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Schürmann L, Bredehorst M, González-González AI, Muth C, van der Wardt V, Puzhko S, Haasenritter J. Recommendations for the primary prevention of atherosclerotic cardiovascular disease in primary care: study protocol for a systematic guideline review. BMJ Open 2023; 13:e074788. [PMID: 38070923 PMCID: PMC10729171 DOI: 10.1136/bmjopen-2023-074788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) was the main cause of death in Germany in 2021, with major risk factors (ie, hypertension, diabetes, dyslipidaemia, obesity and certain lifestyle factors) being highly prevalent. Preventing ASCVD by assessment and modification of these risk factors is an important challenge for general practitioners. This study aims to systematically review and synthesise recent recommendations of national and international guidelines regarding the primary prevention of ASCVD in adults in primary care. METHODS AND ANALYSIS We will conduct a systematic review of clinical practice guidelines (CPGs) to evaluate primary prevention strategies for ASCVD. CPGs will be retrieved from MEDLINE and the Turning Research Into Practice database, guideline-specific databases and websites of guidelines-producing societies, with searches limited to publications from 2016 onwards. We will include CPGs in English, Spanish, German or Dutch languages that provide evidence-based recommendations for ASCVD prevention. The study population will include adults without diagnosed ASCVD. Two independent reviewers will assess guideline eligibility and quality by means of the mini-checklist MiChe, and extract study characteristics and relevant recommendations for further consistency analysis. A third reviewer will resolve disagreements. Findings will be presented as a narrative synthesis and in tabular form. ETHICS AND DISSEMINATION This review does not require ethical approval. Our systematic review will inform the CPG of the German College of General Practitioners and Family Physicians on the primary prevention of ASCVD. The review results will also be disseminated through publications in peer-reviewed journals and presentations at local, national and international conferences. PROSPERO REGISTRATION NUMBER CRD42023394605.
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Affiliation(s)
- Lara Schürmann
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
| | - Maren Bredehorst
- Department of Primary Care, University of Marburg, Marburg, Germany
| | - Ana I González-González
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
| | - Christiane Muth
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
| | | | - Svetlana Puzhko
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
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Sourial N, Develay E, Quesnel-Vallee A, Holyoke P, Dassieu L, Archambault P, Godard-Sebillotte C, Karunananthan S, Puzhko S. The Importance of Proximity in the Social Network of Older Persons Living Alone During the Pandemic. Geriatrics (Basel) 2023. [DOI: 10.1370/afm.21.s1.4006] [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: 01/26/2023] Open
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Dassieu L, Develay E, Beauchet O, Quesnel-Vallée A, Godard-Sebillotte C, Tchouaket E, Puzhko S, Karunananthan S, Archambault P, Launay C, Holyoke P, Sauriol C, Galery K, Sourial N. Implementing a Telehealth Support Tool for Community-Dwelling Older Adults During the COVID-19 Pandemic: A Qualitative Investigation of Provider Experiences. J Aging Soc Policy 2022:1-18. [PMID: 35994512 DOI: 10.1080/08959420.2022.2111166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/19/2022] [Indexed: 10/15/2022]
Abstract
During the COVID-19 pandemic, policymakers had to quickly offer telehealth services to address older adults' needs. This study aimed to understand the experiences of providers who implemented a telephone-based telehealth tool named Socio-Geriatric Evaluation (ESOGER), which assessed health and social isolation risks in community-dwelling older adults in Quebec (Canada). This qualitative study used 20 semi-structured online/phone interviews with health and social service providers coming from publicly-funded healthcare facilities and community organizations. We included adopters and non-adopters of the telehealth tool. Interviews were audio-recorded and transcribed verbatim. We used reflexive thematic analysis to interpret the data. Three dimensions of providers' practice influenced the tool's implementation: service organization, working conditions, and interactions with older adults. Participants reported that the tool fostered continuity of care, provided guidance for their pandemic-related new tasks, and helped identify and support socially isolated older adults. Challenges to implementation included limited appropriateness of the telehealth tool for diverse services, feasibility barriers to adopting a new tool amid the health crisis, and acceptability challenges with some older adults. Despite relevance of the telehealth tool for providers, organizational, professional, and interactional barriers could hinder implementation success. Participatory approaches to telehealth may be promising avenues for future policies in this field.
