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Rathomi HS, Mavaddat N, Katzenellenbogen J, Thompson SC. Weight management in primary care: the call for a practical and evidence-informed approach. Fam Pract 2023:cmad101. [PMID: 37931175 DOI: 10.1093/fampra/cmad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Hilmi S Rathomi
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - Nahal Mavaddat
- Discipline of General Practice, Medical School University of Western Australia, Perth, Australia
| | | | - Sandra C Thompson
- Western Australia Centre for Rural Health, University of Western Australia, Geraldton, Australia
- School of Allied Health, University of Western Australia, Perth, Australia
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Mavaddat N, Mavaddat N, Adab P, Fozdar S. Religion and health: complexities and contradictions. BMJ 2023; 382:p2246. [PMID: 37775139 DOI: 10.1136/bmj.p2246] [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] [Indexed: 10/01/2023]
Affiliation(s)
- Nasim Mavaddat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nahal Mavaddat
- School of Medicine, University of Western Australia, Australia
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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McLaughlin S, Staniland L, Egan SJ, Wheadon J, Munro C, Preece D, Furlong Y, Mavaddat N, Thompson A, Robinson S, Chen W, Myers B. Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol. BMJ Open 2023; 13:e073438. [PMID: 37678945 PMCID: PMC10496663 DOI: 10.1136/bmjopen-2023-073438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION The demand for adolescent mental health services has increased significantly in recent years, leading to excessive wait times for adolescents seeking mental health services and poor mental health outcomes. Timely access to mental health services is critical to reducing the risk of symptom chronicity and progression to mental disorder. A better understanding of whether and how interventions to reduce wait times impact mental health outcomes is needed to guide mental health policymakers and service planners in their approach to reducing wait times. METHODS AND ANALYSIS The scoping review will use Arksey and O'Malley's six-stage framework for scoping reviews and Rayyan to support screening, data extraction and evidence synthesis. The review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We will search the Cochrane Library, EBSCOhost, MEDLINE (Ovid), PsycArticles (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Web of Science, ProQuest and Scopus databases for peer-reviewed texts published in English between 1 January 2000 and 28 February 2023. We will also search Google Scholar for additional grey literature. To be eligible for inclusion, studies must focus on adolescent populations aged 13-18 years and report on interventions to reduce wait times for any mental health service except crisis and emergency services. Title, abstract and full-text screening will be done by two reviewers. We will extract data describing the interventions and their effects on wait times and adolescent mental health outcomes, and we will identify strengths and limitations in the evidence base to inform recommendations for future research. A youth advisory group with lived experience of mental health difficulties will be consulted throughout the review process. ETHICS AND DISSEMINATION Ethics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences. STUDY REGISTRATION The protocol was registered with the Open Science Framework on 20 February 2023 (https://osf.io/qt4zy).
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Affiliation(s)
- Stella McLaughlin
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Lexy Staniland
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Sarah J Egan
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jessica Wheadon
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Caitlin Munro
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - David Preece
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Yulia Furlong
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Nahal Mavaddat
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Alexander Thompson
- Western Australia Country Health Service, Perth, Western Australia, Australia
| | - Suzanne Robinson
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Health Economics Unit, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Wai Chen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Youth Mental Health and Developmental Neuropsychiatry, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Newnham EA, Mergelsberg ELP, Tearne J, McEvoy P, Stanley S, Celenza A, Kavanagh H, Stevenson T, Mavaddat N, Demore G, Hood S. Mental Health Status, Risk and Protective Factors for Healthcare Staff Prior to the First Major COVID-19 Outbreak in Western Australia. Int J Public Health 2023; 68:1606102. [PMID: 37732330 PMCID: PMC10507727 DOI: 10.3389/ijph.2023.1606102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives: Western Australia's unique public health response delayed the first wave of community COVID-19 transmission for 2 years. We aimed to determine the status of post-traumatic stress (PTSS), depressive, and anxiety symptoms among healthcare staff in major tertiary hospitals, together with associated risk and protective factors prior to the first substantial outbreak of COVID-19. Methods: A cross-sectional study was conducted with 431 healthcare staff immediately prior to the Western Australian border re-opening in 2022. Staff were recruited via notices in email newsletters, at four tertiary hospitals and a public mental health clinic in metropolitan Perth. Validated and original questionnaires were administered via Qualtrics. Results: Moderate levels of PTSS (22.3%), depression (21.9%), and anxiety (25.9%) were reported. Pathway analyses indicated that sleep difficulties, workplace stressors, and infectious disease training were associated with higher PTSS, depression and anxiety symptoms, and younger age was associated with higher levels of depression and anxiety. Nursing roles were associated with higher PTSS. Social support and workplace support were associated with lower levels of depression and anxiety but were not associated with PTSS. Conclusion: The findings illustrate high levels of resilience, but indicate a need for structural supports within the health system to foster staff mental health prior to the onset of emergencies.
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Affiliation(s)
- Elizabeth A. Newnham
- School of Population Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Perth, WA, Australia
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Jessica Tearne
- Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Hospital, Perth, WA, Australia
- State Major Trauma Unit, Royal Perth Hospital, Perth, WA, Australia
| | - Peter McEvoy
- School of Population Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Perth, WA, Australia
- Centre for Clinical Interventions, North Metropolitan Health Service, Perth, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Antonio Celenza
- Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
- Emergency Department, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Hyranthi Kavanagh
- Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Teresa Stevenson
- Peel and Rockingham Kwinana Mental Health Service, Rockingham, WA, Australia
| | - Nahal Mavaddat
- Discipline of General Practice, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Gavin Demore
- Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
- Western Australia Country Health Service, Perth, WA, Australia
| | - Sean Hood
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, WA, Australia
- Sir Charles Gairdner Hospital Mental Health Unit, North Metropolitan Health Service Mental Health, Public Health and Dental Services (MHPHDS), Perth, WA, Australia
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Gilkes L, Bulsara C, Mavaddat N. Chronic non-cancer pain management - insights from Australian general practitioners: a qualitative descriptive study. Aust J Prim Health 2023; 29:365-374. [PMID: 36683146 DOI: 10.1071/py22144] [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] [Received: 07/11/2022] [Accepted: 12/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The study explored the experiences and perceptions of GPs regarding the management of chronic non-cancer pain (CNCP). Specifically, participants were asked to identify perceived enablers and barriers to CNCP care and how the care of patients with CNCP may be improved. METHODS The study utilised a qualitative descriptive methodology. General practice in Western Australia. The sample was purposive with 12 Australian GPs from predominantly metropolitan locations and with experience in managing CNCP. Semi structured interviews were conducted. Each interview was of 45-60min duration. All interviews were audio recorded and transcribed using a secure transcription service. Thematic analysis developed themes inductively and deductively. RESULTS Themes emerged regarding: the importance of a holistic and personalised approach; the important role of a coordinating GP; the need for an evidence-based approach to opioid management; concerns relating to access to multidisciplinary services; the importance of clinician and patient education regarding CNCP; and an acknowledgement of the challenges for doctors and patients in managing CNCP. CONCLUSIONS Currently, the management of CNCP in Australia is challenging. Notable challenges include: difficulties with continuity of patient care; challenges with patient expectations of treatment, in particular opioid medications; difficulty with access to the health services required to enable holistic care; and the need for improved pain education in the community. The breadth of these challenges suggests there is a need for supportive organisational and structural considerations in the healthcare system to enable optimal care of CNCP in the community.
