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Mannix D, Holleran L, Cevikel P, McMorrow C, Nerney D, Phelan S, McDonald C, Hallahan B. A comparison of rate and methods of probable suicide for 2 years pre and post the onset of the COVID-19 pandemic. Ir J Psychol Med 2024:1-6. [PMID: 38229585 DOI: 10.1017/ipm.2023.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To examine and compare rates and methods of probable suicide in a Western region of Ireland during a 24 month period since the onset of the COVID-19 pandemic compared with a similar period immediately prior to the pandemic onset. METHODS Post-mortem reports between March 1st 2018 and February 29th 2020 were reviewed and compared with data from March 1st 2020 to February 28th 2022. Relevant demographic data, rates and methods of probable suicide and lifetime engagement with mental health services were compared across the two time points. RESULTS Identical rates of probable suicide (85 individuals at both time points) were demonstrated with no difference evident in the utilisation of violent compared to non-violent methods. CONCLUSIONS This study demonstrates that despite previous reports of increased rates of self-harm and some evidence of increased mental distress since the onset of the COVID-19 pandemic, no change in rates of or methods employed by individuals who died by probable suicide were evident in this geographical region.
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Affiliation(s)
- D Mannix
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - L Holleran
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - P Cevikel
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - C McMorrow
- Department of Pathology, University College hospital Galway, Galway, Ireland
| | - D Nerney
- Department of Pathology, University College hospital Galway, Galway, Ireland
| | - S Phelan
- Department of Pathology, University College hospital Galway, Galway, Ireland
| | - C McDonald
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - B Hallahan
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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Hart CN, Phelan S, Coffman DL, Jelalian E, Ventura AK, Hodges EA, Hawley N, Fisher JO, Wing RR. Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions. Appetite 2023; 180:106348. [PMID: 36272545 DOI: 10.1016/j.appet.2022.106348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.
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Affiliation(s)
- C N Hart
- Department of Social and Behavioral Sciences and Center for Obesity Research and Education, College of Public Health, Temple University, USA.
| | - S Phelan
- Department of Kinesiology & Public Health and Center for Health Research, California Polytechnic State University, USA
| | - D L Coffman
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Department of Psychiatry and Human Behavior, USA
| | - E Jelalian
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, USA
| | - A K Ventura
- Department of Kinesiology & Public Health and Center for Health Research, California Polytechnic State University, USA
| | - E A Hodges
- School of Nursing, The University of North Carolina at Chapel Hill, USA
| | - N Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, USA
| | - J O Fisher
- Department of Social and Behavioral Sciences and Center for Obesity Research and Education, College of Public Health, Temple University, USA
| | - R R Wing
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, USA
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Brennan M, Phelan S, Breen D. 90 A RETROSPECTIVE COHORT STUDY COMPARING THE CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOMES OF BIOPSY-CONFIRMED SARCOIDOSIS IN LATE-ONSET AND YOUNGER-ONSET PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.074] [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: 11/13/2022] Open
Abstract
Abstract
Background
Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare the clinical presentation, treatment and outcomes in patients with biopsy confirmed sarcoidosis in older and younger patients
Methods
A retrospective cohort analysis was performed on all patients with EBUS-confirmed sarcoidosis at a tertiary referral centre between 2012 and 2019. Electronic healthcare records were reviewed to obtain information on clinical presentation, confirmatory investigations, treatment and outcomes. LOS was defined as patients aged >65 years
Results
In total, 247 patients were included, 68.8% were male. LOS accounted for 9.3% (n=23).Extra-pulmonary and systemic features were less common in LOS (26.1% vs 58%, p<0.002). There was no difference in systemic treatment between cohorts (84.6% vs 67.9%, p=0.21) and LOS patients experienced comparably high rates of satisfactory outcomes. At follow up, the majority of patients either improved or achieved clinical stability in both groups (92.3% vs 76.1%, p=0.18). Clinical and/or radiological progression occurred in 7% in both groups with no reported deaths. Confirmatory investigations were infrequent and EBUS was safe and well-tolerated in older patients.