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Affiliation(s)
- Lise Dassieu
- Senior Postdoctoral Researcher, Department of Biomedical Sciences, Université de Montréal, and Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Elise Develay
- Research Professional, Research Centre, Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Beauchet
- Professor, Department of Medicine, Université de Montréal, and Research Center of the Institut Universitaire en Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Amélie Quesnel-Vallée
- Professor, Department of Sociology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Claire Godard-Sebillotte
- Assistant Professor, Division of Geriatrics, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eric Tchouaket
- Professor, Department of Nursing Sciences, Université du Quebec en Outaouais, Saint-Jérôme, Quebec, Canada
| | - Svetlana Puzhko
- Postdoral Researcher, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Patrick Archambault
- Associate Professor, Department of Family and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Cyrille Launay
- Geriatrician, Clinical Researcher, Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Paul Holyoke
- Executive Director, SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Caroline Sauriol
- Director, Little Brothers Organization, Montreal, Quebec, Canada
| | - Kevin Galery
- Assistant Director, Research Centre, Research Center of the Institut Universitaire en Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Nadia Sourial
- Assistant Professor, Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montreal, Université de Montréal, and Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Puzhko S, Eisenberg MJ, Filion KB, Windle SB, Hébert-Losier A, Gore G, Paraskevopoulos E, Martel MO, Kudrina I. Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews. Front Public Health 2022; 10:749033. [PMID: 35273933 PMCID: PMC8901608 DOI: 10.3389/fpubh.2022.749033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The North American opioid crisis is marked by high opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs). Users of pharmaceutical and non-pharmaceutical opioids are at an increased risk of acquiring hepatitis C (HCV), human immunodeficiency virus (HIV), and other infections. No high-level evidence, however, has been synthesized regarding effectiveness of interventions to prevent OUAIs in legal, and illegal/mixed opioid users. The aim of the study is to synthesize available systematic review (SR)-level evidence on the scope and effectiveness of interventions to prevent OUAIs among opioid users. Methods A SR of SRs approach was applied. We searched PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos and Google Scholar from inception to September 2020. Data selection and extraction were performed independently by three researchers. Risk of bias and quality of evidence were assessed using the AMSTAR2 tool. Results were narratively synthesized. Strength of evidence for each category was reported. Results Eleven of twelve identified SRs included interventions to prevent HCV/HIV transmission in persons who inject drugs (PWID), including opioids. One SR evaluated interventions to prevent recurrent infectious endocarditis. There was sufficient and tentative SR of SRs-level evidence for the effectiveness of opioid substitution therapy (OST) in preventing HIV and HCV, respectively. We found tentative evidence to support effectiveness of needle/syringe exchange programs (NSP) in HIV prevention, and sufficient evidence to support effectiveness of the combined OST and NSP in HCV prevention. There was insufficient SR-level evidence to support or discount effectiveness of other interventions to prevent OUAIs. No SR focused on non-PWID populations. Conclusion SR-level evidence supports the use of OST, NSP, and combined interventions for the reduction of HCV and HIV transmission in PWID. More research on prevention of other OUAIs and on prevention of OUAIs in non-PWID populations is urgently needed. Systematic Review Registration Registered in PROSPERO on July 30, 2020. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195929, identifier: #195929.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Sarah B Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andréa Hébert-Losier
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | | | - Marc O Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montréal, QC, Canada
| | - Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Puzhko S, Schuster T, Barnett TA, Renoux C, Munro K, Barber D, Bartlett G. Difference in patterns of prescribing antidepressants known for their weight-modulating and cardiovascular side effects for patients with obesity compared to patients with normal weight. J Affect Disord 2021; 295:1310-1318. [PMID: 34706445 DOI: 10.1016/j.jad.2021.08.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with depression and comorbid obesity may be more prone to weight modulating and cardiovascular side effects of selected antidepressants (AD). It is important to ascertain whether these AD prescriptions differ by patient weight status. METHODS Canadian Primary Care Sentinel Surveillance Network (CPCSSN) electronic medical records were used. Participants were adults with depression prescribed an AD in 2000-2016, with weight categories established before the first prescription. Logistic regression and mixed effects models were applied to examine associations between obesity and AD prescribing, adjusted for sex, age, and comorbidities. Machine learning algorithm random forest (RF) was used to evaluate the importance of weight in predicting prescribing patterns. RESULTS Of 26,571 participants, 72.4% were women, mean age was 38.9 years (standard deviation (SD)=14.2) and mean BMI 27.0 kg/m2 (SD = 6.5); 9.5% had ≥ 1 comorbidity. Patients with obesity, compared to normal weight patients, were more likely to receive bupropion (adjusted odds ratio (aOR) 1.24, 95%CI: 1.09,1.42), fluoxetine (aOR 1.14, 95%CI: 0.97,1.34), and amitriptyline (aOR 1.13, 95%CI: 0.93,1.36), and less likely to receive mirtazapine (aOR 0.55, 95%CI: 0.44,0.68) and escitalopram (aOR 0.88, 95%CI: 0.80, 0.97). RF analysis showed that weight was among the most important predictors of prescribing patterns, equivalent to age and more important than sex. CONCLUSIONS AD prescribing patterns for patients with obesity appear to be different for selected AD types, including AD known for their weight-modulating and cardiovascular side effects. Longitudinal studies are needed to examine whether these prescribing patterns are associated with significant health outcomes.