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Affiliation(s)
- Lucy Gilkes
- School of Medicine, The University of Notre Dame, PO Box 1225, Fremantle, WA 6959, Australia
| | - Caroline Bulsara
- School of Medicine, The University of Notre Dame, PO Box 1225, Fremantle, WA 6959, Australia
| | - Nahal Mavaddat
- School of Medicine, Division of General Practice, University of Western Australia, Crawley, WA, Australia
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Rathomi HS, Dale T, Mavaddat N, Thompson SC. General Practitioners' Knowledge, Attitudes, and Practices of Dietary Advice for Weight Control in Their Overweight Patients: A Scoping Review. Nutrients 2023; 15:2920. [PMID: 37447247 PMCID: PMC10346254 DOI: 10.3390/nu15132920] [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: 05/29/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This scoping review assessed the knowledge, attitudes, and practices of general practitioners (GPs) regarding dietary advice for weight management. A systematic search of PubMed, EMBASE, CINAHL, and MEDLINE was conducted for any qualitative, quantitative, and mixed-methods studies published in the past five years that informed GPs' dietary advice for weight control. Thirteen studies were included in the analysis after screening 881 papers. These studies tended to focus mostly on GPs' practices rather than their knowledge and attitudes. The most frequently mentioned dietary advice was to reduce calorie intake; however, 32 different types of dietary advice were identified in the literature, including approaches such as intermittent fasting and a ketogenic diet that are not recommended in current guidelines. GPs showed varying levels of knowledge and attitudes regarding the best dietary advice for patients. Further research is needed to better understand GP perspectives, with efforts to assist GPs in providing tailored advice based on the latest evidence to improve patient outcomes required.
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Affiliation(s)
- Hilmi S. Rathomi
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
- Faculty of Medicine, Universitas Islam Bandung, Bandung 40116, Indonesia
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
| | - Tanya Dale
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
| | - Nahal Mavaddat
- UWA Medical School, University of Western Australia, Crawley, WA 6009, Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
- School of Allied Health, University of Western Australia, Crawley, WA 6009, Australia
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7
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Carr SE, Harris A, Scott K, Ani-Amponsah M, Hooker C, Phillips B, Noya F, Mavaddat N, Vuillermin DM, Reid S, Brett-MacLean P. InspirE5: a participatory, internationally informed framework for health humanities curricula in health professions education. BMC Med Educ 2022; 22:490. [PMID: 35739520 PMCID: PMC9225807 DOI: 10.1186/s12909-022-03551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Reporting on the effect of health humanities teaching in health professions education courses to facilitate sharing and mutual exchange internationally, and the generation of a more interconnected body of evidence surrounding health humanities curricula is needed. This study asked, what could an internationally informed curriculum and evaluation framework for the implementation of health humanities for health professions education look like? METHODS The participatory action research approach applied was based on three iterative phases 1. Perspective sharing and collaboration building. 2. Evidence gathering 3. Development of an internationally relevant curriculum and evaluation framework for health humanities. Over 2 years, a series of online meetings, virtual workshops and follow up communications resulted in the production of the curriculum framework. RESULTS Following the perspective sharing and evidence gathering, the InspirE5 model of curriculum design and evaluation framework for health humanities in health professions education was developed. Five principal foci shaped the design of the framework. ENVIRONMENT Learning and political environment surrounding the program. Expectations: Graduate capabilities that are clearly articulated for all, integrated into core curricula and relevant to graduate destinations and associated professional standards. EXPERIENCE Learning and teaching experience that supports learners' achievement of the stated graduate capabilities. EVIDENCE Assessment of learning (formative and/or summative) with feedback for learners around the development of capabilities. Enhancement: Program evaluation of the students and teachers learning experiences and achievement. In all, 11 Graduate Capabilities for Health Humanities were suggested along with a summary of common core content and guiding principles for assessment of health humanities learning. DISCUSSION Concern about objectifying, reductive biomedical approaches to health professions education has led to a growing expansion of health humanities teaching and learning around the world. The InspirE5 curriculum and evaluation framework provides a foundation for a standardised approach to describe or compare health humanities education in different contexts and across a range of health professions courses and may be adapted around the world to progress health humanities education.
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Affiliation(s)
- Sandra E Carr
- Health Professions Education, University of Western Australia, Perth, Australia.
| | - Anna Harris
- Faculty of Arts and Social Sciences, Maastricht University, Maastricht, Netherlands
| | - Karen Scott
- Medical School, University of Sydney, Sydney, Australia
| | | | - Claire Hooker
- Medical School, University of Sydney, Sydney, Australia
| | - Brid Phillips
- Health Professions Education, University of Western Australia, Perth, Australia
| | - Farah Noya
- Health Professions Education, University of Western Australia, Perth, Australia
- Medical School, University of Pattimura Indonesia, Nusaniwe, Indonesia
| | - Nahal Mavaddat
- Medical School, University of Western Australia, Perth, Australia
| | | | - Steve Reid
- University of Cape Town, Cape Town, South Africa
| | - Pamela Brett-MacLean
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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8
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Carr SE, Noya F, Phillips B, Harris A, Scott K, Hooker C, Mavaddat N, Ani-Amponsah M, Vuillermin DM, Reid S, Brett-MacLean P. Health Humanities curriculum and evaluation in health professions education: a scoping review. BMC Med Educ 2021; 21:568. [PMID: 34753482 PMCID: PMC8579562 DOI: 10.1186/s12909-021-03002-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/27/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND The articulation of learning goals, processes and outcomes related to health humanities teaching currently lacks comparability of curricula and outcomes, and requires synthesis to provide a basis for developing a curriculum and evaluation framework for health humanities teaching and learning. This scoping review sought to answer how and why the health humanities are used in health professions education. It also sought to explore how health humanities curricula are evaluated and whether the programme evaluation aligns with the desired learning outcomes. METHODS A focused scoping review of qualitative and mixed-methods studies that included the influence of integrated health humanities curricula in pre-registration health professions education with programme evaluate of outcomes was completed. Studies of students not enrolled in a pre-registration course, with only ad-hoc health humanities learning experiences that were not assessed or evaluated were excluded. Four databases were searched (CINAHL), (ERIC), PubMed, and Medline. RESULTS The search over a 5 year period, identified 8621 publications. Title and abstract screening, followed by full-text screening, resulted in 24 articles selected for inclusion. Learning outcomes, learning activities and evaluation data were extracted from each included publication. DISCUSSION Reported health humanities curricula focused on developing students' capacity for perspective, reflexivity, self- reflection and person-centred approaches to communication. However, the learning outcomes were not consistently described, identifying a limited capacity to compare health humanities curricula across programmes. A set of clearly stated generic capabilities or outcomes from learning in health humanities would be a helpful next step for benchmarking, clarification and comparison of evaluation strategy.