Conclusion
LOS was lower than expected and extra-pulmonary involvement was uncommon suggesting a pre-selected population. Referral for EBUS should be considered as first line for older patients with unexplained thoracic adenopathy provided further diagnostic investigations are in line with their goals of care. Clinical outcomes were excellent with low rates of progression, extra-pulmonary organ involvement and systemic therapy initiation, differing from prior studies and may represent less severe disease at diagnosis, enhanced diagnostic certainty or referral bias.
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Affiliation(s)
- M Brennan
- Galway University Hospital , Galway, Ireland
| | - S Phelan
- Galway University Hospital , Galway, Ireland
| | - D Breen
- Galway University Hospital , Galway, Ireland
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O'Connor E, Mullins M, O'Connor D, Phelan S, Bruzzi J. The relationship between ultrasound microcalcifications and psammoma bodies in thyroid tumours: a single-institution retrospective study. Clin Radiol 2021; 77:e48-e54. [PMID: 34627599 DOI: 10.1016/j.crad.2021.09.014] [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] [Received: 06/21/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic accuracy of ultrasound microcalcifications for the detection of malignancy in thyroid nodules and determine the validity of the concept that ultrasound microcalcification reflects the presence of psammoma body calcification in thyroid nodules. MATERIALS AND METHODS The laboratory information system at University Hospital Galway, a tertiary referral hospital, was used to compile a list of patients who underwent thyroid lobectomy or complete thyroidectomy over a continuous 12-month period with both preoperative ultrasound and postoperative histology available (n=106) from January to December 2019. The haematoxylin and eosin-stained histology slides of each case were sourced and reviewed under light microscopy by a histopathologist to determine the presence of psammoma body calcification within both benign and malignant thyroid nodules. Two radiologists reviewed preoperative thyroid ultrasound images of each case independently and blindly, and reported on the presence of ultrasonographic microcalcification. RESULTS There was a strong and significant relationship between the presence of preoperative ultrasound microcalcification and thyroid malignancy (p<0.001). Ultrasound microcalcification had a high specificity (93%) and positive predictive value (75%) for thyroid malignancy, with a diagnostic accuracy of 76%. Negative predictive value was high at 76.7%, while sensitivity was low at 42.8%. There was a strong and significant association between the presence of preoperative ultrasound microcalcification in thyroid nodules and the presence of pathological psammoma bodies on histology (p<0.001). DISCUSSION Ultrasound microcalcification has a strong and significant association with malignancy in thyroid nodules. This study supported the theory that ultrasound microcalcification occurs secondary to the presence of psammoma bodies within thyroid nodules.
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Affiliation(s)
- E O'Connor
- Histopathology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland.
| | - M Mullins
- Radiology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
| | - D O'Connor
- Histopathology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
| | - S Phelan
- Histopathology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
| | - J Bruzzi
- Radiology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
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Donohoe E, Courtney R, Phelan S, McCann P. A case report of pleomorphic adenoma squamous metaplasia resembling metastatic oral squamous cell carcinoma. Advances in Oral and Maxillofacial Surgery 2021. [DOI: 10.1016/j.adoms.2021.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cullivan S, Ahmed M, Weedle R, Bruzzi J, Phelan S, Da Costa M, Soo A, Breen D. The Role of Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer. Ir Med J 2020; 113:122. [PMID: 35575042] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim The aim of this study is to assess the impact of EBUS on the concordance of clinical and pathological NSCLC staging in our center. Methods Data was collected retrospectively from the hospital database regarding patients who underwent surgical resection for early stage NSCLC between 2012 and 2017. Results A total of 251 patients were included. The mean age was 67 (±9), 55% (n=137) were male and 83% (n=209) were current/former smokers. In group A (n=154, 61%) clinical nodal stage (cN) was established from a combination of CT, PET CT and mediastinoscopy. Group B underwent additional EBUS (n=97, 39%). cN and pathological nodal staging (pN) were concordant in 78% (n=120) in group A versus 62% (n=60) in group B (p=0.009). Conclusion This study demonstrated higher rates of nodal discordance in patients who underwent EBUS which contrasts existing data that demonstrates improved concordance with EBUS. We describe these findings and potential explanations further in this study.