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Affiliation(s)
- S Puzhko
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, suite 300, H3S 1Z1, Montréal, Qc, Canada.
| | - T Schuster
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, suite 300, H3S 1Z1, Montréal, Qc, Canada.
| | - T A Barnett
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, suite 300, H3S 1Z1, Montréal, Qc, Canada.
| | - C Renoux
- Department of Neurology & Neurosurgery, McGill University, 3801 Rue Université, H3A 2B4, Montréal, Qc, Canada; Department of Epidemiology and Biostatistics, McGill University, Montréal, Qc, Canada; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Qc, Canada.
| | - K Munro
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, suite 300, H3S 1Z1, Montréal, Qc, Canada.
| | - D Barber
- Department of Family Medicine, Faculty of Medicine, Queen's University, 220 Bagot Street, K7L 3G2, Kingston, On, Canada.
| | - G Bartlett
- School of Medicine, University of Missouri, 7 Hospital Drive, Medical Sciences Building, Suite MA306N, 65211, Columbia, MO, United States.
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Kudrina I, Puzhko S, Filion KB, Gore G, Paraskevopoulos E, Windle S, Martel MO, Eisenberg MJ. Effectiveness of interventions for prevention of common infections in people who use opioids: a protocol for a systematic review of systematic reviews. Syst Rev 2021; 10:298. [PMID: 34782008 PMCID: PMC8591821 DOI: 10.1186/s13643-021-01852-w] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society. Users of legal and illegal opioids are at an increased risk of OUAIs compared to individuals not using opioids. As reported for hepatitis C virus (HCV), human immunodeficiency virus (HIV), bacterial, fungal, and other infections, OUAIs transmission and acquisition risks may be modifiable. Several systematic reviews (SRs) synthetized data regarding interventions to prevent infections in persons using drugs (e.g., opioid substitution therapy, needle and syringes exchange programs, psycho-social interventions); however, their conclusions varied. Therefore, SR of published SRs is needed to synthesize the highest level of evidence on the scope and effectiveness of interventions to prevent OUAIs in people using opioids legally or illegally. METHODS We will comprehensively search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and Google Scholar databases from inception to November 2020. Data selection and extraction for each SR will be performed independently by two researchers, with disagreements resolved by consensus. All SRs regarding interventions with evaluated effectiveness to prevent OUAI in legal and/or illegal opioid users will be eligible. Risk of bias assessment will be performed using the AMSTAR2 tool. The results will be qualitatively synthesized, and a typology of interventions' effectiveness with a statement on the strength of evidence for each category will be created. DISCUSSION Our pilot search of PubMed resulted in 379 SRs analyzing the effectiveness of interventions to prevent HCV and HIV in persons who inject different types of drugs, including opioids. Of these 379 SRs, 8 evaluated primary studies where participants used opioids and would therefore be eligible for inclusion. The search results thus justify the application of SR of SRs approach. Comprehensive data on the scope and effectiveness of existing interventions to prevent OUAIs will help policy-makers to plan and implement preventive interventions and will assist clinicians in the guidance for their patients using opioids. SYSTEMATIC REVIEW REGISTRATION Registered in PROSPERO on 30 July 2020 ( #195929 ).
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Affiliation(s)
- Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
| | - Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Kristian B. Filion
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, 1001 Decarie Boulevard, Suite D05-2212, Montreal, QC H4A3JI Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 3459 rue McTavish, Montreal, QC H3A OC9 Canada
| | - Elena Paraskevopoulos
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON K2H 8P4 Canada
| | - Sarah Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
| | - Marc O. Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College, Suite 500, Montreal, QC H3A 1G1 Canada
| | - Mark J. Eisenberg
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Qc H3G 2M1 Canada
- Division of Cardiology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
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Puzhko S, Schuster T, Barnett TA, Renoux C, Rosenberg E, Barber D, Bartlett G. Evaluating Prevalence and Patterns of Prescribing Medications for Depression for Patients With Obesity Using Large Primary Care Data (Canadian Primary Care Sentinel Surveillance Network). Front Nutr 2020; 7:24. [PMID: 32258046 PMCID: PMC7090027 DOI: 10.3389/fnut.2020.00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/25/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Depression is a serious disorder that brings a tremendous health and economic burden. Many antidepressants (AD) have obesogenic effects, increasing the population of obese patients at increased risk for a more severe disease course and poor treatment response. In addition, obese patients with depression may not be receiving the recommended standard of care due to "obesity bias." It is important to evaluate prescribing pharmacological treatment of depression in patients with obesity. Objectives: To describe the prevalence and patterns of AD prescribing for patients with depression and comorbid obesity compared with normal weight patients, and to examine the association of prescribing prevalence with obesity class. Methods: Study sample of adult patients (>18 years