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Affiliation(s)
- Sandra E Carr
- Health Professions Education, University of Western Australia, Perth, Australia.
| | - Farah Noya
- Health Professions Education, University of Western Australia, Perth, Australia
| | - Brid Phillips
- Health Professions Education, University of Western Australia, Perth, Australia
| | - Anna Harris
- Faculty of Arts and Social Sciences, Maastricht University, Maastricht, Netherlands
| | - Karen Scott
- Medical School, University of Sydney, Sydney, Australia
| | - Claire Hooker
- Medical School, University of Sydney, Sydney, Australia
| | - Nahal Mavaddat
- Medical School, University of Western Australia, Perth, Australia
| | | | | | - Steve Reid
- University of Cape Town, Cape Town, South Africa
| | - Pamela Brett-MacLean
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Mavaddat N, Sadler E, Lim L, Williams K, Warburton E, Kinmonth AL, Mckevitt C, Mant J. What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK. BMC Neurol 2021; 21:315. [PMID: 34388983 PMCID: PMC8362227 DOI: 10.1186/s12883-021-02338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Levels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors. Methods Face to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’. Results Individuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals. Conclusions The disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02338-x.
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Affiliation(s)
- Nahal Mavaddat
- School of Medicine, Division of General Practice, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.
| | - Euan Sadler
- Department of Nursing, Midwifery and Health, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lisa Lim
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Kate Williams
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Elizabeth Warburton
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ann Louise Kinmonth
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Chris Mckevitt
- School of Population Health and Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
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10
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Kramer I, Hooning MJ, Mavaddat N, Canisius S, Keeman R, van den Broek AJ, Steyerberg E, Hauptmann M, Pharoah PD, Easton DF, Hall P, Schmidt MK. Abstract P1-09-04: Association between a breast cancer polygenic risk score and contralateral breast cancer risk. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-09-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Breast cancer patients are at significant risk of a second contralateral, breast cancer (CBC). Identification of women at high or low CBC risk could improve patient management decisions. Previous research has shown that breast cancer-associated single nucleotide polymorphisms (SNPs) summarized in a polygenic risk score (PRS) predict the risk of a first breast cancer with an odds ratio (OR) per 1 SD of 1.55 (95% confidence interval (95%CI)=1.52-1.58) (77-SNP PRS). The aim of this study was to evaluate the association between a recently developed PRS and CBC risk.
Methods
We identified 19 studies from the Breast Cancer Association Consortium (BCAC) with follow-up information on participating patients and at least 10 patients diagnosed with CBC. This included 38,228 females of European ancestry diagnosed with first invasive breast cancer since 1990. Genotyping was done using the iCOGS array or OncoArray, with genotypes for SNPs not on the arrays estimated by imputation. We used a 313-SNP PRS, optimized for prediction of overall (first) breast cancer in the BCAC dataset. Metachronous CBC risk by PRS was quantified using univariable and multivariable Cox regression analyses stratified by country and adjusted for multiple patient, tumor, and treatment characteristics. We assessed PRS interaction with age, family history, adjuvant systemic therapy, and ER-status.
Results
Median time to develop a CBC (N=1,046) after a first breast cancer was 5.8 years (range 0.3-21.9). Higher PRS was associated with increased CBC risk: hazard ratio (HR) per 1 SD=1.31 (95%CI=1.23-1.39). Patients in the highest and lowest 5% of the PRS had 1.95 fold and 0.67 fold risks of CBC, respectively, compared with patients in the middle quintile. Adjustments for age, year of diagnosis, family history, tumor size, nodal status, ER-status, or treatment (chemotherapy, endocrine therapy, radiotherapy) did not substantially alter these results. We found an interaction with age at first breast cancer diagnosis (Pinteraction=.002); the PRS was associated with an increased CBC risk for patients aged ≥40 years (HR=1.37, 95%CI=1.28-1.47), but not for patients <40 years (HR=1.06, 95%CI=0.93-1.21).
Conclusion
The PRS is predictive for the development of CBC in patients ≥40 years at first breast cancer diagnosis. For this group, the PRS could be incorporated in CBC risk prediction models to help define high and low risk patients, and hence optimize screening and treatment strategies.
Citation Format: Kramer I, Hooning MJ, Breast Cancer Association Consortium (BCAC), Mavaddat N, Canisius S, Keeman R, van den Broek AJ, Steyerberg E, Hauptmann M, Pharoah PD, Easton DF, Hall P, Schmidt MK. Association between a breast cancer polygenic risk score and contralateral breast cancer risk [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-09-04.
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Affiliation(s)
- I Kramer
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - MJ Hooning
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - N Mavaddat
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - S Canisius
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - R Keeman
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - AJ van den Broek
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - E Steyerberg
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - M Hauptmann
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - PD Pharoah
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - DF Easton
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - P Hall
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
| | - MK Schmidt
- Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; University of Cambridge, Cambridge, United Kingdom; Leiden University Medical Centre, Leiden, Netherlands; Karolinska Institutet, Stockholm, Sweden; South General Hospital, Stockholm, Sweden
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11
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Mavaddat N, Sadler E, Lim L, Williams K, Warburton E, Kinmonth AL, Mant J, Burt J, McKevitt C. Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom. BMC Geriatr 2018; 18:81. [PMID: 29609550 PMCID: PMC5879795 DOI: 10.1186/s12877-018-0765-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
Abstract
Background Self-rated health predicts health outcomes independently of levels of disability or mood. Little is known about what influences the subjective health experience of stroke survivors. Our aim was to investigate stroke survivors’ perceptions of self-rated health, with the intention of informing the design of interventions that may improve their subjective health experience. Methods We conducted semi-structured interviews with a purposive sample of 28 stroke survivors recruited from a stroke unit and follow-up outpatient clinic, 4–6 months after stroke, to explore what factors are perceived to be part of self-rated health in the early stages of recovery. Qualitative data were analysed using a thematic analysis approach to identify underlying themes. Results Participants’ accounts show that stroke survivors’ perceptions of self-rated health are multifactorial, comprising physical, psychological and social components. Views on future recovery after stroke play a role in present health experience and are shaped by psychosocial resources that are influenced by past experiences of ill-health, dispositional outlook such as degree of optimism, a sense of control and views on ageing. Conclusions Severity of physical limitations alone does not influence perceptions of self-rated health among stroke survivors. Self-rated health in stroke survivors is a multidimensional construct shaped by changes in health status occurring after the stroke, individual characteristics and social context. Understanding the factors stroke survivors themselves associate with better health will inform the development of effective approaches to improve rehabilitation and recovery after stroke.