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Affiliation(s)
- S Cullivan
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - M Ahmed
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - R Weedle
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - J Bruzzi
- Department of Radiology, Galway University Hospital - Galway, Ireland
| | - S Phelan
- Department of Histopathology, Galway University Hospital - Galway, Ireland
| | - M Da Costa
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - A Soo
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - D Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
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Matthews C, McMahon D, Murphy A, Phelan S, Blazkova S. A case of toxic epidermal necrolysis following a single treatment with pembrolizumab. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flynn A, Kilmartin D, Phelan S, McMenamin M, Kelly J, Laing ME. Delayed immunological reaction to Integra™ skin graft. Clin Exp Dermatol 2019; 44:714-716. [PMID: 30675916 DOI: 10.1111/ced.13855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A Flynn
- Department of Dermatology, Galway University Hospital, Galway, Ireland
| | - D Kilmartin
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - S Phelan
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - M McMenamin
- Department of Pathology, St James's Hospital, Dublin, Ireland
| | - J Kelly
- Department of Plastics, Galway University Hospital, Galway, Ireland
| | - M E Laing
- Department of Dermatology, Galway University Hospital, Galway, Ireland
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Phelan S, Hagobian TA, Ventura A, Brannen A, Erickson-Hatley K, Schaffner A, Muñoz-Christian K, Mercado A, Tate DF. 'Ripple' effect on infant zBMI trajectory of an internet-based weight loss program for low-income postpartum women. Pediatr Obes 2019; 14:10.1111/ijpo.12456. [PMID: 30225981 PMCID: PMC7368392 DOI: 10.1111/ijpo.12456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Weight loss interventions can have positive 'ripple' effects on untreated partners in the home, but ripple effects on infants are unknown. OBJECTIVE To examine whether a 12-month internet-based weight loss intervention for postpartum mothers had a positive ripple effect on participants' infants. METHODS A 12-month cluster randomized, assessor-blind, clinical trial enrolling 371 postpartum women at 12 Women, Infants, Children clinics in CA. Clinics were randomized to standard Women, Infants, Children or an internet-based weight loss intervention for mothers. RESULTS A total of 333 of the 371 (89.8%) mothers assented for infant participation. Infants were 5.3 ± 3.2 months; 75.9% were Hispanic and 64% were breastfeeding. Infant retention was 272/333 (82.7%) at 6 months post enrollment and 251/333 (75.3%) at 12 months post enrollment. In intent-to-treat analysis, a significant interaction between group and time was observed (p = 0.008) with the offspring of intervention mothers exhibiting lower zBMI change from study entry through 6 months (0.23 [CI, 0.03, 0.44] vs. 0.65 [0.50, 0.79] zBMI change, respectively; p = 0.001) but was not significant through 12 months (p = 0.16). Regardless of group, maternal reports at the final assessment indicated that infants (aged =17.2 ± 3.4 months) consumed sweetened beverages (0.93 ± 1.5/week), juice (2.0 ± 1.4/day), 'junk food' (7.8 ± 5.4/week) and fast food (2/month), and 46.7% of the infants had a TV in their bedroom. CONCLUSIONS An internet-based weight loss program for low-income, postpartum mothers had a positive 'ripple' effect on the zBMI of infants in the home during the first 6 months of treatment.