old) with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. Measures were prescribing of at least one AD (outcome) and body mass index (BMI) to categorize patients into weight categories (exposure). Data were analyzed cross-sectionally using descriptive statistics and mixed effects logistic regression model with clustering on CPCSSN networks and adjusting for age, sex, and the comorbidities. Results: Of 120,381 patients with depression, 63,830 patients had complete data on studied variables (complete cases analysis). Compared with normal weight patients, obese patients were more likely to receive an AD prescription (adjusted Odds Ratio [aOR] = 1.17; 95% Confidence Interval [CI]: 1.12-1.22). Patients with obesity classes II and III were 8% (95% CI: 1.00, 1.16) and 6% (95% CI: 0.98, 1.16) more likely, respectively, to receive AD. After imputing missing data using Multiple Imputations by Chained Equations, the results remained unchanged. The prevalence of prescribing >3 AD types was higher in obese category (7.27%, [95% CI: 6.84, 7.73]) than in normal weight category (5.6%; [95% CI: 5.24, 5.99]). Conclusion: The association between obesity and high prevalence of AD prescribing and prescribing high number of different AD to obese patients, consistent across geographical regions, raises a public health concern. Study results warrant qualitative studies to explore reasons behind the difference in prescribing, and quantitative longitudinal studies evaluating the association of AD prescribing patterns for obese patients with health outcomes.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tracie A Barnett
- Department of Epidemiology and Biostatistics, INRS-Institut Armand-Frappier, Université du Québec à Montreal (UQAM), Laval, QC, Canada
| | - Christel Renoux
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Ellen Rosenberg
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - David Barber
- Department of Family Medicine, Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Gillian Bartlett
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
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Merati N, Siedlikowski S, Puzhko S, Hamzeh J, Wary N, Clark R, Zekri H, Longo C. In Their Words: Children's Perspectives on an El Sistema Music Program's Effects on their Well-Being. Prog Community Health Partnersh 2019; 13:359-369. [PMID: 31866591 DOI: 10.1353/cpr.2019.0069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The El Sistema movement uses music as a promising tool to promote healthy childhood development and well-being, particularly in children facing socioeconomic challenges. Recognizing the need to better support underprivileged children in their neighborhood, the community-based organization Share the Warmth (STW) created an El Sistema-inspired music program named STW El Sistema. Owing to their program's recent rise in popularity and corresponding costs, STW El Sistema coordinators partnered with McGill University researchers to formally evaluate and better understand the program's effects on participating children. We sought to understand participating children's lived experiences in STW El Sistema, and their perspectives on the program's impact in their lives and on their well-being. METHODS Community-based participatory research (CBPR), where STW partners were actively involved in the identification of the research question and in the interpretation and dissemination of research findings. This qualitative descriptive study included eight children aged 7-12 years stratified by age into two semistructured focus groups for thematic analysis. RESULTS Children described STW El Sistema as associated with their well-being: 1) emotionally, by learning to cope with stress, and learning patience and confidence; 2) socially, by fostering a sense of community and relationships with peers and family; and 3) personally and educationally, by promoting scholarly motivation and career ambition. CONCLUSIONS Children expressed that STW El Sistema music program improved aspects of their well-being. Study results warrant longitudinal studies to further assess El Sistema's impact on quality-of-life indicators.
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Abstract
BACKGROUND Infant tongue-tie can cause breastfeeding problems, which may be improved by frenotomy. However, controversy exists among the medical community. RESEARCH AIM To examine the influence of frenotomy on infants with posterior ankyloglossia, by quantifying the changes in breastfeeding and maternal nipple pain using standardized tools. METHODS Newborns (N = 30) below 12 weeks of age were recruited from the Herzl-Goldfarb Breastfeeding Clinic between April 2014 and April 2015. Diagnosis of posterior ankyloglossia was made clinically. Frenotomy was performed. Mothers received breastfeeding counseling before and after the procedure. Pain and breastfeeding were assessed before the procedure, immediately after the procedure, and after 2 days, 7 days and 14 days. Breastfeeding was assessed using the LATCH Tool and by subjective questioning. Maternal nipple pain was assessed using the Numeric Rating System. RESULTS No complications were reported with frenotomy. There was a significant improvement in LATCH score immediately post-frenotomy, with an increase in median scores from 7.5 to 8.5 (p < .0001, Wilcoxon signed rank test). There was a significant decrease in median pain score immediately post-frenotomy, from 3.0 on the left nipple and 3.25 on the right nipple, to 0 bilaterally (p < .0001, Wilcoxon signed rank test). Subjective improvement in breastfeeding was reported by 90% of mothers immediately after frenotomy and 83% of mothers at Day 14. CONCLUSION Frenotomy for posterior ankyloglossia may improve breastfeeding and nipple pain.