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Affiliation(s)
- N Mavaddat
- Division of General Practice, School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia. .,Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK.
| | - E Sadler
- Health Service & Population Research Department, King's Improvement Science and Centre for Implementation Science, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - L Lim
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - K Williams
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - E Warburton
- Department of Clinical Neurosciences, University of Cambridge, Neurology Unit, R3, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - A L Kinmonth
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - J Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - J Burt
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK
| | - C McKevitt
- School of Population Health Sciences, King's College London, Addison House, London, SE1 1UL, UK
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12
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Liira H, Mavaddat N, Eineluoto M, Kautiainen H, Strandberg T, Suominen M, Laakkonen ML, Eloniemi-Sulkava U, Sintonen H, Pitkälä K. Health-related quality of life as a predictor of mortality in heterogeneous samples of older adults. Eur Geriatr Med 2018; 9:227-234. [PMID: 34654255 DOI: 10.1007/s41999-018-0029-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is associated with survival in older people with multimorbidities and disabilities. However, older people differ in their characteristics, and less is known about whether HRQoL predicts survival in heterogeneous older population samples differing in their functional, cognitive, psychological or social disabilities. The aim of this study was to explore HRQoL in heterogeneous samples of older men and women, and to explore its prognostic significance for mortality. METHODS We analysed combined individual patient data from eight heterogeneous study samples all of which were assessed with the same methods. We used 15D, a generic, comprehensive instrument for measuring HRQoL, which provides a single index in addition to a profile. Two-year mortality was retrieved from central registers. RESULTS Health-related quality of life measurements with 15D were available for 3153 older adults. The mean HRQoL was highest among older businessmen (0.878) and lowest among nursing home residents (0.601). 15D predicted independently and significantly the 2-year survival in the total sample [hazard ratio (HR)/SD 0.44, 95% CI 0.40-0.48)]. However, 15D did not predict mortality in samples of spousal caregivers, lonely older adults and cardiovascular patients. CONCLUSIONS 15D captures health and disability factors associated with prognosis whereas in older populations suffering from psychological and social impairments such as caregiver burden or loneliness HRQoL may not reflect their health risks.
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Affiliation(s)
- Helena Liira
- Department of General Practice, University of Helsinki, Helsinki, Finland. .,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland. .,General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia.
| | - Nahal Mavaddat
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
| | - Maija Eineluoto
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Timo Strandberg
- Geriatric Clinic, Department of Medicine, University of Helsinki, Helsinki, Finland.,Institute of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | - Merja Suominen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | | | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kaisu Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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13
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Mavaddat N, Ross S, Dobbin A, Williams K, Graffy J, Mant J. Training in positivity for stroke? A qualitative study of acceptability of use of Positive Mental Training (PosMT) as a tool to assist stroke survivors with post-stroke psychological problems and in coping with rehabilitation. NeuroRehabilitation 2017; 40:259-270. [PMID: 28106572 DOI: 10.3233/nre-161411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/15/2022]
Abstract
BACKGROUND Post-stroke psychological problems predict poor recovery, while positive affect enables patients to focus on rehabilitation and may improve functional outcomes. Positive Mental Training (PosMT), a guided self-help audio shows promise as a tool in promoting positivity, optimism and resilience. OBJECTIVE To assess acceptability of training in positivity with PosMT for prevention and management of post-stroke psychological problems and to help with coping with rehabilitation. METHODS A modified PosMT tool consisted of 12 audio tracks each lasting 18 minutes, one listened to every day for a week. Survivors and carers were asked to listen for 4 weeks, but could volunteer to listen for more. Interviews took place about experiences of the tool after 4 and 12 weeks. SUBJECTS 10 stroke survivors and 5 carers from Stroke Support Groups in the UK. RESULTS Three stroke survivors did not engage with the tool. The remainder reported positive physical and psychological benefits including improved relaxation, better sleep and reduced anxiety after four weeks. Survivors who completed the programme gained a positive outlook on the future, increased motivation, confidence and ability to cope with rehabilitation. No adverse effects were reported. CONCLUSIONS The PosMT shows potential as a tool for coping with rehabilitation and overcoming post-stroke psychological problems including anxiety and depression.
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Affiliation(s)
- Nahal Mavaddat
- Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, UK.,School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Australia
| | | | - Alastair Dobbin
- School of Clinical Sciences and Community Health, University of Edinburgh, UK
| | - Kate Williams
- Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, UK
| | - Jonathan Graffy
- Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, UK
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14
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Mavaddat N, van der Linde R, Parker R, Savva G, Kinmonth AL, Brayne C, Mant J. Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population. PLoS One 2016; 11:e0150178. [PMID: 26928666 PMCID: PMC4771829 DOI: 10.1371/journal.pone.0150178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/10/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke. METHODS MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years. RESULTS 11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)). CONCLUSIONS Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.
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Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN
- * E-mail:
| | - Rianne van der Linde
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR
| | - Richard Parker
- Health Services Research Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - George Savva
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom, NR4 7TJ
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN
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15
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Mavaddat N, Valderas JM, van der Linde R, Khaw KT, Kinmonth AL. Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study. BMC Fam Pract 2014; 15:185. [PMID: 25421440 PMCID: PMC4245775 DOI: 10.1186/s12875-014-0185-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/28/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated health in a middle-aged and older population in England, and to determine whether any association is mediated by depression and other psychosocial factors. METHODS 25 268 individuals aged 39 to 79 years recruited from general practice registers in the European Prospective Investigation of Cancer (EPIC-Norfolk) study, completed a survey including self-rated health, psychosocial function and presence of common physical chronic conditions (cancer, stroke, heart attack, diabetes, asthma/bronchitis and arthritis). Logistic regression models determined odds of "moderate/poor" compared to "good/excellent" health by condition and number of conditions adjusting for psychosocial measures. RESULTS One-third (8252) reported one, around 7.5% (1899) two, and around 1% (194) three or more conditions. Odds of "moderate/poor" self-rated health worsened with increasing number of conditions (one (OR = 1.3(1.2-1.4)) versus three or more (OR = 3.4(2.3-5.1)), and were highest where there was comorbidity with stroke (OR = 8.7(4.6-16.7)) or heart attack (OR = 8.5(5.3-13.6)). Psychosocial measures did not explain the association between chronic diseases and multimorbidity with self-rated health.The relationship of multimorbidity with self-rated health was particularly strong in men compared to women (three or more conditions: men (OR = 5.2(3.0-8.9)), women OR = 2.1(1.1-3.9)). CONCLUSIONS Self-rated health provides a simple, integrative patient-centred assessment for evaluation of illness in the context of multiple chronic disease diagnoses. Those registering in general practice in particular men with three or more diseases or those with cardiovascular comorbidities and with poorer self-rated health may warrant further assessment and intervention to improve their physical and subjective health.
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Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.