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Affiliation(s)
- S. Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - T. A. Hagobian
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - A. Ventura
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - A. Brannen
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - K. Erickson-Hatley
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A. Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - K. Muñoz-Christian
- Modern Languages Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - A. Mercado
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - D. F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
It is important to understand how wild-caught animals may respond to captivity, and whether their behaviours in captivity are reflective of their wild counterparts. We observed the behaviour of wild-caught western grey kangaroos (Macropus fuliginosus) and red kangaroos (Osphranter rufus; formerly M. rufus) that were transferred to a large naturally vegetated enclosure. Observations were made on the first day of captivity and again after 7–10 days, and were compared with the behaviour of free-living kangaroos at the same locality and over the same period. We quantified feeding, moving, grooming and non-alert behaviours. Of these, grooming was higher in captive kangaroos than in free-living animals on the first day of captivity only, and was no different to that of wild animal by 7–10 days’ captivity. Such self-directed behaviour may be indicative of heightened distress for kangaroos on the first day of captivity, but it may also be indicative of grooming to eliminate contamination of human smells or debris following capture by darting and recovery. Overall, our findings indicate that after a short period of captivity, wild-caught kangaroos adjust to a novel environment relatively quickly, and animals from each species showed behaviour patterns comparable with free-ranging counterparts within 7–10 days after capture and captivity.
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Rogozinska E, D'Amico MI, Khan KS, Cecatti JG, Teede H, Yeo S, Vinter CA, Rayanagoudar G, Barakat R, Perales M, Dodd JM, Devlieger R, Bogaerts A, van Poppel MNM, Haakstad L, Shen GX, Shub A, Luoto R, Kinnunen TI, Phelan S, Poston L, Scudeller TT, El Beltagy N, Stafne SN, Tonstad S, Geiker NRW, Ruifrok AE, Mol BW, Coomarasamy A, Thangaratinam S. Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy: a Delphi survey. BJOG 2015; 123:190-8. [DOI: 10.1111/1471-0528.13764] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
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Anderson R, Gilani W, Leblanc A, Branda M, Bellolio M, Phelan S, Hess E. 306 Do Clinicians Recommend Cardiovascular Testing Less Frequently in Women? An a Priori Secondary Analysis of Videographic Data in the Chest Pain Choice Trial. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE As large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared the amount of weight regain, behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods. DESIGN Surgical participants (n=105) were matched with two non-surgical participants (n=210) on gender, entry weight, maximum weight loss and weight-maintenance duration, and compared prospectively over 1 year. RESULTS Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping > or =13.6 kg off for 5.5+/-7.1 years. Both groups gained small but significant amounts of weight from registry entry to 1 year (P=0.034), but did not significantly differ in magnitude of weight regain (1.8+/-7.5 and 1.7+/-7.0 kg for surgical and non-surgical groups, respectively; P=0.369). Surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year. Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups. CONCLUSIONS Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts. Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight-loss method.
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Affiliation(s)
- D S Bond
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA.
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Amin M, Glynn F, Phelan S, Sheahan P, Crotty P, McShane D. Silver nitrate cauterisation: a response to Persaud et al. Clin Otolaryngol 2008; 33:377. [PMID: 18983361 DOI: 10.1111/j.1749-4486.2008.01775.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Amin M, Glynn F, Phelan S, Sheahan P, Crotty P, McShane D. Response to Agada et al. Clin Otolaryngol 2008. [DOI: 10.1111/j.1749-4486.2008.01752.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Epistaxis from the anterior septum is frequently treated with a topical application of silver nitrate. There are two concentrations commercially available and in use by otolaryngologists, these are 75% and 95% silver nitrate. The purpose of the present study was to investigate the histological effect of the two different silver nitrate concentrations on mucosal tissue at a fixed contact time of 5 s. Twelve children undergoing routine tonsillectomy were included in this study. Prominent blood vessels on the mucosal surface of the tonsils were identified and a single vessel on each tonsil was selected for application of either 75% or 95% concentration of silver nitrate for 5 s. Depth of penetration across the tonsil tissue was measured following application of the two different silver nitrate concentrations. This study demonstrated a significant difference in depth of tissue penetration with the 95% averaging a twofold increase in penetration depth. It is likely that the increased depth of penetration with 95% silver nitrate may increase the risk of complication of nasal cautery such as septal perforation, particularly in patients undergoing repeated or bilateral nasal cautery.
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Affiliation(s)
- M Amin
- Department of Paediatric Otolaryngology, Head and Neck Surgery, The National Children's Hospital, Dublin, Ireland.