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Affiliation(s)
- Anjana Srinivasan
- Department of Family Medicine, McGill University, Montreal, Canada.,Herzl-Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Alex Al Khoury
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Svetlana Puzhko
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Carole Dobrich
- Herzl-Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Meira Stern
- Department of Family Medicine, McGill University, Montreal, Canada.,Herzl-Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Howard Mitnick
- Department of Family Medicine, McGill University, Montreal, Canada.,Herzl-Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Lenore Goldfarb
- Herzl-Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
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Puzhko S, Gagnon J, Simard J, Knoppers BM, Siedlikowski S, Bartlett G. Health professionals' perspectives on breast cancer risk stratification: understanding evaluation of risk versus screening for disease. Public Health Rev 2019; 40:2. [PMID: 30858992 PMCID: PMC6394012 DOI: 10.1186/s40985-019-0111-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/12/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Younger women at higher-than-population-average risk for breast cancer may benefit from starting screening earlier than presently recommended by the guidelines. The Personalized Risk Stratification for Prevention and Early Detection of Breast Cancer (PERSPECTIVE) approach aims to improve the prevention of breast cancer through differential screening recommendations based on a personal risk estimate. In our study, we used deliberative stakeholder consultations to engage health professionals in an in-depth dialog to explore the feasibility of the proposed implementation strategies for this new personalized breast cancer screening approach. METHODS Deliberative stakeholder consultation is a qualitative descriptive study design used to engage health professionals in the discussion, while the mediators play a more passive role. A purposeful sample of 11 health professionals (family physicians and genetic counselors) working in Montreal was used. The deliberations were organized in two phases, including small group deliberations according to the deliberants' health profession and a mixed group deliberation combining participants from the small groups. Inductive thematic content analysis was performed on the transcripts by two coders to create the deliberative and analytic outputs. Quality of deliberations was assessed quantitatively using the de Vries method and qualitatively using participant observation. RESULTS One of our key findings was that health professionals lacked understanding of the two steps of the screening approach: risk stratification "screening," which is an evaluation for the level of risk and screening for disease. As part of this confusion, the main topic of concern was a justification of program implementation as a population-wide screening, based on their uncertainty that it will be beneficial for women with near-population risks. Despite the noted difficulties concerning implementation, health professionals acknowledged the substantial benefits of the proposed PERSPECTIVE program. CONCLUSIONS Our study was the first to evaluate the perspectives of health professionals on the implementation and benefits of a new program for breast cancer risk stratification with the purpose of personalizing screening for disease. This new multi-step approach to screening requires more clarity in communication with health professionals. To implement and maintain effective screening, engagement of family physicians with other health professionals or even development of a centralized public health system may be needed.
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Affiliation(s)
- Svetlana Puzhko
- 1Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montréal, Québec H3S 1Z1 Canada
| | - Justin Gagnon
- 1Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montréal, Québec H3S 1Z1 Canada
| | - Jacques Simard
- 2Genomics Center, CHU de Québec-Université Laval Research Center, Room R4-4787, 2705 Laurier Blvd, Québec, Québec G1V 4G2 Canada
- 4Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Bartha Maria Knoppers
- 3Genome Quebec Innovation Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine, McGill University, 3640 University Street, Room W-315, 740 Dr. Penfield Ave, 5214, Montréal, Québec H3A 0C7OG1 Canada
| | - Sophia Siedlikowski
- 1Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montréal, Québec H3S 1Z1 Canada
| | - Gillian Bartlett
- 1Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montréal, Québec H3S 1Z1 Canada
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Merati N, Siedlikowski S, Puzhko S, Hamzeh J, Wary N, Clark R, Zekri H, Longo C. In Their Words: Children’s Perspectives on an El Sistema Music Program’s Effects on their Well-Being. Prog Community Health Partnersh 2019. [DOI: 10.1353/cpr.2019.0066] [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: 11/11/2022]
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Bartlett G, Longo C, Puzhko S, Gagnon J, Rahimzadeh V. Deliberative stakeholder consultations: creating insights into effective practice-change in family medicine. Fam Pract 2018; 35:749-752. [PMID: 30541124 DOI: 10.1093/fampra/cmy056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Cristina Longo
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Svetlana Puzhko
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Justin Gagnon
- Department of Family Medicine, McGill University, Montreal, Canada
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Artenie AA, Zang G, Daniel M, Fortier E, Jutras-Aswad D, Puzhko S, Bruneau J. Short-term injection drug use changes following hepatitis C virus (HCV) assessment and treatment among persons who inject drugs with acute HCV infection. International Journal of Drug Policy 2017; 47:239-243. [DOI: 10.1016/j.drugpo.2017.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/20/2017] [Accepted: 05/08/2017] [Indexed: 01/15/2023]