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16
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Mavaddat N, Roalfe A, Fletcher K, Lip GYH, Hobbs FDR, Fitzmaurice D, Mant J. Response to letter regarding article, "warfarin versus aspirin for prevention of cognitive decline in atrial fibrillation: randomized controlled trial (birmingham atrial fibrillation treatment of the aged study)". Stroke 2014; 45:e192. [PMID: 25096732 DOI: 10.1161/strokeaha.114.006301] [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: 11/16/2022]
Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Cambridge, United Kingdom
| | - Andrea Roalfe
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kate Fletcher
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Diseases, City Hospital, Birmingham, United Kingdom
| | - F D Richard Hobbs
- Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom
| | - David Fitzmaurice
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Cambridge, United Kingdom
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17
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Mavaddat N, Roalfe A, Fletcher K, Lip GY, Hobbs FR, Fitzmaurice D, Mant J. Warfarin Versus Aspirin for Prevention of Cognitive Decline in Atrial Fibrillation. Stroke 2014; 45:1381-6. [DOI: 10.1161/strokeaha.113.004009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nahal Mavaddat
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
| | - Andrea Roalfe
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
| | - Kate Fletcher
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
| | - Gregory Y.H. Lip
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
| | - F.D. Richard Hobbs
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
| | - David Fitzmaurice
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
| | - Jonathan Mant
- From the Primary Care Unit, Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (N.M., J.M.); Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (A.R., K.F., D.F.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University
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18
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Lee AJ, Cunningham AP, Kuchenbaecker KB, Mavaddat N, Easton DF, Antoniou AC. BOADICEA breast cancer risk prediction model: updates to cancer incidences, tumour pathology and web interface. Br J Cancer 2014; 110:535-45. [PMID: 24346285 PMCID: PMC3899766 DOI: 10.1038/bjc.2013.730] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) is a risk prediction model that is used to compute probabilities of carrying mutations in the high-risk breast and ovarian cancer susceptibility genes BRCA1 and BRCA2, and to estimate the future risks of developing breast or ovarian cancer. In this paper, we describe updates to the BOADICEA model that extend its capabilities, make it easier to use in a clinical setting and yield more accurate predictions. METHODS We describe: (1) updates to the statistical model to include cancer incidences from multiple populations; (2) updates to the distributions of tumour pathology characteristics using new data on BRCA1 and BRCA2 mutation carriers and women with breast cancer from the general population; (3) improvements to the computational efficiency of the algorithm so that risk calculations now run substantially faster; and (4) updates to the model's web interface to accommodate these new features and to make it easier to use in a clinical setting. RESULTS We present results derived using the updated model, and demonstrate that the changes have a significant impact on risk predictions. CONCLUSION All updates have been implemented in a new version of the BOADICEA web interface that is now available for general use: http://ccge.medschl.cam.ac.uk/boadicea/.
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Affiliation(s)
- A J Lee
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - A P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - K B Kuchenbaecker
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - N Mavaddat
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - D F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - A C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - The Consortium of Investigators of Modifiers of BRCA1/21
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - The Breast Cancer Association Consortium1
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
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19
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Mavaddat N, Van der Linde R, Savva GM, Brayne C, Mant J. What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study. BMC Geriatr 2013; 13:85. [PMID: 23968389 PMCID: PMC3847649 DOI: 10.1186/1471-2318-13-85] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 08/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS). METHODS The MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke. RESULTS After excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not "getting out and about" (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not "getting out and about" (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated health irrespective of stroke status. CONCLUSIONS Self-rated health is determined by a range of psychological and social factors in addition to disability in older patients with stroke. Addressing social integration and mobility out of the home is an important element of rehabilitation for older people with stroke as well as those without.
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Affiliation(s)
- Nahal Mavaddat
- Department of Public Health and Primary Care, University of Cambridge Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Rianne Van der Linde
- Department of Public Health and Primary Care, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - George M Savva
- School of Nursing Sciences, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
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20
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van der Linde RM, Mavaddat N, Luben R, Brayne C, Simmons RK, Khaw KT, Kinmonth AL. Self-rated health and cardiovascular disease incidence: results from a longitudinal population-based cohort in Norfolk, UK. PLoS One 2013; 8:e65290. [PMID: 23755212 PMCID: PMC3670935 DOI: 10.1371/journal.pone.0065290] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/24/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics. METHODS Population-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39-74 years without prevalent CVD attended a baseline health examination (1993-1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale--excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors. RESULTS Baseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8-4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9-3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4-4.4). Associations were strong for both fatal and non-fatal events and remained strong over time. CONCLUSIONS SRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.
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Affiliation(s)
- Rianne M van der Linde
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom.
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Mavaddat N, Savva GM, Lasserson DS, Giles MF, Brayne C, Mant J. Transient neurological symptoms in the older population: report of a prospective cohort study--the Medical Research Council Cognitive Function and Ageing Study (CFAS). BMJ Open 2013; 3:bmjopen-2013-003195. [PMID: 23883888 PMCID: PMC3731761 DOI: 10.1136/bmjopen-2013-003195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Transient ischaemic attack (TIA) is a recognised risk factor for stroke in the older population requiring timely assessment and treatment by a specialist. The need for such TIA services is driven by the epidemiology of transient neurological symptoms, which may not be caused by TIA. We report prevalence and incidence of transient neurological symptoms in a large UK cohort study of older people. DESIGN Longitudinal cohort study SETTING The Medical Research Council Cognitive Function and Aging Study (CFAS) is a population representative study based on six centres across England and Wales. PARTICIPANTS Random samples of people in their 65th year were obtained from Family Health Service Authority lists. The participation rate was 80% (n=13 004). Interview at baseline included questions about stroke and three transient neurological symptoms, repeated in a subsample after 2 years. Patients were flagged for mortality. MAIN OUTCOME MEASURES Prevalence and 2-year incidence of transient neurological symptoms. RESULTS In 11 903 participants without a history of stroke, 271 (2.3%) reported transient problems with speech, 872 (7.6%) with sight and 596 (5.1%) weakness in a limb with 1456 (12.7%) reporting at least one symptom. Of those reinterviewed (n=6748), 675 (9.8%) reported at least one symptom over 2 years. CONCLUSIONS Lifetime prevalence and incidence of transient neurological symptoms in people aged 65 years and over is high and is substantially greater than the incidence of TIA in hospital-based and population-based studies. These high rates of transient neurological symptoms in the community in the older population should be considered when planning TIA services.
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Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge, UK
| | - George M Savva
- School of Nursing Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Daniel S Lasserson
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew F Giles
- Stroke Prevention Research Unit, Department of Clinical Neurology,John Radcliffe Hospital, NIHR Biomedical Research Centre, Oxford University,Oxford, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge, UK
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Edwards D, Cohn SR, Mavaddat N, Virdee SK, Lasserson D, Milner S, Giles M, McManus R, Mant J. Varying uses of the ABCD2 scoring system in primary and secondary care: a qualitative study. BMJ Open 2012. [PMID: 23194953 PMCID: PMC3532987 DOI: 10.1136/bmjopen-2012-001501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the usage of the ABCD2 risk stratification score by general practitioners (GPs) and hospital staff during the referral of patients with suspected transient ischaemic attack (TIA) or minor stroke. DESIGN Qualitative study using semistructured interviews. SETTING Nine general practices and two hospital sites in England (Birmingham and Cambridge). PARTICIPANTS Nine GPs and nine hospital staff (two consultants, four nurses, two ultrasonographers and one administrator). RESULTS In both sites, clinicians used a referral proforma based around the ABCD2 scoring system for a range of purposes including self-education, to assist emphasising urgency to the patient, as a referral pathway facilitator and as a diagnostic tool. Negative views of its role included potential medicolegal threats, that it was a barrier to appropriate care, and led to misdiagnoses. Despite having differing uses by different clinicians, the ABCD2 proforma was the central means of interprofessional communication in TIA referrals across both sites. CONCLUSIONS Understanding how prediction rules are used in practice is key to determining their impact on processes of care and clinical outcomes. In practice, GPs and their colleagues use the ABCD2 score in subtly different ways and it functions as a 'boundary object' by both accommodating these multiple purposes, yet still successfully aiding communication between them.
