, Tangey A, Comerford C, Schultz R, Campbell N, Mathew S, Liddle Z, Russell D, Wakerman J. Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol. BMJ Open 2021; 11:e043902. [PMID: 34408027 PMCID: PMC8375723 DOI: 10.1136/bmjopen-2020-043902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or 'fly-in, fly-out/drive-in, drive-out' health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies. METHODS AND ANALYSIS This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services. ETHICS AND DISSEMINATION The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.
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Affiliation(s)
- Michelle S Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - John Humphreys
- School of Rural Health, Monash University, Strathdale, Victoria, Australia
| | - Terry Dunbar
- Indigenous Social and Wellbeing Centre, School of Population Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Edward Mulholland
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
| | - Steven Guthridge
- Centre for Child Development and Education, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Yuejen Zhao
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Michael P Jones
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - Mark Ramjan
- Top End Health Service, Northern Territory Government, Casuarina, Northern Territory, Australia
| | - Lorna Murakami-Gold
- Poche SA + NT, Flinders University, Alice Springs, Northern Territory, Australia
| | - Annie Tangey
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Clarissa Comerford
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Rosalie Schultz
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Narelle Campbell
- Flinders Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Deborah Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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