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Puzhko S. Québec’s emergency room overcrowding and long wait times: don’t apply “Band-Aids”, treat the underlying disease! Mcgill J Med 2017. [DOI: 10.26443/mjm.v15i1.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Puzhko S, Roy É, Jutras-Aswad D, Artenie AA, Fortier E, Zang G, Bruneau J. High hepatitis C incidence in relation to prescription opioid injection and poly-drug use: Assessing barriers to hepatitis C prevention. Int J Drug Policy 2017; 47:61-68. [PMID: 28666636 DOI: 10.1016/j.drugpo.2017.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/26/2017] [Accepted: 05/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prescription opioid (PO) injection and poly-drug use have been associated with hepatitis C virus (HCV) infection among people who inject drugs (PWID). Poly-drug use is often a barrier to key HCV preventive programmes including opioid agonist treatment. The contribution of specific drug combinations to high HCV incidence in poly-drug users has not been assessed previously. Addressing this knowledge gap could enhance HCV treatment and prevention efforts. We examined the association between specific drugs and number of drugs used in addition to injected POs, and HCV seroconversion. METHODS PWID participating in a cohort study in Montréal (HEPCO), HCV-seronegative at baseline and followed between 2004 and 2013, were included. Data were collected by interview-administered questionnaires. Blood samples were tested for HCV new infections at each 3-6 month follow-up visit. Time-varying Cox regression models were utilized. RESULTS Of 356 participants (81.5% males; mean age: 34.7 years), 123 (34.6%) reported injected POs in the past month at baseline. In univariate analyses, recent use of the following drugs was associated with HCV seroconversion: injected POs, injected cocaine, injected heroin, non-injected tranquilisers, and smoked crack/cocaine. The relative excess risk of HCV seroconversion due to interaction (RER1HR) was the highest for co-use of injected POs with the following substances: injected cocaine (RER1HR=3.44), smoked crack/cocaine (RER1HR=1.27), and non-injected tranquilisers (RER1HR=0.8). In addition, a significant linear trend (p<0.001) towards higher risk was observed with increasing the number of these three drugs used in combination with injected POs. CONCLUSION Specific drugs and number of drugs used in addition to injected POs play a modulating role in the risk of HCV primary infection. Poly-drug use among people who inject POs has to be addressed in order to improve harm reduction programmes and reduce HCV transmission in this high-risk population.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montréal, QC H3S 1Z1, Canada; Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1111 rue St-Charles Ouest, Suite 500, Longueuil, QC J4 K 5G4, Canada; Institut National de Santé Publique, 190 Crémazie Blvd. E, Montréal, QC H2P 1E2, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Andreea Adelina Artenie
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Emmanuel Fortier
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada.
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Artenie AA, Roy É, Zang G, Jutras-Aswad D, Bamvita JM, Puzhko S, Daniel M, Bruneau J. Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C prevention. Int J Drug Policy 2015; 26:970-5. [PMID: 26005038 DOI: 10.1016/j.drugpo.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/28/2015] [Accepted: 04/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP). METHODS A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004-2013). Interviews scheduled at 3- or 6-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence. RESULTS At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection. CONCLUSION Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention.
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Affiliation(s)
- Andreea Adelina Artenie
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1
| | - Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, Canada J4K 0A8; Institut National de Santé Publique du Québec, 190 Crémazie E, Montréal, QC, Canada H2P 1E2
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montréal, QC, Canada H3C 3J7
| | - Jean-Marie Bamvita
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9
| | - Svetlana Puzhko
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1
| | - Mark Daniel
- School of Population Health, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montréal, QC, Canada H3C 3J7.
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Clément A, Raymond K, Puzhko S, Bruneau J, Jutras-Aswad D. [Exploration of potential mechanisms underlying substance use disorders in individuals with personality disorders]. Sante Ment Que 2014; 39:99-115. [PMID: 25590546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Background Cluster-B personality disorders (DSM-V), particularly borderline and antisocial personality disorders, are associated with high rates of substance use disorder. However, the mechanisms underlying this relationship have yet to be fully understood. Craving has recently been identified as an important component of substance use disorder. The purpose of this article is therefore to review the current literature and explore whether craving could be implicated as an underlying mechanism of comorbid substance use disorder in antisocial and borderline personality disorders.Method Critical review of the literature.Results Emerging evidence indicates that there is in fact an association between craving and personality disorders. Patients afflicted with the latter, incidentally, respond differently to anti-craving medication when compared to normal subjects. While a limited number of studies have directly assessed craving in patients with personality disorders, a growing number have looked at the association between craving and specific personality traits. The correlation between impulsivity, negative affect and craving seems like a plausible explanation for the high prevalence and severity of substance use disorder in subjects with antisocial or borderline personality disorders.Conclusion These findings suggest that specific personality traits are related to craving and could represent promising targets for the prevention, assessment and management of comorbid substance use disorders.