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Affiliation(s)
- Duncan Edwards
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon R Cohn
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nahal Mavaddat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Satnam K Virdee
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Lasserson
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Siobhan Milner
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Matthew Giles
- Stroke Prevention Research Unit, University of Oxford, Oxford, UK
| | - Richard McManus
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Abel G, Mavaddat N, Elliott M, Lyratzopoulos Y, Roland M. Primary care experience of people with long-standing psychological problems: evidence from a national survey in England. Int Rev Psychiatry 2011; 23:2-9. [PMID: 21338292 DOI: 10.3109/09540261.2010.545985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
People with psychological problems face important challenges in obtaining high quality healthcare. We review evidence on the experience of primary care by people with mental health problems, including reasons why their care may be reported as worse than other groups. In the 2009 English GP Patient Survey, 5.7% of 2,163,456 respondents reported that they had a long-standing psychological or emotional condition. In an unadjusted regression model, respondents with long-standing emotional or psychological conditions rated their experiences worse than people without such problems, with scores which were up to 3 percentage points lower on individual survey items. However, after controlling for age, gender, ethnicity, deprivation and self-reported general health, people with long-standing psychological or emotional problems had slightly higher scores on 16 out of the 18 survey items, though with the equivalent of less than 2 percentage points difference for most items. Part of the reason for the difference between the adjusted and unadjusted models was the high prevalence of self-reported 'fair' or 'poor' general health among people who reported psychological problems. Overall, the results suggest that people with long-standing psychological and emotional conditions have similar experiences of English primary care compared to the rest of the population.
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Affiliation(s)
- Gary Abel
- Cambridge Centre for Health Services Research, University of Cambridge, UK
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Abstract
INTRODUCTION There are no validated measures available for use in assessing patients' views of the quality of primary care mental healthcare at practice level. METHODS The Patient Experience Questionnaire was developed through an initial information-gathering phase with focus groups followed by questionnaire development and validation with patients in nine general practices in the West Midlands. Statistical analyses were performed to test the internal consistency, validity and reliability of the questionnaire. RESULTS Fifty-six patients participated in focus groups, and 241 patients completed the questionnaire. The 20-item questionnaire had good internal consistency (Cronbach alpha = 0.94) and test-retest reliability (r = 0.859; p = 0.01). DISCUSSION The Patient Experience Questionnaire appears to be a valid and reliable instrument, able to assess patients' views of the quality of primary care mental healthcare at practice level.
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Affiliation(s)
- N Mavaddat
- Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK
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Abstract
Improvement in survival of patients with cardiovascular diseases and an ageing population mean that management of cardiovascular conditions remains an important challenge for primary care. Traditionally cardiovascular research has been based largely in secondary or tertiary care settings. The majority of care for people with cardiovascular diseases, however, takes place in the community and within primary care. In recent years, progress has been made in conducting cardiovascular research within primary care itself. A number of different methodologies including large prospective cohort studies, randomised controlled trials, and qualitative designs have been used to inform optimal cardiovascular disease management for those in the community. Some of the recent research evidence in primary care in three areas of cardiovascular medicine--atrial fibrillation, heart failure, and cardiovascular risk prediction and management--are discussed in this review. These seek to demonstrate the contribution made by primary care research to the management of cardiovascular diseases.
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Affiliation(s)
- N Mavaddat
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
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Mavaddat N, Kinmonth AL, Sanderson S, Surtees P, Bingham S, Khaw KT. What determines Self-Rated Health (SRH)? A cross-sectional study of SF-36 health domains in the EPIC-Norfolk cohort. J Epidemiol Community Health 2010; 65:800-6. [PMID: 20551149 DOI: 10.1136/jech.2009.090845] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Self-Rated Health (SRH) as assessed by a single-item measure is an independent predictor of health outcomes. However, it remains uncertain which elements of the subjective health experience it most strongly captures. In view of its ability to predict outcomes, elucidation of what determines SRH is potentially important in the provision of services. This study aimed to determine the extent to which dimensions of physical, mental and social functioning are associated with SRH. METHODS We studied 20,853 men and women aged 39-79 years from a population-based cohort study (European Prospective Investigation of Cancer study) who had completed an SRH (Short Form (SF)-1) measure and SF-36 questionnaire. SF-36 subscales were used to quantify dimensions of health best predicting poor or fair SRH within a logistic regression model. RESULTS In multivariate models adjusting for age, gender, social class, medical conditions and depression, all subscales of the SF-36 were independently associated with SRH, with the Physical Functioning subscale more strongly associated with poor or fair compared with excellent, very good or good health (OR 3.7 (95% CI 3.3 to 4.1)) than Mental Health (OR 1.4 (95% CI 1.2 to 1.5)) or Social Functioning subscales (OR 1.8 (95% CI 1.6 to 2.0)) for those below and above the median. CONCLUSION This study confirms that physical functioning is more strongly associated with SRH than mental health and social functioning, even where the relative associations between each dimension and SRH may be expected to differ, such as in those with depression. It suggests that the way people take account of physical, mental and social dimensions of function when rating their health may be relatively stable across groups.
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Affiliation(s)
- Nahal Mavaddat
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
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Keenan S, Mavaddat N, Iddon J, Pickard JD, Sahakian BJ. Effects of methylphenidate on cognition and apathy in normal pressure hydrocephalus: a case study and review. Br J Neurosurg 2005; 19:46-50. [PMID: 16147583 DOI: 10.1080/02688690500080893] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The psychostimulant methylphenidate has been previously shown to improve cognitive performance in both normal control volunteers and patient populations. In the present case study, the effects of methylphenidate on cognitive and behavioural function were examined in a single patient with idiopathic normal pressure hydrocephalus (NPH) who had undergone ventriculoperitoneal shunting. A double-blind placebo-controlled ABBA drug design was employed, with the administration of two different doses of methylphenidate followed by neuropsychological assessment on a number of psychometric tests and cognitive tasks drawn from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methylphenidate produced a dose-dependent positive improvement in behavioural measures in the patient associated with a reduction in apathy. It also had a dose-independent enhancing effect on performance of a Spatial Recognition task. These findings require replication in a large sample of patients to determine whether methylphenidate may prove to be generally useful in enhancing cognition and reducing apathy in normal pressure hydrocephalus.
