1
|
Thouvenin L, Charrier M, Clement S, Christinat Y, Tille JC, Frigeri M, Homicsko K, Michielin O, Bodmer A, Chappuis PO, McKee TA, Tsantoulis P. Ovarian cancer with high-level focal ERBB2 amplification responds to trastuzumab and pertuzumab. Gynecol Oncol Rep 2021; 37:100787. [PMID: 34095423 PMCID: PMC8165411 DOI: 10.1016/j.gore.2021.100787] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 12/27/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is usually diagnosed at an advanced stage and significantly contributes to cancer mortality in women. Despite multimodal treatment associating chemotherapy and surgery, most patients ultimately progress and require palliative systemic therapy. In EOC, the efficacy of anti-HER2 agents is minimal even after selecting patients for HER2 expression. ERBB2 gene amplification is observed in 3-10% of patients, depending on the specific method of detection and cutoffs. We report the case of a young woman with a FIGO stage IV high-grade serous ovarian cancer with an amplification of ERBB2. She was treated with the association of trastuzumab - pertuzumab after two lines of standard treatment and presented an excellent long-lasting partial response after 36 months of treatment. The association of trastuzumab and pertuzumab, without chemotherapy, has not been previously tested in this context and could be more efficacious than monotherapy with either agent. In addition, the significant benefit observed in this case could be attributed to the presence of a high-level focal amplification that is relatively rare and probably more specific than an increase in HER2 expression. In conclusion, prospective trials of the trastuzumab and pertuzumab combination should be considered in an appropriately selected EOC patient population.
Collapse
Affiliation(s)
- Laure Thouvenin
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Mélinda Charrier
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Sophie Clement
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Yann Christinat
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Jean-Christophe Tille
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Mauro Frigeri
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Krisztian Homicsko
- Multidisciplinary Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Michielin
- Multidisciplinary Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Bodmer
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Pierre O. Chappuis
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Thomas A. McKee
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Petros Tsantoulis
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| |
Collapse
|
2
|
Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez‐Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 PMCID: PMC8359367 DOI: 10.1111/cobi.13671] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 06/11/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
Collapse
Affiliation(s)
- C. Wyborn
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
- Institute for Water Futures, Fenner School of Environment and SocietyAustralian National UniversityCanberraACT0200Australia
| | - J. Montana
- School of Geography and the EnvironmentUniversity of OxfordSouth Parks RoadOxfordOX1 3QYU.K.
| | - N. Kalas
- Department of Environmental Systems ScienceETH ZürichUniversitätstrasse 8‐22Zürich8092Switzerland
| | - S. Clement
- Geography and PlanningUniversity of LiverpoolLiverpoolL69 3BXU.K.
| | - F. Davila
- Institute for Sustainable FuturesUniversity of Technology Sydney253 Jones StreetUltimoNSW2007Australia
| | - N. Knowles
- Department of Geography and Environmental ManagementUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - E. Louder
- School of Geography and DevelopmentUniversity of ArizonaENR2 Building, South 4th floor 1064 E. Lowell StreetTucsonAZ85721U.S.A.
| | - M. Balan
- The Forest WayNo 8, 2nd St, D P Nagar, KotturpuramChennaiTamil Nadu600085India
| | - J. Chambers
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - L. Christel
- School of Politics and Government (EPyG)National University of San MartinAvenida 25 de Mayo 1021San MartínProvincia de Buenos Aires1650Argentina
| | - T. Forsyth
- Department of International DevelopmentLondon School of Economics and Political ScienceHoughton StreetLondonWC2A 2AEU.K
| | - G. Henderson
- Harry Ransom CenterThe University of Texas at AustinP.O. Drawer 7219, 300 W 21st StreetAustinTX78712U.S.A.
| | - S. Izquierdo Tort
- Institut des Sciences de la Forêt TempéréeUniversité du Québec en Outaouais58 rue PrincipaleRiponQCJ0V 1V0Canada
- Natura y Ecosistemas Mexicanos A.C.Plaza San Jacinto 23D, San Ángel, Álvaro ObregónMexico City01000Mexico
| | - M. Lim
- Centre for Environmental Law, Macquarie Law SchoolMacquarie University6 First WalkSydneyNSW2109Australia
| | - M. J. Martinez‐Harms
- Center for Applied Ecology and Sustainability (CAPES)Pontificia Universidad Católica de ChileSantiago, Avd. Libertador Bernardo O'Higgins 340SantiagoChile
| | - J. Merçon
- Instituto de Investigaciones en EducasiónUniversidad VeracruzanaPaseo 112, Nuevo JalapaXalapa‐Enríquez91193Mexico
| | - E. Nuesiri
- Social Science FacultyAfrican Leadership University (ALU)Powder Mill RoadPamplemousses21001Mauritius
| | - L. Pereira
- Stockholm Resilience CentreStockholm UniversityKräftriket 2BStockholmSE‐10691Sweden
- Copernicus Institute of Sustainable DevelopmentUtrecht UniversityPrincetonlaan 8aUtrecht3584 CBThe Netherlands
- Centre for Complex Systems in TransitionStellenbosch University19 Jonkershoek Rd, MostertsdriftStellenbosch7600South Africa
| | - V. Pilbeam
- Clear Horizon Consulting132B Gwynne StCremorneVIC3121Australia
| | - E. Turnhout
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - S. Wood
- Future Earth1250 Guy St, MontrealQuebecONH3H 2L3Canada
| | - M. Ryan
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
| |
Collapse
|
3
|
Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez-Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 DOI: 10.13140/rg.2.2.12086.52804/2] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 05/18/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
Collapse
Affiliation(s)
- C Wyborn
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
- Institute for Water Futures, Fenner School of Environment and Society, Australian National University, Canberra, ACT, 0200, Australia
| | - J Montana
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, U.K
| | - N Kalas
- Department of Environmental Systems Science, ETH Zürich, Universitätstrasse 8-22, Zürich, 8092, Switzerland
| | - S Clement
- Geography and Planning, University of Liverpool, Liverpool, L69 3BX, U.K
| | - F Davila
- Institute for Sustainable Futures, University of Technology Sydney, 253 Jones Street, Ultimo, NSW, 2007, Australia
| | - N Knowles
- Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - E Louder
- School of Geography and Development, University of Arizona, ENR2 Building, South 4th floor 1064 E. Lowell Street, Tucson, AZ, 85721, U.S.A
| | - M Balan
- The Forest Way, No 8, 2nd St, D P Nagar, Kotturpuram, Chennai, Tamil Nadu, 600085, India
| | - J Chambers
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - L Christel
- School of Politics and Government (EPyG), National University of San Martin, Avenida 25 de Mayo 1021, San Martín, Provincia de Buenos Aires, 1650, Argentina
| | - T Forsyth
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, U.K
| | - G Henderson
- Harry Ransom Center, The University of Texas at Austin, P.O. Drawer 7219, 300 W 21st Street, Austin, TX, 78712, U.S.A
| | - S Izquierdo Tort
- Institut des Sciences de la Forêt Tempérée, Université du Québec en Outaouais, 58 rue Principale, Ripon, QC, J0V 1V0, Canada
- Natura y Ecosistemas Mexicanos A.C., Plaza San Jacinto 23D, San Ángel, Álvaro Obregón, Mexico City, 01000, Mexico
| | - M Lim
- Centre for Environmental Law, Macquarie Law School, Macquarie University, 6 First Walk, Sydney, NSW, 2109, Australia
| | - M J Martinez-Harms
- Center for Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Santiago, Avd. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - J Merçon
- Instituto de Investigaciones en Educasión, Universidad Veracruzana, Paseo 112, Nuevo Jalapa, Xalapa-Enríquez, 91193, Mexico
| | - E Nuesiri
- Social Science Faculty, African Leadership University (ALU), Powder Mill Road, Pamplemousses, 21001, Mauritius
| | - L Pereira
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, Stockholm, SE-10691, Sweden
- Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, The Netherlands
- Centre for Complex Systems in Transition, Stellenbosch University, 19 Jonkershoek Rd, Mostertsdrift, Stellenbosch, 7600, South Africa
| | - V Pilbeam
- Clear Horizon Consulting, 132B Gwynne St, Cremorne, VIC, 3121, Australia
| | - E Turnhout
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - S Wood
- Future Earth, 1250 Guy St, Montreal, Quebec, ON, H3H 2L3, Canada
| | - M Ryan
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
| |
Collapse
|
4
|
Frisone D, Charrier M, Clement S, Christinat Y, Thouvenin L, Homicsko K, Michielin O, Bodmer A, Chappuis PO, McKee TA, Tsantoulis P. Durable response to palbociclib and letrozole in ovarian cancer with CDKN2A loss. Cancer Biol Ther 2019; 21:197-202. [PMID: 31709901 PMCID: PMC7012162 DOI: 10.1080/15384047.2019.1685291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/13/2019] [Accepted: 10/22/2019] [Indexed: 01/27/2023] Open
Abstract
Alterations of the Retinoblastoma (Rb) pathway are frequent in ovarian cancer, typically resulting from CDKN2A down-regulation, CCNE1 amplification, CCND1/2 amplification, and RB1 loss. However, bi-allelic CDKN2A mutation or homozygous deletion is a very rare event, concerning less than 5% of patients.Initial trials with palbociclib in serous ovarian cancer have shown very modest benefit in unselected patient populations, thus underlining the need for a biomarker predicting response. We report the case of a heavily pre-treated patient with a serous ovarian tumor harboring a homozygous deletion of the CDKN2A gene that derived significant, prolonged clinical benefit from palbociclib, a CDK4/6 oral inhibitor, with letrozole. Treatment with palbociclib and letrozole started on February 2018, with an ongoing response after 12 months.In conclusion, homozygous CDKN2A deletion is rare and could be used to predict response to CDK4/6 inhibitors in association with other genomic features. We encourage further trials in this direction.