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Affiliation(s)
- Angelica Clément
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)
| | | | - Svetlana Puzhko
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)
| | - Julie Bruneau
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM); Département de médecine familiale, Université de Montréal
| | - Didier Jutras-Aswad
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Département de psychiatrie, Université de Montréal; Fonds de recherche Santé - Québec (FRQS)
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Puzhko S, Goodyer CG, Kerachian MA, Canaff L, Misra M, Jüppner H, Bastepe M, Hendy GN. Parathyroid hormone signaling via Gαs is selectively inhibited by an NH(2)-terminally truncated Gαs: implications for pseudohypoparathyroidism. J Bone Miner Res 2011; 26:2473-85. [PMID: 21713996 PMCID: PMC3916968 DOI: 10.1002/jbmr.461] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pseudohypoparathyroid patients have resistance predominantly to parathyroid hormone (PTH), and here we have examined the ability of an alternative Gαs-related protein to inhibit Gαs activity in a hormone-selective manner. We tested whether the GNAS exon A/B-derived NH(2)-terminally truncated (Tr) αs protein alters stimulation of adenylate cyclase by the PTH receptor (PTHR1), the thyroid-stimulating hormone (TSH) receptor (TSHR), the β(2)-adrenergic receptor (β(2)AR), or the AVP receptor (V2R). HEK293 cells cotransfected with receptor and full-length (FL) Gαs ± Tr αs protein expression vectors were stimulated with agonists (PTH [10(-7) to 10(-9) M], TSH [1 to 100 mU], isoproterenol [10(-6) to 10(-8) M], or AVP [10(-6) to 10(-8) M]). Following PTH stimulation, HEK293 cells cotransfected with PTHR1 + FL Gαs + Tr αs had a significantly lower cAMP response than those transfected with only PTHR1 + FL Gαs. Tr αs also exerted an inhibitory effect on the cAMP levels stimulated by TSH via the TSHR but had little or no effect on isoproterenol or AVP acting via β(2)AR or V2R, respectively. These differences mimic the spectrum of hormone resistance in pseudohypoparathyroidism type 1a (PHP-1a) and type 1b (PHP-1b) patients. In opossum kidney (OK) cells, endogenously expressing the PTHR1 and β(2)AR, the exogenous expression of Tr αs at a level similar to endogenous FL Gαs resulted in blunting of the cAMP response to PTH, whereas that to isoproterenol was unaltered. A pseudopseudohypoparathyroid patient with Albright hereditary osteodystrophy harbored a de novo paternally inherited M1I Gαs mutation. Similar maternally inherited mutations at the initiation codon have been identified previously in PHP-1a patients. The M1I αs mutant (lacking the first 59 amino acids of Gαs) blunted the increase in cAMP levels stimulated via the PTHR1 in both HEK293 and OK cells similar to the Tr αs protein. Thus NH(2)-terminally truncated forms of Gαs may contribute to the pathogenesis of pseudohypoparathyroidism by inhibiting the activity of Gαs itself in a GPCR selective manner.
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Affiliation(s)
- Svetlana Puzhko
- Endocrine Research Laboratory, McGill University, Montreal, Quebec, Canada
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Kenth G, Puzhko S, Goodyer CG. Human growth hormone receptor gene expression is regulated by Gfi-1/1b and GAGA cis-elements. Mol Cell Endocrinol 2011; 335:135-47. [PMID: 21238539 DOI: 10.1016/j.mce.2011.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Received: 10/09/2010] [Revised: 12/20/2010] [Accepted: 01/07/2011] [Indexed: 12/15/2022]
Abstract
Human growth hormone receptor (hGHR) gene regulation is complex: mRNAs are transcribed from multiple variant (V) 5'UTR exons, several ubiquitously while others only in the postnatal hepatocyte. The liver-specific V1 exon promoter contains Gfi-1/1b repressor sites adjacent to a GAGA box, a GH response element (GHRE) in several mammalian genes. GAGA boxes are also present in the ubiquitously expressing V3 exon promoter. Heterologous sites in bovine, ovine and murine GHR genes suggest conserved roles. GAGA factor stimulated V1 and V3 promoters while Gfi-1/1b repressed basal and GAF-stimulated V1 transcription. HGH treatment of HepG2 cells resulted in a new complex forming with V3 GAGA elements, suggesting a functional GHRE. Data suggest liver-specific V1 transcription is regulated by inhibitory Gfi-1/1b and stimulatory GAGA cis-elements and Gfi-1/1b may control the lack of V1 expression in fetal liver, hepatic tumours and non-hepatic tissues. In addition, hGH may regulate hGHR expression through V3 GAGA boxes.