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Abstract
OBJECTIVE To evaluate the effects of weight loss on the risk of having metabolic syndrome after 1 year of treatment with lifestyle modification alone, pharmacotherapy alone (sibutramine) or the combination of the two. DESIGN Randomized, controlled, 1-year clinical trial. PATIENTS One hundred and eighty women and 44 men, 18-65 years of age, with a body mass index of 30-45 kg/m(2), free of uncontrolled hypertension or type 1 or 2 diabetes. INTERVENTION Fifteen milligrams of sibutramine per day alone, lifestyle modification counseling alone, sibutramine plus lifestyle modification counseling or sibutramine plus brief lifestyle modification counseling. MEASUREMENTS The metabolic syndrome, as defined by the Adult Treatment Panel III. RESULTS Before treatment, 34.8% of the participants had the metabolic syndrome. Metabolic syndrome was more prevalent in Caucasians than African Americans (42.5 vs 20.3%; P<0.03), in males than females (65.1 vs 34.9%; P<0.002) and in older (>44 years) than younger (</=44 years) participants (47.5 vs 20.8%; P<0.0001). After 1 year of treatment, a moderate decrease in weight (8.0+/-8.7 kg) resulted in significant reductions in the prevalence of metabolic syndrome from 34.8 to 27.2% of all participants (P<0.02). Logistic regression analyses indicated that for each 1 kg of weight lost, the odds of metabolic syndrome were reduced by 8% (CI=0.89-0.97; P<0.003). Lifestyle modification either alone (P<0.04), or in combination with sibutramine (P<0.05), significantly reduced the prevalence of metabolic syndrome compared with sibutramine alone. The group effect was removed after controlling for weight loss. CONCLUSIONS The metabolic syndrome was prevalent in over one-third of obese individuals who sought weight loss treatment, and the prevalence differed by age, sex and ethnicity. Moderate weight loss markedly reduced the odds of metabolic syndrome in this sample.
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Affiliation(s)
- S Phelan
- Brown Medical School/The Miriam Hospital, Providence, RI, USA.
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Smith WP, Prince S, Phelan S. The role of imaging and surgery in the management of vascular tumors of the masseter muscle. J Oral Maxillofac Surg 2006; 63:1746-52. [PMID: 16297696 DOI: 10.1016/j.joms.2005.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE Intramuscular vascular malformations are uncommon lesions in the head and neck that may mimic salivary gland disease. This study reports on the use of various imaging modalities and recommends a surgical approach in the management of vascular malformations of the masseter muscle. PATIENTS AND METHODS This is a retrospective study of 7 consecutive patients with vascular tumors of the masseter muscle treated in one unit between 1995 and 2004. The age, gender, signs and symptoms, imaging methods, and surgical outcome are reported. A previously unreported surgical approach is described. RESULTS All patients had atypical swellings in and around the parotid region that were difficult to diagnose on plain radiography and computed tomography. Magnetic resonance imaging provides accurate three-dimensional images and provisional diagnosis of lesions within the masseter muscle. Six of the 7 patients underwent surgery by the recommended approach. No patients developed permanent facial weakness following modified parotidectomy. No recurrence of the vascular tumors occurred when the recommended approach is used. CONCLUSIONS Magnetic resonance imaging remains the imaging modality of choice for the management of tumors of the masseter muscle. The extended parotidectomy approach gives good and safe surgical access in the management of these uncommon lesions.
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Abstract
A 10-year-old girl presented with abdominal distension and vomiting due to a jejunojejunal bowel fistula, forming a blind loop. This was related to neonatal necrotizing enterocolitis (NEC) in her first few weeks of life, which was followed by apparently a full recovery. We would like to raise awareness of possible long-term gastrointestinal sequelae in children who have had NEC.