Collapse
Affiliation(s)
- Daniele Frisone
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Melinda Charrier
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Sophie Clement
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Yann Christinat
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Laure Thouvenin
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Krisztian Homicsko
- Multidisciplinary Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Michielin
- Multidisciplinary Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Bodmer
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Pierre O. Chappuis
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Thomas A. McKee
- Department of Genetic Medicine, Laboratory and Pathology, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Petros Tsantoulis
- Department of Oncology, University Hospitals of Geneva (HUG), Geneva, Switzerland
- Department of Medical Specialties Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
5
|
Yamanishi T, Asakura N, Tobita K, Ohira S, Federici G, Heidinger R, Knaster J, Clement S, Nakajima N. Recent technical progress on BA Program: DEMO activities and IFMIF/EVEDA. Fusion Engineering and Design 2016. [DOI: 10.1016/j.fusengdes.2015.12.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
6
|
Rojas Á, Del Campo JA, Clement S, Lemasson M, García-Valdecasas M, Gil-Gómez A, Ranchal I, Bartosch B, Bautista JD, Rosenberg AR, Negro F, Romero-Gómez M. Effect of Quercetin on Hepatitis C Virus Life Cycle: From Viral to Host Targets. Sci Rep 2016; 6:31777. [PMID: 27546480 PMCID: PMC4992894 DOI: 10.1038/srep31777] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022] Open
Abstract
Quercetin is a natural flavonoid, which has been shown to have anti hepatitis C virus (HCV) properties. However, the exact mechanisms whereby quercetin impacts the HCV life cycle are not fully understood. We assessed the effect of quercetin on different steps of the HCV life cycle in Huh-7.5 cells and primary human hepatocytes (PHH) infected with HCVcc. In both cell types, quercetin significantly decreased i) the viral genome replication; ii) the production of infectious HCV particles and iii) the specific infectivity of the newly produced viral particles (by 85% and 92%, Huh7.5 and PHH respectively). In addition, when applied directly on HCV particles, quercetin reduced their infectivity by 65%, suggesting that it affects the virion integrity. Interestingly, the HCV-induced up-regulation of diacylglycerol acyltransferase (DGAT) and the typical localization of the HCV core protein to the surface of lipid droplets, known to be mediated by DGAT, were both prevented by quercetin. In conclusion, quercetin appears to have direct and host-mediated antiviral effects against HCV.
Collapse
Affiliation(s)
- Ángela Rojas
- UCM Digestive Diseases, Virgen Macarena-Virgen del Rocío University Hospitals and CIBERehd, Institute of Biomedicine, University of Sevilla, Sevilla, Spain.,Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Valme de Sevilla, Sevilla, Spain
| | - Jose A Del Campo
- Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Valme de Sevilla, Sevilla, Spain
| | - Sophie Clement
- Division of Clinical Pathology, University Hospital, Geneva, Switzerland
| | | | - Marta García-Valdecasas
- UCM Digestive Diseases, Virgen Macarena-Virgen del Rocío University Hospitals and CIBERehd, Institute of Biomedicine, University of Sevilla, Sevilla, Spain.,Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Valme de Sevilla, Sevilla, Spain
| | - Antonio Gil-Gómez
- UCM Digestive Diseases, Virgen Macarena-Virgen del Rocío University Hospitals and CIBERehd, Institute of Biomedicine, University of Sevilla, Sevilla, Spain.,Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Valme de Sevilla, Sevilla, Spain
| | - Isidora Ranchal
- Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Valme de Sevilla, Sevilla, Spain
| | - Birke Bartosch
- Inserm U1052, Cancer Research Centre, University of Lyon, France DevWeCan Laboratories of Excellence Network (Labex), Lyon, France
| | - Juan D Bautista
- Biochemistry and Molecular Biology, Faculty of Pharmacy, University of Sevilla, Spain
| | | | - Francesco Negro
- Division of Clinical Pathology, University Hospital, Geneva, Switzerland.,Division of Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland
| | - Manuel Romero-Gómez
- UCM Digestive Diseases, Virgen Macarena-Virgen del Rocío University Hospitals and CIBERehd, Institute of Biomedicine, University of Sevilla, Sevilla, Spain
| |
Collapse
|
7
|
Mehta N, Clement S, Marcus E, Stona AC, Bezborodovs N, Evans-Lacko S, Palacios J, Docherty M, Barley E, Rose D, Koschorke M, Shidhaye R, Henderson C, Thornicroft G. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry 2015; 207:377-84. [PMID: 26527664 PMCID: PMC4629070 DOI: 10.1192/bjp.bp.114.151944] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings. AIMS To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs). METHOD We searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact. RESULTS Eighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and -0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies. CONCLUSIONS There is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - G. Thornicroft
- Correspondence: Professor Graham Thornicroft, Health Service and Population Research Department, Box PO29, Institute of Psychiatry, Pschology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
| |
Collapse
|
8
|
Patel A, Rutherford N, Chandu A, Clement S. Objective critical analysis of lifestyle behaviour and attitudes to health amongst oral & maxillofacial surgeons in Australia & New Zealand. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Abstract
BACKGROUND Suicide is a major global public health issue. Mental illness is a risk factor for suicide, but as many individuals with a diagnosed mental health problem do not experience suicidal ideation or attempt suicide, other individual and societal factors must be considered. Mental illness-related discrimination is one potential risk factor. METHOD Using mixed methods, the influence of discrimination on suicidality amongst 194 individuals diagnosed with depression, bipolar or schizophrenia spectrum disorders was investigated. Qualitative interviews with a sub-sample of 58 individuals who reported a link between experience of discrimination and suicidality were analysed using framework analysis. Quantitative methods were used to examine the model derived from qualitative analyses. RESULTS Results indicate that the experience of discrimination led 38% of the overall sample of 194 participants, to suicidal feelings and 20% reported that it contributed to making a suicide attempt. The qualitative model derived from interviews with a sub-sample of 58 participants suggested that the experience of discrimination is experienced as a stressor that exceeds coping resources, leading to a negative self-image and a perception of decreased supportive networks/social structure. The anticipation of further negative events and treatment, and the perception of a lack of supportive networks led individuals in this study to feelings of hopelessness and suicidality. Quantitative analyses provided support for the model. CONCLUSIONS These data suggest that both psychological therapies aimed at improving coping skills and population-level anti-stigma interventions that reduce the occurrence of discrimination may provide some protection against suicide amongst individuals with mental health problems.