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Affiliation(s)
- S Keenan
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Mavaddat N. NEUROPSYCHOLOGICAL SEQUELAE OF SUBARACHNOID HEMORRHAGE AND ITS TREATMENT.: By B. O. Hitter. 2000. New York: Springer-Verlag. Price $78. Pp. 200. ISBN 3-21183-442-7. Brain 2001. [DOI: 10.1093/brain/124.8.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
In this study, 2 distinct populations of mature dendritic cells (DCs) were identified in the human thymus. The major population is CD11b-, CD11c+, and CD45RO(low) and does not express myeloid-related markers. It displays all the characteristics of mature DCs with a typical dendritic morphology, high surface levels of HLA-DR, CD40, CD83, and CD86, and expression of DC-lysosome-associated membrane glycoprotein messenger RNA (mRNA). In addition, CD11b- thymic DCs do not express macrophage inflammatory protein-1alpha (MIP-1alpha) mRNA, but express thymus-expressed chemokine (TECK) mRNA and are able to secrete bioactive interleukin 12 (IL-12) upon stimulation. In contrast, the minor and variable thymic DC population is CD11b+, CD11c(high), and CD45RO(high) and comprises CD83+CD14- mature and CD83- CD14+ immature DCs. It expresses macrophage-colony stimulating factor receptor, MIP-1alpha mRNA and high amounts of decysin mRNA after CD40 activation, but does not express TECK and is a weak bioactive IL-12 producer. Also identified were the IL-3Ralpha(high) plasmacytoid cells, which are present in the thymic cortex and medulla. Upon culture with IL-3, granulocyte/macrophage-colony stimulating factor, and CD40 ligand, the plasmacytoid cells can adopt a phenotype resembling that of freshly isolated CD11b- thymic DCs. However, these plasmacytoid-derived DCs fail to secrete bioactive IL-12; therefore, conclusions cannot be made about a direct relation between thymic plasmacytoid cells and CD11b- DCs. Whereas CD11b+ thymic DCs appear to be related to tonsillar germinal-center DCs, the major CD11b- IL-12-secreting human thymus DC population has similarities to mouse CD11b- CD8+ DCs.
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Affiliation(s)
- S Vandenabeele
- The Walter and Eliza Hall Institute of Medical Research, P.O. Royal Melbourne Hospital, 3050 Melbourne, Victoria, Australia.
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Mavaddat N, Kirkpatrick PJ, Rogers RD, Sahakian BJ. Deficits in decision-making in patients with aneurysms of the anterior communicating artery. Brain 2000; 123 ( Pt 10):2109-17. [PMID: 11004127 DOI: 10.1093/brain/123.10.2109] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with aneurysmal subarachnoid haemorrhage (SAH) secondary to ruptured anterior communicating artery aneurysms (ACoA) often suffer from neuropsychological sequelae including personality and behavioural changes. In this study, 31 patients with ruptured aneurysms of the ACoA resulting in SAH [mean age 50.9 years, NART (National Adult Reading Test) IQ 108.7] were compared with a group of 29 normal controls (mean age 51.9 years, NART IQ 109.7) on a specific task of decision-making. A similar task has been imaged previously and shown to activate regions involving the ventromedial prefrontal cortex. Patients with ACoA rupture showed no significant difference from controls on the task in their speed or quality of decision-making. They did, however, exhibit increased risk-taking behaviour, placing higher bets in a measure of the task which involved choices between actions associated with differing magnitudes of reward and punishment. ACoA patients demonstrated true risk-taking behaviour as opposed to simple impulsivity. Such a deficit in decision-making may be a result of direct damage to the orbital prefrontal cortex itself (as a result of micro-ischaemia or infarction after ACoA aneurysmal rupture) or to a disconnection in the ventromedial circuits from distant or generalized brain damage.
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Affiliation(s)
- N Mavaddat
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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31
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Mavaddat N, Mason DW, Atkinson PD, Evans EJ, Gilbert RJ, Stuart DI, Fennelly JA, Barclay AN, Davis SJ, Brown MH. Signaling lymphocytic activation molecule (CDw150) is homophilic but self-associates with very low affinity. J Biol Chem 2000; 275:28100-9. [PMID: 10831600 DOI: 10.1074/jbc.m004117200] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Signaling lymphocytic activating molecule ((SLAM) CDw150) is a glycoprotein that belongs to the CD2 subset of the immunoglobulin superfamily and is expressed on the surface of activated T- and B-cells. It has been proposed that SLAM is homophilic and required for bidirectional signaling during T- and B-cell activation. Previous work has suggested that the affinity of SLAM self-association might be unusually high, undermining the concept that protein interactions mediating transient cell-cell contacts, such as those involving leukocytes, have to be weak in order that such contacts are readily reversible. Using surface plasmon resonance-based methods and analytical ultracentrifugation (AUC), we confirm that SLAM is homophilic. However, we also establish a new theoretical treatment of surface plasmon resonance-derived homophilic binding data, which indicates that SLAM-SLAM interactions (solution K(d) approximately 200 micrometer) are in fact considerably weaker than most other well characterized protein-protein interactions at the cell surface (solution K(d) approximately 0.4-20 micrometer), a conclusion that is supported by the AUC analysis. Whereas further analysis of the AUC data imply that SLAM could form "head to head" dimers spanning adjacent cells, the very low affinity raises important questions regarding the physiological role and/or properties of such interactions.
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Affiliation(s)
- N Mavaddat
- Sir William Dunn School of Pathology, The University of Oxford, Oxford OX1 3RE, United Kingdom
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Mehta MA, Owen AM, Sahakian BJ, Mavaddat N, Pickard JD, Robbins TW. Methylphenidate enhances working memory by modulating discrete frontal and parietal lobe regions in the human brain. J Neurosci 2000; 20:RC65. [PMID: 10704519 PMCID: PMC6772505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The indirect catecholamine agonist methylphenidate (Ritalin) is the drug treatment of choice in attention deficit/hyperactivity disorder (AD/HD), one of the most common behavioral disorders of childhood (DSM-IV), although symptoms may persist into adulthood. Methylphenidate can enhance cognitive performance in adults and children diagnosed with AD/HD (Kempton et al., 1999; Riordan et al., 1999) and also in normal human volunteers on tasks sensitive to frontal lobe damage, including aspects of spatial working memory (SWM) performance (Elliott et al., 1997). The present study investigated changes in regional cerebral blood flow (rCBF) induced by methylphenidate during performance of a self-ordered SWM task to define the neuroanatomical loci of the beneficial effect of the drug. The results show that the methylphenidate-induced improvements in working memory performance occur with task-related reductions in rCBF in the dorsolateral prefrontal cortex and posterior parietal cortex. The beneficial effects of methylphenidate on working memory were greatest in the subjects with lower baseline working memory capacity. This is to our knowledge the first demonstration of a localization of a drug-induced improvement in SWM performance in humans and has relevance for understanding the treatment of AD/HD.