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Affiliation(s)
- C Houben
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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20
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Sonis ST, O'Donnell KE, Popat R, Bragdon C, Phelan S, Cocks D, Epstein JB. The relationship between mucosal cyclooxygenase-2 (COX-2) expression and experimental radiation-induced mucositis. Oral Oncol 2004; 40:170-6. [PMID: 14693241 DOI: 10.1016/s1368-8375(03)00148-9] [Citation(s) in RCA: 64] [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: 12/17/2022]
Abstract
Although cycloooxygenase-2 (COX-2) is upregulated by factors associated with oral mucositis, its role in the pathogenesis of mucositis has not been studied. We investigated the kinetics of mucosal COX-2 expression following radiation exposure, and assessed its relationship to the development of oral mucositis in an established animal model using immunohistochemical endpoints. While little or no COX-2 expression was observed in unirradiated mucosa or in tissue taken 2 days after radiation, COX-2 expression was dramatic on days 10 and 16, especially in submucosal fibroblasts and endothelium. The kinetics of COX-2 expression paralleled mucositis severity. A burst of angiogenic activity was seen on day 21 following peak COX-2 expression. The kinetics of COX-2 expression relative to mucositis progression suggests that COX-2 is not a primary driver of radiation injury, but instead plays an amplifying role.
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Affiliation(s)
- S T Sonis
- Division of Oral Medicine, Oral and Maxillofacial Surgery and Dentistry, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, USA.
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Abstract
OBJECTIVE The present study examined whether long-term weight loss maintenance is enhanced by maintaining the same diet regimen across the week and year or by dieting more strictly on weekdays and nonholiday periods than at other times. METHOD National Weight Control Registry participants (N=1429) indicated on an eight-point scale whether they dieted more strictly on weekends than weekdays, adhered to the same diet regimen throughout the week, or dieted more strictly on weekdays. Participants responded to a similar question about holiday and vacation eating. Participants were then followed prospectively to determine whether scores on these questions were related to self-reported weight regain over the subsequent 12 months. RESULTS There was a linear relationship between scores on the dieting consistency questions and weight change over the 1-y period (P's <0.01), with smaller weight gains in those who reported more consistency. Participants who reported a consistent diet across the week were 1.5 times more likely to maintain their weight within 5 pounds over the subsequent year (OR=1.58, 95% CI: 1.2-2.2) than participants who dieted more strictly on weekdays. A similar relationship emerged between dieting consistency across the year and subsequent weight regain. CONCLUSION Dieting consistency appears to be a behavioral strategy that predicts subsequent long-term weight loss maintenance.
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Affiliation(s)
- A A Gorin
- Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, USA.
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22
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Sonis ST, Scherer J, Phelan S, Lucey CA, Barron JE, O'Donnell KE, Brennan RJ, Pan H, Busse P, Haley JD. The gene expression sequence of radiated mucosa in an animal mucositis model. Cell Prolif 2002; 35 Suppl 1:93-102. [PMID: 12139712 PMCID: PMC6496665 DOI: 10.1046/j.1365-2184.35.s1.10.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Oral mucositis is a common, dose-limiting, acute toxicity of radiation therapy administered for the treatment of cancers of the head and neck. Accumulating data would suggest that the pathogenesis of mucositis is complex and involves the sequential interaction of all cell types of the oral mucosa, as well as a number of cytokines and elements of the oral environment. While a number of studies have reported on gene expression of particular cell types in response to radiation, the overall response of irradiated mucosa has only been evaluated in a limited way. The present study was undertaken to evaluate the expression of a target group of genes using RNA quantification assays and, more broadly, to assess patterns of mucosal gene expression using DNA microarray hybridization. Our results demonstrate the sequential upregulation of a series of genes that, when taken collectively, suggest an intricate functional interaction.
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Affiliation(s)
- S T Sonis
- Division of Oral Medicine, Oral and Maxillofacial Surgery and Dentistry, Brigham and Women's Hospital and the Department of Otal Medicine and Diagnostic Sciences, Harvard School of Dental Medicine, USA.