Collapse
Affiliation(s)
- S Farrelly
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - D Jeffery
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - N Rüsch
- Department of Psychiatry II,University of Ulm and BKH Günzburg,Germany
| | - P Williams
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - G Thornicroft
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - S Clement
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| |
Collapse
|
10
|
Lassman F, Henderson RC, Dockery L, Clement S, Murray J, Bonnington O, Farrelly S, Thornicroft G. How does a decision aid help people decide whether to disclose a mental health problem to employers? Qualitative interview study. J Occup Rehabil 2015; 25:403-11. [PMID: 25427673 DOI: 10.1007/s10926-014-9550-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Decisions about whether to disclose mental health problems to employers are complex, with potential personal, employment and legal implications. Decision aids are evidence based tools, designed to help individuals make specific choices between treatment options. We previously developed a decision aid-Conceal Or ReveAL (CORAL)-to assist service users with decisions about disclosure to employers. As part of a mixed methods exploratory RCT, which demonstrated that the CORAL decision aid was effective in reducing decisional conflict, we aimed to explore its mechanism of action and to optimise the intervention for a future full scale trial. Methods In depth interviews were conducted with individuals receiving vocational support from a mental health trust and participating in the intervention arm of the pilot trial. Thematic analysis was conducted to identify the main themes relating to participants' perceptions of the CORAL decision aid. Results Thirteen participants were interviewed and five main themes were identified: sense of self and values; sense of control; anticipation of disclosure; experience of disclosure; and mechanism of action of the decision aid. Conclusions Data from our 13 participants suggest that the CORAL decision aid acts on several dimensions of decisional conflict: clarifying the pros and cons of different choices; increasing knowledge; structuring the decision making process; and clarifying needs and values. The current study indicated that it would be most effective when delivered by a professional well versed in employment and mental health matters such as a vocational adviser. The need for employers and policymakers to reduce the negative impact of disclosure is also highlighted.
Collapse
Affiliation(s)
- F Lassman
- Health Service and Population Research Department P029, David Goldberg Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JSL, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 2015; 45:11-27. [PMID: 24569086 DOI: 10.1017/s0033291714000129] [Citation(s) in RCA: 1339] [Impact Index Per Article: 148.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking? METHOD Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted. RESULTS The review identified 144 studies with 90,189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = - 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma. CONCLUSIONS Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.
Collapse
Affiliation(s)
- S Clement
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - O Schauman
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - T Graham
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - F Maggioni
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - S Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - N Bezborodovs
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - C Morgan
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - N Rüsch
- Department of Psychiatry II,University of Ulm,Germany
| | - J S L Brown
- Department of Psychology, Institute of Psychiatry,King's College London,UK
| | - G Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| |
Collapse
|
12
|
Younossi ZM, Stepanova M, Saab S, Kalwaney S, Clement S, Henry L, Frost S, Hunt S. The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US. Aliment Pharmacol Ther 2014; 40:686-94. [PMID: 25040315 DOI: 10.1111/apt.12881] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 2 diabetes is known to negatively impact the outcome of chronic liver disease. AIM To evaluate the impact of diabetes on the outcomes of liver transplants (LT). METHODS Study cohort included adults (>18 years) who received LT in the US between 1994 and 2013 (The Scientific Registry of Transplant Recipients). Pre- and post-transplant diabetes was recorded in patients with mortality follow-up. RESULTS We included 85 194 liver transplant recipients. Of those, 11.2% had history of pre-transplant diabetes. The most common indications for liver transplant were hepatitis C (36.4%), alcohol-related liver disease (20.6%), primary liver malignancy of unspecified aetiology (14.7%), cryptogenic cirrhosis (8.0%), hepatitis B (4.6%) and non-alcoholic steatohepatitis (3.9%). A total of 96.5% transplants were from deceased donors, and 7.9% donors had history of diabetes. During an average 6.5 years of follow-up, 31.3% recipients died and 8.8% had a graft failure. In multivariate survival analysis [at least 5 years of cohort follow-up (N = 35 870)], after adjustment for age, ethnicity, insurance type, history of chronic diseases, HCV infection and noncompliance, independent predictors of recipient mortality included the presence of pre-transplant diabetes [adjusted hazard ratio (95%CI) = 1.21 (1.12-1.30)] and developing diabetes post-transplant [1.06 (1.02-1.11)]. Donor's history of diabetes was also independently associated with higher mortality [1.10 (1.02-1.19)]. Furthermore, donor's history of diabetes was also associated with an increased the risk of liver graft failure [1.35 (1.24-1.47)]. CONCLUSIONS Presence of type 2 diabetes pre- and post-transplant, as well as presence of type 2 diabetes in the donors, are all associated with an increased risk of adverse post-transplant outcomes.
Collapse
Affiliation(s)
- Z M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Boussat S, Clement S, Henard S, Rabaud S, Rabaud C. COL04-05 Retour sur l’utilisation pratique de l’outil ConsoRes – un plébiscite à 3 ans du début d’un déploiement progressif. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70058-7] [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]
|
14
|
Godfrey KJ, Mathew B, Bulman JC, Shah O, Clement S, Gallicano GI. Stem cell-based treatments for Type 1 diabetes mellitus: bone marrow, embryonic, hepatic, pancreatic and induced pluripotent stem cells. Diabet Med 2012; 29:14-23. [PMID: 21883442 DOI: 10.1111/j.1464-5491.2011.03433.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Type 1 diabetes mellitus--characterized by the permanent destruction of insulin-secreting β-cells--is responsive to cell-based treatments that replace lost β-cell populations. The current gold standard of pancreas transplantation provides only temporary independence from exogenous insulin and is fraught with complications, including increased mortality. Stem cells offer a number of theoretical advantages over current therapies. Our review will focus on the development of treatments involving tissue stem cells from bone marrow, liver and pancreatic cells, as well as the potential use of embryonic and induced pluripotent stem cells for Type 1 diabetes therapy. While the body of research involving stem cells is at once promising and inconsistent, bone marrow-derived mesenchymal stem cell transplantation seems to offer the most compelling evidence of efficacy. These cells have been demonstrated to increase endogenous insulin production, while partially mitigating the autoimmune destruction of newly formed β-cells. However, recently successful experiments involving induced pluripotent stem cells could quickly move them into the foreground of therapeutic research. We address the limitations encountered by present research and look toward the future of stem cell treatments for Type 1 diabetes.