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Affiliation(s)
- M A Mehta
- University of Cambridge, Department of Psychiatry, Cambridge, CB2 2QQ, United Kingdom
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Mavaddat N, Sahakian BJ, Hutchinson PJ, Kirkpatrick PJ. Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery. J Neurosurg 1999; 91:402-7. [PMID: 10470814 DOI: 10.3171/jns.1999.91.3.0402] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This study was conducted to define neuropsychological changes following operation for subarachnoid hemorrhage (SAH) caused by rupture of an anterior communicating artery (ACoA) aneurysm and to assess the influence of the timing of surgery to clip the aneurysm. METHODS Cognitive outcome was evaluated using the Cambridge Neuropsychological Test Automated Battery in patients with an ACoA aneurysm that had caused an SAH. Adult patients younger than 70 years of age who had achieved a favorable neurological outcome (Glasgow Outcome Scale scores of 4 or 5) were studied 6 to 24 months postsurgery. Patients were divided into early (Days 0-3) and late surgery groups (after Day 3) according to the timing of surgery after the ictus. Neuropsychological analysis was performed by reviewers who were blinded to the timing of surgery. Forty-seven patients whose mean age was 51.5 years were tested. They were compared with age- and intelligence quotient (IQ)matched controls by using premorbid IQ as estimated on the National Adult Reading Test. Patients showed deficiencies in several tasks of verbal fluency, pattern recognition, and spatial working memory; this profile of deficits was similar to that seen in patients who underwent temporal lobe excisions. However, there was no significant difference in cognitive performance between the early and late surgery groups. CONCLUSIONS After open surgery for ruptured ACoA aneurysms, patients who have achieved a favorable neurological outcome still exhibit significant cognitive deficits, primarily in tests sensitive to temporal lobe dysfunction. However, early surgery does not carry a higher risk of neuropsychological disability.
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Affiliation(s)
- N Mavaddat
- Department of Neurosurgery, Cambridge University, United Kingdom
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Crowley MP, Reich Z, Mavaddat N, Altman JD, Chien Y. The recognition of the nonclassical major histocompatibility complex (MHC) class I molecule, T10, by the gammadelta T cell, G8. J Exp Med 1997; 185:1223-30. [PMID: 9104809 PMCID: PMC2196254 DOI: 10.1084/jem.185.7.1223] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Recent studies have shown that many nonclassical major histocompatibility complex (MHC) (class 1b) molecules have distinct antigen-binding capabilities, including the binding of nonpeptide moieties and the binding of peptides that are different from those bound to classical MHC molecules. Here, we show that one of the H-2T region-encoded molecules, T10, when produced in Escherichia coli, can be folded in vitro with beta2-microglobulin (beta2m) to form a stable heterodimer in the absence of peptide or nonpeptide moieties. This heterodimer can be recognized by specific antibodies and is stimulatory to the gammadelta T cell clone, G8. Circular dichroism analysis indicates that T10/beta2m has structural features distinct from those of classical MHC class I molecules. These results suggest a new way for MHC-like molecules to adopt a peptide-free structure and to function in the immune system.
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Affiliation(s)
- M P Crowley
- Program in Immunology, Stanford University School of Medicine, California 94305, USA
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35
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Schild H, Mavaddat N, Litzenberger C, Ehrich EW, Davis MM, Bluestone JA, Matis L, Draper RK, Chien YH. The nature of major histocompatibility complex recognition by gamma delta T cells. Cell 1994; 76:29-37. [PMID: 8287478 DOI: 10.1016/0092-8674(94)90170-8] [Citation(s) in RCA: 310] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Despite intensive efforts, the general rules for gamma delta T cell recognition remain undefined. Here, we take advantage of the detailed knowledge of the molecular structure and biosynthetic pathways of major histocompatibility complex (MHC) molecules to analyze the recognition properties of the gamma delta T cell clones LBK5 (specific for the class II MHC, IEk) and G8 (specific for the nonclassical class I MHC, TL10b). We find that the activation of these clones requires neither class I nor class II antigen-processing and that peptides do not confer specificity. Epitope mapping also shows that the topology of gamma delta T cell receptor interaction with the MHC is distinct from that of alpha beta T cells. These results suggest that the molecular nature of gamma delta T cell recognition is fundamentally different than that of alpha beta T cells.
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Affiliation(s)
- H Schild
- Department of Microbiology and Immunology, Stanford University School of Medicine, California 94305
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Mavaddat N, Robinson BW, Rose AH, Manning LS, Garlepp MJ. An analysis of the relationship between gamma delta T cell receptor V gene usage and non-major histocompatibility complex-restricted cytotoxicity. Immunol Cell Biol 1993; 71 ( Pt 1):27-37. [PMID: 8436409 DOI: 10.1038/icb.1993.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
gamma delta T cells are capable of mediating non-major histocompatibility complex (MHC) restricted lysis of a variety of tumour cell lines. The mechanism of this lysis and its significance in tumour immunity are not clear. We have used a panel of five malignant mesothelioma (MM) cell lines, as well as standard tumour targets K562 and Daudi, to investigate some of the factors which could be involved in non-MHC restricted cytotoxicity mediated by gamma delta T cells. Individual MM cell lines, representing a panel of lines derived from a single cell type, varied in their susceptibility to lysis by gamma delta T cell clones. Individual gamma delta T cell clones also showed unique cytotoxic profiles, and differed in their cytotoxic potential. T cell receptor (TCR) V gamma gene usage correlated with the ability of clones to lyse Daudi or K562; clones lysing Daudi expressing V gamma 9 and clones lysing K562 expressing V gamma I subgroup genes. No strict correlation between V gamma and V delta gene usage and MM reactivity was, however, demonstrable. There was also no correlation between gamma delta T cell lysis of MM cell lines and the capacity of gamma delta T cells to produce interferon-gamma, tumour necrosis factor-alpha, interleukin-2 or interleukin-4, nor with their expression of CD8.
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Affiliation(s)
- N Mavaddat
- Department of Medicine, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands
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Garlepp MJ, Rose AH, Bowman RV, Mavaddat N, Dench J, Holt BJ, Baron-Hay M, Holt PG, Robinson BW. A clonal analysis of lung T cells derived by bronchoalveolar lavage of healthy individuals. Immunology 1992; 77:31-7. [PMID: 1356914 PMCID: PMC1421596] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The characteristics of the T-cell population in the healthy human lung have been investigated by analysing the properties of T-cell clones derived from bronchoalveolar lavage (BAL) samples and comparing them with T cells cloned from the blood of the same individuals. The proportions of CD4+ and CD8+ T cells in the starting populations from BAL and blood were similar although only 14% of BAL T cells were CD45RA+ compared to 70% of blood T cells. The precursor frequency of T-cell clones derived from BAL was less than from blood. The cytokine profiles [after phytohaemagglutinin (PHA) stimulation] of the clones derived from both sources were markedly different and these differences lay in the CD4+ population. BAL-derived CD4+ clones produced interferon-gamma (IFN-gamma) more frequently than did those from blood while blood-derived clones were more likely to produce interleukin-2 (IL-2) than those from BAL. IL-4 was produced by the majority of BAL- or blood-derived clones (93% and 88% respectively) either along with IFN-gamma (BAL) or IL-2 (blood). The cytokine profiles of BAL-derived T-cell clones are consistent with those derived from lung interstitium and suggest that the BAL T-cell populations reflect those in the lung wall. Whether the unique properties of lung T cells are acquired after leaving the blood or whether there is selective entry of T-cell subpopulations into the lung remains to be determined.
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Affiliation(s)
- M J Garlepp
- Department of Medicine, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands
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