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23
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Foster GD, Wadden TA, Phelan S, Sarwer DB, Sanderson RS. Obese patients' perceptions of treatment outcomes and the factors that influence them. Arch Intern Med 2001; 161:2133-9. [PMID: 11570944 DOI: 10.1001/archinte.161.17.2133] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite considerable professional consensus that modest weight losses of 5% to 10% are successful for reducing the comorbid conditions associated with obesity, obese patients often desire weight losses 2 to 3 times greater than this. Examining ways to reduce the disparities between treatment expectations and subsequent outcomes, this study evaluated the role of physical characteristics, treatment setting, and mood in patients' evaluations of treatment outcomes. METHODS This study was conducted in a university outpatient weight loss clinic with a sample of 397 obese individuals seeking weight loss by a variety of modalities. Before treatment, participants' heights and weights were measured, and the Beck Depression Inventory and the Goals and Relative Weight Questionnaire were administered. RESULTS Outcome evaluations ranged from 64.4 +/- 11.1 kg (mean +/- SD) for dream weight to 90.1 +/- 19.1 kg for disappointed weight. Initial body weight was the strongest predictor of disappointed, acceptable, and happy weights (beta =.90,.76, and.57, respectively). Sex (beta = -.37) and height (beta =.37) were the strongest determinants of dream weight. Heavier participants chose higher absolute weights, but the weight loss required to reach each of the outcomes was greater for heavier than for lighter patients. CONCLUSIONS These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.
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Affiliation(s)
- G D Foster
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Lowe MR, Miller-Kovach K, Phelan S. Weight-loss maintenance in overweight individuals one to five years following successful completion of a commercial weight loss program. Int J Obes (Lond) 2001; 25:325-31. [PMID: 11319628 DOI: 10.1038/sj.ijo.0801521] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/1999] [Revised: 03/22/2000] [Accepted: 08/30/2000] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine weight loss maintenance among participants in a commercial weight loss program (Weight Watchers) who had reached their goal weights 1-5 y previously. DESIGN A national sample (n=1002) was surveyed by phone to obtain demographic and weight-related information. An oversample (n=258) was recruited and weighed in person to develop a correction factor for self-reported weights in the national sample. RESULTS Based on corrected weights, weight regain from 1 to 5 y following weight loss ranged between 31.5 and 76.5%. At 5 y, 19.4% were within 5 lb of goal weight, 42.6% maintained a loss of 5% or more, 18.8% maintained a loss of 10% or more, and 70.3% were below initial weight. CONCLUSIONS These results are not directly comparable to those obtained in clinical settings because of differences in the populations studied. Nonetheless, they suggest that the long-term prognosis for weight maintenance among individuals who reach goal weight in at least one commercial program is better than that suggested by existing research.
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Affiliation(s)
- M R Lowe
- Department of Clinical and Health Psychology, MCP Hahnemann University, Philadelphia, Pennsylvania 19102, USA.
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Schumacher JE, Engle M, Reynolds K, Houser S, Mukherjee S, Caldwell E, Kohler C, Phelan S, Raczynski JM. Measuring self-efficacy in substance abuse intervention in obstetric practices. South Med J 2000; 93:406-14. [PMID: 10798512] [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: 02/16/2023]
Abstract
BACKGROUND This study presents findings on the effect of an office-based obstetrics training program (given the acronym OBIWOM) on substance use assessment, management, and referral self-efficacy among obstetricians and staff of private, community-based obstetric practices. METHODS Participants were obstetricians and staff from 10 of 27 available community-based, private obstetric practices in the target areas, for a practice participation rate of 37%. This study used a delayed treatment design to compare self-efficacy between practice staff randomly assigned to an immediate or delayed intervention group. RESULTS Self-efficacy increased significantly after intervention from baseline to first follow-up for the immediate group, while no change was shown for the delayed (control) group. The impact of the intervention on self-efficacy was replicated in the assessment construct only after the intervention for the delayed group. CONCLUSION This research shows that education and training can effectively improve self-efficacy in obstetricians and their staff in the management of substance use and pregnancy.