Collapse
Affiliation(s)
- K J Godfrey
- Georgetown University School of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | | | | | | | | | | |
Collapse
|
15
|
Brohan E, Slade M, Clement S, Rose D, Sartorius N, Thornicroft G. Further development and psychometric validation of the discrimination and stigma scale (DISC-12). Psychiat Prax 2011. [DOI: 10.1055/s-0031-1277768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
DeFronzo RA, Banerji MA, Bray GA, Buchanan TA, Clement S, Henry RR, Kitabchi AE, Mudaliar S, Musi N, Ratner R, Reaven P, Schwenke DC, Stentz FD, Tripathy D. Determinants of glucose tolerance in impaired glucose tolerance at baseline in the Actos Now for Prevention of Diabetes (ACT NOW) study. Diabetologia 2010; 53:435-45. [PMID: 20012012 DOI: 10.1007/s00125-009-1614-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [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: 05/05/2009] [Accepted: 10/20/2009] [Indexed: 01/06/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to examine the determinants of oral glucose tolerance in 602 persons with impaired glucose tolerance (IGT) who participated in the Actos Now for Prevention of Diabetes (ACT NOW) study. METHODS In addition to the 602 IGT participants, 115 persons with normal glucose tolerance (NGT) and 50 with impaired fasting glucose (IFG) were identified during screening and included in this analysis. Insulin secretion and insulin sensitivity indices were derived from plasma glucose and insulin during an OGTT. The acute insulin response (AIR) (0-10 min) and insulin sensitivity (S(I)) were measured with the frequently sampled intravenous glucose tolerance test (FSIVGTT) in a subset of participants. RESULTS At baseline, fasting plasma glucose, 2 h postprandial glucose (OGTT) and HbA(1c) were 5.8 +/- 0.02 mmol/l, 10.5 +/- 0.05 mmol/l and 5.5 +/- 0.04%, respectively, in participants with IGT. Participants with IGT were characterised by defects in early (DeltaI (0-30)/DeltaG (0-30) x Matsuda index, where DeltaI is change in insulin in the first 30 min and DeltaG is change in glucose in the first 30 min) and total (DeltaI(0-120)/DeltaG(0-120) x Matsuda index) insulin secretion and in insulin sensitivity (Matsuda index and S(I)). Participants with IGT in whom 2 h plasma glucose was 7.8-8.3 mmol/l had a 63% decrease in the insulin secretion/insulin resistance (disposition) index vs participants with NGT and this defect worsened progressively as 2 h plasma glucose rose to 8.9-9.94 mmol/l (by 73%) and 10.0-11.05 mmol/l (by 80%). The Matsuda insulin sensitivity index was reduced by 40% in IGT compared with NGT (p < 0.005). In multivariate analysis, beta cell function was the primary determinant of glucose AUC during OGTT, explaining 62% of the variance. CONCLUSION Our results strongly suggest that progressive beta cell failure is the main determinant of progression of NGT to IGT.
Collapse
Affiliation(s)
- R A DeFronzo
- Diabetes Division, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Papp S, Dziak E, Kabir G, Backx P, Clement S, Opas M. Evidence for calreticulin attenuation of cardiac hypertrophy induced by pressure overload and soluble agonists. Am J Pathol 2010; 176:1113-21. [PMID: 20110410 DOI: 10.2353/ajpath.2010.090392] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
While calreticulin has been shown to be critical for cardiac development, its role in cardiac pathology is unclear. Previous studies have shown the detrimental effects on the heart of sustained germline calreticulin overexpression, yet without calreticulin, the heart does not develop normally. Thus, carefully balanced calreticulin levels are required for the heart to develop and to function properly into adulthood. But what happens to calreticulin levels, and how is this regulated, during cardiac hypertrophy, during which the fetal gene program is reactivated, at least partially? Our working hypothesis was that c-Src, a kinase whose activity we previously found to be correlated with calreticulin expression, was involved with calreticulin in regulating the response to hypertrophic signals. Thus, we subjected adult mice to transverse aortic constriction to induce left ventricular hypertrophy. We found that aortic constriction caused calreticulin levels to increase, whereas those of c-Src fell with longer constriction time. We also examined the ability of embryonic stem cell-derived cardiomyocytes to respond to soluble hypertrophic agonists. Endothelin-1 treatment caused a significantly greater cell area increase of calreticulin-null cardiomyocytes, which had higher c-Src activity, compared with wild-type cells. c-Src inhibition abolished this difference. Greater c-Src activity may explain the efficacy with which calreticulin-null cells are able to induce the hypertrophic program, while cells containing calreticulin may be able to attenuate the hypertrophic response as a result of decreased c-Src activity. Thus, calreticulin may have a protective effect on the heart in the face of cardiac hypertrophy.
Collapse
Affiliation(s)
- Sylvia Papp
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 6326, Toronto, Ontario, M5S 1A8 Canada
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE This paper describes a measure of continuity of care, establishes its reliability and tests it in a field trial sample for evidence of its validity. In contrast to others, this measure has been generated from the perspectives of service users. As continuity of care is a concern particularly for those with severe mental illness, we have confined our work to this population group. METHOD Service users in focus groups and expert panels generated the measure. The researchers were themselves service users. Test-retest reliability was assessed with an independent sample. The measure was administered to a final independent field trial sample to determine their experiences of continuity of care and for further psychometric testing. RESULTS The measure generated by service users has satisfactory psychometric properties. Service users in the field trial sample were more satisfied when continuity, as assessed by this measure, was in place. CONCLUSION It is possible and valid to construct outcome measures in mental health entirely from the user perspective. This has not been done before.
Collapse
Affiliation(s)
- D Rose
- Institute of Psychiatry, King's College London, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Berni R, Savi M, Bocchi L, Delucchi F, Musso E, Chaponnier C, Gabbiani G, Clement S, Stilli D. Modulation of actin isoform expression before the transition from experimental compensated pressure-overload cardiac hypertrophy to decompensation. Am J Physiol Heart Circ Physiol 2009; 296:H1625-32. [PMID: 19252091 DOI: 10.1152/ajpheart.01057.2008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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: 11/22/2022]
Abstract
In a rat model of long-lasting pressure-overload hypertrophy, we investigated whether changes in the relative expression of myocardial actin isoforms are among the early signs of ventricular mechanical dysfunction before the transition toward decompensation. Forty-four rats with infrarenal aortic banding (AC rats) were studied. Hemodynamic parameters were measured 1 mo (AC(1) group; n = 20) or 2 mo (AC(2); n = 24) after aortic ligature. Then subgroups of AC(1) and AC(2) left ventricles (LV) were used to evaluate 1) LV anatomy and fibrosis (morphometry), 2) expression levels (immunoblotting) and spatial distribution (immunohistochemistry) of alpha-skeletal actin (alpha-SKA), alpha-cardiac actin (alpha-CA), and alpha-smooth muscle actin (alpha-SMA), and 3) cell mechanics and calcium transients in enzimatically isolated myocytes. Although the two AC groups exhibited a comparable degree of hypertrophy (+30% in LV mass; +20% in myocyte surface) and a similar increase in the amount of fibrosis compared with control animals (C group; n = 22), a worsening of LV mechanical performance was observed only in AC(2) rats at both organ and cellular levels. Conversely, AC(1) rats exhibited enhanced LV contractility and preserved cellular contractile behavior associated with increased calcium transients. Alpha-SKA expression was upregulated (+60%) in AC(1). In AC(2) ventricles, prolonged hypertension also induced a significant increase in alpha-SMA expression, mainly at the level of arterial vessels. No significant differences among groups were observed in alpha-CA expression. Our findings suggest that alpha-SKA expression regulation and wall remodeling of coronary arterioles participate in the development of impaired kinetics of contraction and relaxation in prolonged hypertension before the occurrence of marked histopathologic changes.
Collapse
Affiliation(s)
- Roberta Berni
- Dept. of Evolutionary and Functional Biology, Physiology Section, Univ. of Parma, V. le G. P. Usberti 11/A, I-43100, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Burns T, Catty J, White S, Clement S, Ellis G, Jones IR, Lissouba P, McLaren S, Rose D, Wykes T. Continuity of care in mental health: understanding and measuring a complex phenomenon. Psychol Med 2009; 39:313-323. [PMID: 18570700 DOI: 10.1017/s0033291708003747] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness. METHOD A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care. RESULTS Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model. CONCLUSIONS We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.
Collapse
Affiliation(s)
- T Burns
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ravenscroft G, Colley SM, Walker KR, Clement S, Bringans S, Lipscombe R, Fabian VA, Laing NG, Nowak KJ. Expression of cardiac α-actin spares extraocular muscles in skeletal muscle α-actin diseases – Quantification of striated α-actins by MRM-mass spectrometry. Neuromuscul Disord 2008; 18:953-8. [DOI: 10.1016/j.nmd.2008.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 07/09/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
|
22
|
Ravenscroft G, Colley S, Walker K, Clement S, Bringans S, Lipscombe R, Fabian V, Laing N, Nowak K. G.P.9.02 Expression of cardiac α-actin spares extraocular muscles in skeletal muscle α-actin diseases – determination of cardiac α-actin by MRM mass spectrometry. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.214] [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]
|
23
|
Harvey K, Catty J, Langman A, Winfield H, Clement S, Burns E, White S, Burns T. A review of instruments developed to measure outcomes for carers of people with mental health problems. Acta Psychiatr Scand 2008; 117:164-76. [PMID: 18241311 DOI: 10.1111/j.1600-0447.2007.01148.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Community-based care for mental disorders places considerable burden on families and carers. Measuring their experiences has become a priority, but there is no consensus on appropriate instruments. We aimed to review instruments carers consider relevant to their needs and assess evidence for their use. METHOD A literature search was conducted for outcome measures used with mental health carers. Identified instruments were assessed for their relevance to the outcomes identified by carers and their psychometric properties. RESULTS Three hundred and ninety two published articles referring to 241 outcome measures were identified, 64 of which were eligible for review (used in three or more studies). Twenty-six instruments had good psychometric properties; they measured (i) carers' well-being, (ii) the experience of caregiving and (iii) carers' needs for professional support. CONCLUSION Measures exist which have been used to assess the most salient aspects of carers outcome in mental health. All require further work to establish their psychometric properties fully.
Collapse
Affiliation(s)
- K Harvey
- Department of Psychology and Clinical Language Sciences, Reading University, School of Psychology, Reading, UK.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Jackaman C, Ravenscroft G, Lim E, Clement S, Nowak K, Laing N. G.P.6.15 Novel application of FACS: Determination of muscle fibre types and protein levels in whole murine skeletal muscles and heart. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.150] [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: 10/22/2022]
|
25
|
Abstract
OBJECTIVE The study aimed to determine the conceptual basis of measures of the patient-professional relationship used in routine mental health services research by reviewing their face, content and construct validity. METHOD A comprehensive literature search identified measures of the relationship used in mental health services research. The conceptual basis of each identified measure was identified by a review of measures' authors assessments of face, content and construct validity plus item analysis of the measures themselves. RESULTS The search identified 15 measures. The seven developed in psychotherapy were likely to be better validated conceptually; most were based on therapeutic alliance models. Measures developed specifically for mental health services were based on a wider range of models including global assessments of the relationship. CONCLUSION Most of the better validated measures originate in psychotherapy, but there is limited evidence for their validity in general mental health services. Four measures are recommended.
Collapse
Affiliation(s)
- J Catty
- Division of Mental Health, St George's, University of London, London, UK.
| | | | | |
Collapse
|
26
|
Nowak KJ, Sewry CA, Navarro C, Squier W, Reina C, Ricoy JR, Jayawant SS, Childs AM, Dobbie JA, Appleton RE, Mountford RC, Walker KR, Clement S, Barois A, Muntoni F, Romero NB, Laing NG. Nemaline myopathy caused by absence of alpha-skeletal muscle actin. Ann Neurol 2007; 61:175-84. [PMID: 17187373 DOI: 10.1002/ana.21035] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [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
OBJECTIVE To investigate seven congenital myopathy patients from six families: one French Gypsy, one Spanish Gypsy, four British Pakistanis, and one British Indian. Three patients required mechanical ventilation from birth, five died before 22 months, one is ventilator-dependent, but one, at 30 months, is sitting with minimal support. All parents were unaffected. METHODS The alpha-skeletal muscle actin gene (ACTA1) was sequenced. Available muscle biopsies were investigated by standard histological and electron microscopic techniques. The expression of various proteins was determined by immunohistochemistry, western blotting, or both. RESULTS Three homozygous ACTA1 null mutations were identified: p.Arg41X in the French patient, p.Tyr364fsX in the Spanish patient, and p.Asp181fsX10 in all five British patients. An absence of alpha-skeletal muscle actin protein but presence of alpha-cardiac actin was shown in all muscle biopsies examined, with more alpha-cardiac actin in the biopsy from the child with the greatest muscle function. Muscle biopsies from all patients exhibited nemaline bodies whereas three also contained zebra bodies. INTERPRETATION The seven patients have recessive nemaline myopathy caused by absence of alpha-skeletal muscle actin. The level of retention of alpha-cardiac actin, the skeletal muscle fetal actin isoform, may determine alpha-skeletal muscle actin disease severity. This has implications for possible future therapy.
Collapse
Affiliation(s)
- Kristen J Nowak
- Centre for Medical Research, University of Western Australia, Nedlands, Australia, and Centre for Inherited Neuromuscular Disorders, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Plouin-Gaudon I, Clement S, Huggler E, Chaponnier C, François P, Lew D, Schrenzel J, Vaudaux P, Lacroix JS. Intracellular residency is frequently associated with recurrent Staphylococcus aureus rhinosinusitis. Rhinology 2006; 44:249-54. [PMID: 17216740] [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: 05/13/2023]
Abstract
AIM The prevalence of intracellular Staphylococcus aureus organisms in the nasal mucosa of patients with recurrent infectious rhinosinusitis episodes was studied. METHOD Twenty-seven consecutive adult patients who failed medical management of chronic rhinosinusitis (CRS) of multiple origins, associated or not with nasal polyposis, were consecutively enrolled for endonasal sinus surgery (including partial middle turbinectomy, middle antrostomy, ethmoidectomy, sphenoidotomy) and followed for a 12-month post-operative period. RESULTS Seventeen of these patients showed the presence of intracellular S. aureus as detected by confocal laser scan immunofluorescence microscopy in epithelial cells of surgical intranasal biopsy specimens. Nine of the patients with and two without intracellular bacteria yielded S. aureus in endoscopically guided cultures of middle meatus secretions, despite the recent administration of prophylactic antibiotics. Eleven of the 17 patients with intracellular S. aureus relapsed for rhinosinusitis within the 12-month follow-up period. Molecular typing of sequential S. aureus isolates demonstrated the persistence of unique patient-specific S. aureus clonotypes in nine of the patients with intracellular bacteria during the 12-month follow-up. CONCLUSION The presence of intracellular S. aureus in epithelial cells of the nasal mucosa is a significant risk factor for recurrent episodes of rhinosinusitis due to persistent bacterial clonotypes, which appear refractory to antimicrobial and surgical therapy.
Collapse
Affiliation(s)
- I Plouin-Gaudon
- Rhinology - Olfactology Unit, Department of Otorhinolaryngology/Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Bettiol E, Clement S, Krause KH, Jaconi ME. Embryonic and adult stem cell-derived cardiomyocytes: lessons from in vitro models. Rev Physiol Biochem Pharmacol 2006; 157:1-30. [PMID: 17236648 DOI: 10.1007/112_0508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 12/12/2022]
Abstract
For years, research has focused on how to treat heart failure by sustaining the overloaded remaining cardiomyocytes. Recently, the concept of cell replacement therapy as a treatment of heart diseases has opened a new area of investigation. In vitro-generated cardiomyocytes could be injected into the heart to rescue the function of a damaged myocardium. Embryonic and/or adult stem cells could provide cardiac cells for this purpose. Knowledge of fundamental cardiac differentiation mechanisms unraveled by studies on animal models has been improved using in vitro models of cardiogenesis such as mouse embryonal carcinoma cells, mouse embryonic stem cells and, recently, human embryonic stem cells. On the other hand, studies suggesting the existence of cardiac stem cells and the potential of adult stem cells from bone marrow or skeletal muscle to differentiate toward unexpected phenotypes raise hope and questions about their potential use for cardiac cell therapy. In this review, we compare the specificities of embryonic vs adult stem cell populations regarding their cardiac differentiation potential, and we give an overview of what in vitro models have taught us about cardiogenesis.