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Affiliation(s)
- J E Schumacher
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, USA
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Lowe MR, Miller-Kovach K, Frye N, Phelan S. An initial evaluation of a commercial weight loss program: short-term effects on weight, eating behavior, and mood. Obes Res 1999; 7:51-9. [PMID: 10023730 DOI: 10.1002/j.1550-8528.1999.tb00390.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper describes an initial, 4-week evaluation of a commercial weight loss program. RESEARCH METHODS AND PROCEDURES Respondents (n = 985) to newspaper advertisements in two metropolitan areas were assigned to 4 weeks of either the Weight Watchers program or to a Self-Help condition. Weight loss, psychological vitality, and eating behavior were evaluated before and after the 4-week intervention. RESULTS Weight Watchers participants showed greater improvements than Self-Help participants on all measures; weight losses averaged 1.87 and 0.77 kg, respectively. The superior outcomes shown by Weight Watchers participants on measures of vitality and eating behavior were still evident when extent of weight loss was controlled. Weight losses across different sites, incomes, and levels of obesity were similar. DISCUSSION Although the present study's intervention and outcome assessments were short-term, the promising results obtained suggest that longer term studies should be undertaken.
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Affiliation(s)
- M R Lowe
- Department of Clinical and Health Psychology, MCP Hahnemann University, Philadelphia, PA 19102-1192, USA.
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Q’Reilly G, Sheridan A, Carr A, Cherry J, Donohoe E, McGrath K, Phelan S, Tallon M, O’Reilly K. A descriptive study of adolescent sexual offenders in an Irish community based treatment programme. ACTA ACUST UNITED AC 1998. [DOI: 10.1080/03033910.1998.10558177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Professional attributes such as honesty, integrity, and reliability are critical to success in medical school and postgraduate practice, yet such noncognitive attributes have traditionally been poorly evaluated. METHOD A program of evaluating students' noncognitive professional attributes at the University of New Mexico School of Medicine was reviewed over a four-year period, from 1987-88 through 1990-91, involving the approximately 525 students enrolled at the school at that time. The evaluation program enabled faculty and staff to quantify their impressions of problem students in a uniform manner, by using an evaluation form that listed and described seven basic professional traits. RESULTS Over the study years the program identified ten students with difficulties in the basic science and clinical years regarding their character and professionalism. For these ten students, interventions ranged from nothing being done, in one case, to such significant remediations as recommendations of extensive counseling and a leave of absence. One student was dismissed, on the basis of poor academic performance, and the other nine have graduated. In some cases, students noticeably improved their professional behaviors, but whether their behaviors changed as a result of the interventions can't be determined. CONCLUSION By identifying and tracking students with difficulties, the program offers the opportunity for intervention and, ideally, remediation. This program can complement systems that evaluate academic performance. Such a program can help an institution assure not only the cognitive competence of its graduates, but the competence of their professional behaviors as well.
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Affiliation(s)
- S Phelan
- University of Alabama School of Medicine, Birmingham
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Mattox JH, Phelan S. The evaluation of adult females with testosterone producing neoplasms of the adrenal cortex. Surg Gynecol Obstet 1987; 164:98-101. [PMID: 2949380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although uncommon, testosterone producing neoplasms of the ovary and the adrenal cortex occur periodically. Forty-seven instances involving the adrenal gland have been published since 1925; five, including the present patient, have occurred since 1981. Confusion concerning the site of the androgen secretion has been generated in the past because of limited roentgenographic study and the poor predicability of selective suppression or stimulating testing of the adrenal gland and the ovary. Of the 22 patients with testosterone producing neoplasms of the adrenal cortex reported since 1973, 45 per cent underwent needless ovarian surgical treatment prior to the correct diagnosis. By recognizing the significant correlation between a serum testosterone of 200 nanograms per deciliter or greater, a serum dehydroepiandrostenone of greater than 6,600 nanograms per milliliter coupled with a thorough pelvic examination, pelvic ultrasound and a more liberal use of high resolution computerized tomography of the adrenal gland, the correct diagnosis can be made. The patient presented herein illustrates the pitfalls inherent in the management of a patient with this problem.
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