Collapse
Affiliation(s)
- E Bettiol
- University of Geneva, Department of Pathology and Immunology, Faculty of Medicine, Switzerland
| | | | | | | |
Collapse
|
30
|
Ilkovski B, Clement S, Sewry C, North KN, Cooper ST. Defining α-skeletal and α-cardiac actin expression in human heart and skeletal muscle explains the absence of cardiac involvement in ACTA1 nemaline myopathy. Neuromuscul Disord 2005; 15:829-35. [PMID: 16288873 DOI: 10.1016/j.nmd.2005.08.004] [Citation(s) in RCA: 55] [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] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 07/26/2005] [Accepted: 08/05/2005] [Indexed: 11/16/2022]
Abstract
Mutations in alpha-skeletal actin (ACTA1) underlie several congenital muscle disorders including nemaline myopathy (NM). Almost all ACTA1-NM patients have normal cardiac function, and, even lethally affected congenital NM patients exhibit an unremarkable gestation with decreased foetal movement just prior to birth. Although alpha-skeletal actin is thought to be the predominant sarcomeric actin in human heart (Boheler KR, Carrier L, de la Bastie D, et al. Skeletal actin mRNA increases in the human heart during ontogenic development and is the major isoform of control and failing adult hearts. J Clin Invest 1991;88:323-30 ), ACTA1-NM patients almost never exhibit a cardiac phenotype. In this study, we define the relative expression of skeletal and cardiac actin proteins in human heart and skeletal muscle. We show that alpha-cardiac actin is the predominant sarcomeric isoform in human donor hearts and in early foetal skeletal muscle development. Skeletal actin is the predominant isoform from 25 to 27 weeks gestation and is the exclusive isoform expressed in muscle from infancy through to adulthood. These findings are consistent with clinical observations of NM patients and assist us to better understand the pathogenesis of inherited myopathies and cardiomyopathies with mutations in actin.
Collapse
Affiliation(s)
- Biljana Ilkovski
- Institute for Neuromuscular Research, Children's Hospital at Westmead, Sydney, Australia
| | | | | | | | | |
Collapse
|
31
|
Haggenmacher C, Biarent D, Otte F, Fonteyne C, Clement S, Deckers S. [Non-invasive bi-level ventilation in paediatric status asthmaticus]. Arch Pediatr 2005; 12:1785-7. [PMID: 16126378 DOI: 10.1016/j.arcped.2005.03.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 03/29/2005] [Indexed: 11/17/2022]
Abstract
Invasive ventilation in status asthmaticus is associated with an increased mortality and morbidity. To avoid intubation associated complications, non-invasive bi-level ventilation is often used in adults and children. We report the clinical history of an 11-month old infant, which encountered intubation criteria but was treated successfully by full-face mask non-invasive bi-level ventilation. Despite difficulties in application due to young age and lack of age related material, non-invasive bi-level ventilation is a good tool in the treatment of children with status asthmaticus.
Collapse
Affiliation(s)
- C Haggenmacher
- Service des soins intensifs pédiatriques, hôpital universitaire des enfants-reine-Fabiola, université libre de Bruxelles, 15, avenue J.-J.- Crocq, 1020 Bruxelles, Belgique
| | | | | | | | | | | |
Collapse
|
32
|
Clement S, Vaudaux P, Francois P, Schrenzel J, Huggler E, Kampf S, Chaponnier C, Lew D, Lacroix JS. Evidence of an intracellular reservoir in the nasal mucosa of patients with recurrent Staphylococcus aureus rhinosinusitis. J Infect Dis 2005; 192:1023-8. [PMID: 16107955 DOI: 10.1086/432735] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 04/21/2005] [Indexed: 11/04/2022] Open
Abstract
Severe infections due to Staphylococcus aureus require prolonged therapy for cure, and relapse may occur even years after the first episode. Persistence of S. aureus may be explained, in part, by nasal carriage of S. aureus, which occurs in a large percentage of healthy humans and represents a major source of systemic infection. However, the persistence of internalized S. aureus within mucosal cells has not been evaluated in humans. Here, we provide the first in vivo evidence of intracellular reservoirs of S. aureus in humans, which were assessed in endonasal mucosa specimens from patients suffering from recurrent S. aureus rhinosinusitis due to unique, patient-specific bacterial clonotypes. Heavily infected foci of intracellular bacteria located in nasal epithelium, glandular, and myofibroblastic cells were revealed by inverted confocal laser scan fluorescence and electron microscopic examination of posttherapy intranasal biopsy specimens from symptom-free patients undergoing surgery on the sinuses. Intracellular residence may provide a sanctuary for pathogenic bacteria by protecting them from host defense mechanisms and antibiotic treatment during acute, recurrent S. aureus rhinosinusitis.
Collapse
Affiliation(s)
- Sophie Clement
- Department of Pathology and Immunology, University of Geneva, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ilkovski B, Nowak KJ, Domazetovska A, Maxwell AL, Clement S, Davies KE, Laing NG, North KN, Cooper ST. Evidence for a dominant-negative effect in ACTA1 nemaline myopathy caused by abnormal folding, aggregation and altered polymerization of mutant actin isoforms. Hum Mol Genet 2004; 13:1727-43. [PMID: 15198992 DOI: 10.1093/hmg/ddh185] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [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: 11/13/2022] Open
Abstract
We have studied a cohort of nemaline myopathy (NM) patients with mutations in the muscle alpha-skeletal actin gene (ACTA1). Immunoblot analysis of patient muscle demonstrates increased gamma-filamin, myotilin, desmin and alpha-actinin in many NM patients, consistent with accumulation of Z line-derived nemaline bodies. We demonstrate that nebulin can appear abnormal secondary to a primary defect in actin, and show by isoelectric focusing that mutant actin isoforms are present within insoluble actin filaments isolated from muscle from two ACTA1 NM patients. Transfection of C2C12 myoblasts with mutant actin(EGFP) constructs resulted in abnormal cytoplasmic and intranuclear actin aggregates. Intranuclear aggregates were observed with V163L-, V163M- and R183G-actin(EGFP) constructs, and modeling shows these residues to be adjacent to the nuclear export signal of actin. V163L and V163M actin mutants are known to cause intranuclear rod myopathy, however, intranuclear bodies were not reported in patient R183G. Transfection studies in C2C12 myoblasts showed significant alterations in the ability of V136L and R183G actin mutants to polymerize and contribute to insoluble actin filaments. Thus, we provide direct evidence for a dominant-negative effect of mutant actin in NM. In vitro studies suggest that abnormal folding, altered polymerization and aggregation of mutant actin isoforms are common properties of NM ACTA1 mutants. Some of these effects are mutation-specific, and likely result in variations in the severity of muscle weakness seen in individual patients. A combination of these effects contributes to the common pathological hallmarks of NM, namely intranuclear and cytoplasmic rod formation, accumulation of thin filaments and myofibrillar disorganization.
Collapse
Affiliation(s)
- Biljana Ilkovski
- The Institute for Neuromuscular Research, The Children's Hospital at Westmead, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Wang Q, Clement S, Gabbiani G, Horisberger JD, Burnier M, Rossier BC, Hummler E. Chronic hyperaldosteronism in a transgenic mouse model fails to induce cardiac remodeling and fibrosis under a normal-salt diet. Am J Physiol Renal Physiol 2004; 286:F1178-84. [PMID: 14761862 DOI: 10.1152/ajprenal.00386.2003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [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: 11/22/2022] Open
Abstract
Primary aldosteronism causes severe hypertension in humans (Conn's syndrome) with cardiac hypertrophy, characterized by a fibrosis more severe than the one observed in patients with essential hypertension. This suggests that aldosterone by itself may have specific and direct effects on cardiac remodeling through the activation of the cardiac mineralocorticoid receptor. Experimental evidence obtained in studying uninephrectomized rats treated with aldosterone or deoxycorticosterone (DOC) together with salt loading has led to similar conclusions. To examine the direct consequences of chronically elevated aldosterone levels on cardiac pathophysiology, we analyzed a mouse model (α-epithelial Na channel −/−Tg) that is normotensive under normal-salt diet but exhibits chronic hyperaldosteronism. Sixteen-month-old transgenic rescue mice that were kept under a regular salt diet that contains a small amount of sodium (0.3% Na+) displayed a compensated PHA-1 phenotype with normal body weight, normal kidney index, normal blood pressure, but 6.3-fold elevated plasma aldosterone levels compared with the age-matched control group. Peripheral resistance of distal colon to aldosterone was shown by a significant decrease of the amiloride-sensitive rectal potential difference, and its diurnal cyclicity was blunted. Despite chronically high plasma aldosterone levels, these animals do not show any evidence of cardiac hypertrophy, remodeling, or fibrosis, using collagen staining and anti-α-skeletal and α-smooth actin immunochemical labeling of heart sections. Cardiac fibrosis as seen in DOC- or aldosterone/salt-treated animal models is therefore likely to be due to the synergistic effect of salt, aldosterone, and other confounding factors rather than to the elevated circulating aldosterone levels alone.
Collapse
Affiliation(s)
- Qing Wang
- Dept. of Pharmacology and Toxicology, Rue du Bugnon 27, CH-1005 Lausanne, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
35
|
Clement S, Candy B, Heath V, To M, Nicolaides KH. Transvaginal ultrasound in pregnancy: its acceptability to women and maternal psychological morbidity. Ultrasound Obstet Gynecol 2003; 22:508-514. [PMID: 14618665 DOI: 10.1002/uog.893] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To assess the acceptability to women of antenatal transvaginal ultrasound scans; to compare the characteristics of women who accept the offer of a transvaginal scan with those who decline; to establish the prevalence of any psychological morbidity associated with the scan. METHODS The study was a cross-sectional questionnaire survey. Women were recruited from two hospitals in South London. The sample consisted of 755 pregnant women who had a transvaginal scan at 23 weeks' gestation to assess the risk of preterm delivery and 167 women who were offered the transvaginal scan but declined. Women completed a questionnaire at home. Those who reported finding the scan a difficult experience were sent a questionnaire 4 weeks post-scan to assess its longer term impact. The main outcomes were acceptability (assessed by individual questionnaire items); anxiety before and during the scan (Spielberger State-trait Anxiety Inventory); pain during the scan (Present Pain Intensity Scale of the McGill Pain Questionnaire); psychological trauma (Impact of Event Scale). RESULTS Over half (55.2%) of women accepted the offer of a transvaginal scan, according to hospital records. The majority of study participants who had transvaginal ultrasound reported finding the experience acceptable. Women experienced some anxiety before and during the scan and over a third experienced some (usually mild) pain during the procedure. Twelve women (1.6%) reported clinically significant levels of psychological trauma in relation to the scan. CONCLUSIONS Antenatal transvaginal ultrasound for assessing the risk of preterm delivery is an acceptable procedure for the majority of women. A significant minority decline the scan. The procedure has some psychological sequelae for some women.
Collapse
Affiliation(s)
- S Clement
- Department of General Practice and Primary Care, Guy's King's and St Thomas' School of Medicine, King's College London, London, UK.
| | | | | | | | | |
Collapse
|
36
|
|
37
|
Dumont JE, Maenhaut C, Lamy F, Pirson I, Clement S, Roger PP. Growth and proliferation of the thyroid cell in normal physiology and in disease. Ann Endocrinol (Paris) 2003; 64:10-1. [PMID: 12707625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- J E Dumont
- Institut de recherche interdisciplinaire en biologie humaine et nucléaire, Faculté de Médecine, Université Libre de Bruxelles, Bruxelles, Belgique
| | | | | | | | | | | |
Collapse
|
38
|
van Veen TAB, van Rijen HVM, Wiegerinck RF, Opthof T, Colbert MC, Clement S, de Bakker JMT, Jongsma HJ. Remodeling of gap junctions in mouse hearts hypertrophied by forced retinoic acid signaling. J Mol Cell Cardiol 2002; 34:1411-23. [PMID: 12393001 DOI: 10.1006/jmcc.2002.2102] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Beta-MHC-hRARalpha transgenic mice express a constitutively active (truncated) form of the human retinoic acid receptor which triggers development of dilated cardiomyopathy. In those hearts, we studied expression of gap junction proteins in relation to electrical impulse propagation. METHODS AND RESULTS As compared to wildtype mice, hearts of 4-6 month old mice with 7-12 inserted hRARalpha copies are marked by an increased heart weight/body weight- and heart weight/tibia length ratio. 3-extremity lead ECGs revealed prolongation of the Q-j interval suggesting delayed ventricular activation. Mapping of electrical activity of epi- and endocardial left ventricular free wall revealed activation delay, increased heterogeneity in conduction and regional conduction block. Ventricular tachycardias did not occur spontaneously nor could be induced by ventricular pacing. Immunohistochemical analysis showed profound and heterogeneous redistribution and down-regulation of the gap junction protein connexin43 (Cx43) in the left ventricular free wall. Here, hRARalpha expression induced re-expression of the hypertrophic markers alpha-skeletal actin and beta-MHC, and in 3 out of 10 severely affected mice, re-expression of Cx40. Concomitant with changes in expression/distribution of Cx43, changes in expression and distribution of beta-catenin and N-cadherin (two other intercalated disk associated proteins) were observed. CONCLUSIONS Beta-MHC-hRARalpha transgenic hearts show heterogeneous re-expression of (early) sarcomeric genes while expression of connexin43, N-cadherin and beta-catenin is down-regulated. We postulate that the resulting aberrant ventricular activation does not trigger development of lethal arrhythmias due to the small size of remaining healthy ventricular tissue where the transgene is not expressed.
Collapse
Affiliation(s)
- Toon A B van Veen
- Department of Medical Physiology, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Abstract
This chapter gives an overview of research relating to psychological aspects of caesarean section. It focuses on four main questions: *What are the psychological effects of caesarean section on the mother, her partner and her relationship with her infant? *What factors (obstetric, psychological, attitudinal, and health care-related) make women more vulnerable to adverse psychological outcomes after a caesarean section? *What are women distressed about when they have had a caesarean section? *How can post-caesarean psychological distress be prevented or managed?A methodological critique of existing studies on psychological aspects of caesarean section is also given. In conclusion, recommendations for practice and for future research are made.
Collapse
Affiliation(s)
- S Clement
- Department of General Practice and Primary Care, Guy's, King's and St Thomas' School of Medicine, King's College London, 5 Lambeth Walk, London, SE11 6SP, UK
| |
Collapse
|
41
|
Clement S, Pickering A, Rowlands G, Thiru K, Candy B, de Lusignan S. Towards a conceptual framework for evaluating primary care research networks. Br J Gen Pract 2000; 50:651-2. [PMID: 11042918 PMCID: PMC1313777] [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: 02/18/2023] Open
Abstract
We describe a conceptual framework that we have developed for evaluating primary care research networks. The framework includes objectives, process indicators, and outcome indicators. We propose the framework as a provisional model that we hope will promote further research and debate.
Collapse
Affiliation(s)
- S Clement
- Department of General Practice and Primary Care, Guy's, King's and St Thomas' School of Medicine, King's College London
| | | | | | | | | | | |
Collapse
|
42
|
Shum C, Humphreys A, Wheeler D, Cochrane MA, Skoda S, Clement S. Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial. BMJ 2000; 320:1038-43. [PMID: 10764365 PMCID: PMC27346 DOI: 10.1136/bmj.320.7241.1038] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the acceptability and safety of a minor illness service led by practice nurses in general practice. DESIGN Multicentre, randomised controlled trial. SETTING 5 general practices in south east London and Kent representing semi-rural, suburban, and urban settings. PARTICIPANTS 1815 patients requesting and offered same day appointments by receptionists. INTERVENTION Patients were assigned to treatment by either a specially trained nurse or a general practitioner. Patients seen by a nurse were referred to a general practitioner when appropriate. MAIN OUTCOME MEASURES The general satisfaction of the patients as measured by the consultation satisfaction questionnaire. Other outcome measures included the length of the consultation, number of prescriptions written, rates of referral to general practitioners, patient's reported health status, patient's anticipated behaviour in seeking health care in future, and number of patients who returned to the surgery, visits to accident and emergency, and out of hours calls to doctors. RESULTS Patients were very satisfied with both nurses and doctors, but they were significantly more satisfied with their consultations with nurses (mean (SD) score of satisfaction 78.6 (16. 0) of 100 points for nurses v 76.4 (17.8) for doctors; 95% confidence interval for difference between means -4.07 to -0.38). Consultations with nurses took about 10 minutes compared with about 8 minutes for consultations with doctors. Nurses and doctors wrote prescriptions for a similar proportion of patients (nurses 481/736 (65.4%) v doctors 518/816 (63.5%)). 577/790 (73%) patients seen by nurses were managed without any input from doctors. CONCLUSION Practice nurses seem to offer an effective service for patients with minor illnesses who request same day appointments.
Collapse
Affiliation(s)
- C Shum
- Walderslade Village Surgery, Walderslade ME5 9LD.
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
OBJECTIVES To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. METHODS Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This took place between 1993 and 1994 in antenatal clinics in South East London and involved 2794 women at low risk of complications. RESULTS The estimated baseline costs to the UK National Health Service (NHS) for the traditional schedule were 544 Pounds per woman, of which 251 Pounds occurred antenatally, with a range of 327-1203 Pounds per woman. The estimated baseline costs to the NHS for the reduced visit schedule was 563 Pounds per woman, of which 225 Pounds occurred antenatally, with a range of 274-1741 Pounds per woman. Savings from new style care that arose antenatally were offset by the greater numbers of babies in this group who required special or intensive care. Sensitivity analyses based on possible variations in unit costs and resource use and modelled postnatal stay showed considerable variation and substantial overlap in costs. CONCLUSIONS Patterns of antenatal care involving fewer routine visits for women at low risk of complications are unlikely to result in savings to the Health Service. In addition, women who had the reduced schedule of care reported greater dissatisfaction with their care and poorer psychosocial outcomes which argues against reducing numbers of antenatal visits.
Collapse
Affiliation(s)
- J Henderson
- National Perinatal Epidemiology Unit, Institute of Health Sciences, Oxford, UK
| | | | | | | | | |
Collapse
|
44
|
Abstract
The purpose of this work is to analyze the various negotiations involved in setting up and developing a caregiving relationship with a disabled elderly person, to understand the processes inducing caregiver stress. Within the conceptual framework defined by the paradigm of negotiation, this study uses the theoretical contributions of the parallelist theory and the theory of the gift. It is based on a qualitative inquiry including fifty-four caregivers conducted in Toulouse (South West France). The analysis focuses on two undersystems of the caregiver's relationships: 1) the caregiver/cared-for's relationship, which is characterized by the establishment and maintenance of a "tacit contract" and 2) the relationships with other eligible caregivers, which are marked by the "designation" of the principal caregiver. This analysis shows that a failure in the negotiation process can induce a designation and/or a weak tacit contract-the result of which is the caregiver's expression of stress. This expression is closely linked to the caregiver's perception of a negative balance in his/her exchanges with the partners. This study should help break away from the one-way arrow model currently dominating the field of caregiver stress research.
Collapse
Affiliation(s)
- A Grand
- Département de Santé Publique, Faculté de Médecine, Toulouse, France
| | | | | | | |
Collapse
|
45
|
Candy B, Clement S, Sikorski J, Wilson J. Antenatal visits. Pract Midwife 2000; 3:21-4. [PMID: 11052063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
46
|
Harris HE, Ellison GT, Clement S. Do the psychosocial and behavioral changes that accompany motherhood influence the impact of pregnancy on long-term weight gain? J Psychosom Obstet Gynaecol 1999; 20:65-79. [PMID: 10422038 DOI: 10.3109/01674829909075579] [Citation(s) in RCA: 64] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of the present study was to assess whether the psychosocial and behavioral changes that occur during and after pregnancy influence long-term weight gain. The study examined 74 mothers enrolled in the Antenatal Care (ANC) Project (a randomized controlled trial of antenatal care based in South London), all of whom had volunteered to take part in a subsequent follow-up study. Data on body weight at the beginning of pregnancy; lifestyle and behavior during pregnancy; antenatal care and obstetric history; together with measures of postnatal depression and parenting stress following pregnancy were taken from the existing ANC Project database. Additional measurements of height and weight together with information on a variety of lifestyle changes and psychosocial characteristics, were gathered during semi-structured interviews at each mother's home, two and a half years after their children had been born. The results show that pregnancy-related weight gains are not simply the result of retaining weight that is gained during pregnancy, but that they also originate from gaining additional weight in the postpartum period. Mothers who felt they ate more after their children were born, had significantly greater long-term weight gains (2.78 (1.42) kg) than those who felt that they had not increased their food intake (-1.15 (0.76) kg; t = 2.49, p = 0.016). Similarly, mothers who felt they had greater access to food postpartum, had significantly greater long-term weight gains (1.70 (0.87) kg) than those who felt they did not have greater access to food (-1.37 (1.13) kg; t = 2.18, p = 0.032). There was some evidence that the lifestyle changes which accompany pregnancy and motherhood increase some women's vulnerability to eating disorder psychopathology. Mothers who felt they did less exercise after pregnancy than they did before, were also at greater risk of long-term weight gain (p = 0.028), as were mothers with low numbers of supportive individuals (p = 0.033). Neither the stress of parenting nor maternal depression were significantly associated with an increased risk of long-term weight gain (p > 0.05).
Collapse
Affiliation(s)
- H E Harris
- Maternal and Child Health Research Programme, University of Greenwich, London, UK
| | | | | |
Collapse
|
47
|
Clement S, Reed B. To stitch or not to stitch? A long-term follow-up study of women with unsutured perineal tears. Pract Midwife 1999; 2:20-8. [PMID: 10427286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- S Clement
- Albany Midwifery Practice King's Healthcare Trust
| | | |
Collapse
|
48
|
Clement S, Candy B, Sikorski J, Wilson J, Smeeton N. Does reducing the frequency of routine antenatal visits have long term effects? Follow up of participants in a randomised controlled trial. Br J Obstet Gynaecol 1999; 106:367-70. [PMID: 10426245 DOI: 10.1111/j.1471-0528.1999.tb08276.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
1117 low risk women, who had been randomly allocated to either the traditional schedule of 13 antenatal visits or a reduced schedule of six to seven visits, were followed up 2.7 years after their delivery. Follow up was by means of a postal questionnaire (assessing the mother-child relationship, maternal psychological wellbeing, health service use, health-related behaviour and health beliefs), and patient record data on the frequency of contacts in general practice. There was no evidence of differences between the two groups for any of the outcomes examined. Offering a reduced schedule of routine antenatal visits to low risk women does not appear to have any long term effects.
Collapse
Affiliation(s)
- S Clement
- Department of General Practice and Primary Care, Guy's, King's and St. Thomas' School of Medicine, King's College, London, UK
| | | | | | | | | |
Collapse
|
49
|
|
50
|
|