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Affiliation(s)
- Gurvinder Kenth
- Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
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Abstract
Human GH (hGH) has important effects on growth as well as carbohydrate, fat, and protein metabolism. These actions require the presence of normal levels of a functional hGH receptor (hGHR) on the surface of target cells. hGHR gene expression is characterized by the use of several 5'-noncoding exons and alternative splicing, resulting in the generation of multiple mRNA isoforms. The hGHR V2 transcript is predominant in most tissues, including human fat. However, factors regulating its ubiquitous expression have remained unidentified. The present study was aimed at characterizing the mechanisms regulating hGHR V2 transcription. Two major V2 transcriptional start sites were identified by primer extension assays. The V2 proximal promoter is TATA-less, with several characteristics of a housekeeping gene promoter. Transient transfection analyses of 2.6 kb of the 5'-flanking region of V2 confirmed its promoter activity in multiple primate cell lines. Similar promoter activity patterns were observed in human SGBS preadipocytes and mature adipocytes but with much higher V2 promoter activity in mature adipocytes, suggesting that changes in the availability of specific factors during adipocyte differentiation play a role in V2 promoter regulation. Serial deletion and mutation analyses revealed that transcription of hGHR V2 in different cell types, including adipocytes, is determined by a core promoter and distinct inhibitory and activation domains in the 5'-promoter region as well as within the V2 exon. Our data suggest that V2 transcription is the result of a complex interplay involving multiple factors, to ensure appropriate expression of hGHR in different hGH target cells.
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Affiliation(s)
- Yuhong Wei
- McGill University Health Centre, Montreal Children's Hospital Research Institute, 4060 St. Catherine West, Room 415-1, Montreal, Quebec, Canada H3Z 2Z3
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Wei Y, Puzhko S, Wabitsch M, Goodyer CG. Transcriptional regulation of the human growth hormone receptor (hGHR) gene V2 promoter by transcriptional activators and repressor. Mol Endocrinol 2008; 23:373-87. [PMID: 19116245 DOI: 10.1210/me.2008-0190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The V2 transcript is the major ubiquitously expressed human GH receptor (hGHR) mRNA in all tissues examined to date. In a previous investigation, we defined the V2 promoter as TATA-less and exhibiting many characteristics of a housekeeping gene promoter. We also demonstrated that its basal activity is determined by several different cis-regulatory regions within both the promoter and the V2 exon. In the present study, we used luciferase-reporter, site-directed mutagenesis, gel shift, chromatin immunoprecipitation, and quantitative RT-PCR assays to investigate the ability of certain transcription factors to regulate hGHR V2 transcription through these regions in mammalian cells, including human adipocytes. Ets1 was found to transactivate the V2 proximal promoter through specific Ets sites. Two CCAAT/enhancer-binding protein (C/EBP) family members [C/EBP-homologous protein (CHOP) and C/EBPbeta] enhanced V2 transcription via different pathways: indirectly, by association with a V2 exon region (CHOP), and directly, using a V2 proximal promoter noncanonical binding site (C/EBPbeta). The Notch signaling mediator, Hes1, potently suppressed V2 promoter activity through interaction with two Hes sites within the V2 exon. We propose that these transcriptional factors regulate hGHR V2 expression by acting as downstream nuclear effectors, linking specific signaling cascades (e.g. MAPK and Notch) triggered by different growth factor-, development-, and nutrition- as well as stress-related stimuli. Our data also suggest that these factors are likely to be important in the differentiation-induced increase in V2 mRNA expression in adipocytes, with Ets1 and CHOP functioning at the preadipocyte stage to prepare the cells for differentiation and increasing C/EBPs and decreasing Hes1 levels contributing during adipocyte maturation.
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Affiliation(s)
- Yuhong Wei
- McGill University Health Centre-Montreal Children's Hospital Research Institute, 4060 St. Catherine West, Room 415-1, Montreal, Quebec, Canada H3Z 2Z3
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Neshkova E, Puzhko S, Dotsenko V, Nenasheva N, Yarovaya G, Gorjachkina L. Activity of leukocyte elastase in patients' plasma is a significant indicator of atopic diseases. Immunopharmacology 1996; 33:383-6. [PMID: 8856193 DOI: 10.1016/0162-3109(96)00092-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is commonly known that activation of plasma kallikrein-kinin system is of great importance in the pathogenesis of atopic diseases. Plasma kallikrein most likely activates other arginine-esterases in human plasma. Diagnostic and prognostic values of the total arginine-esterase activity and the activity of leukocyte elastase (LE) in plasma of patients with allergic rhinitis (AR), atopic bronchial asthma (ABA) and atopic dermatitis (AD) were examined in this study. Our results demonstrate that the level of arginine-esterase activity was slightly elevated only in plasma of patients with ABA (424 +/- 24; N-360 +/- 20 mU/ml), but not with AR and AD. Elastase-like activity in human plasma proved to be a far more informative indicator of the atopic states than arginine-esterase activity. In plasma of patients with AR, ABA and AD the activity of LE exceeded the normal level in 1.7, 1.8, and 2.4 times, respectively. Treatment of these atopic states with Ditec (Boehringer Ingelheim) led to some improvements of the patient' states. The main component of this drug (disodium chromoglycate) inhibited the activity of leukocyte elastase in experiments in vitro.
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Affiliation(s)
- E Neshkova
- Department of Biochemistry, Russian Medical Academy for Postgraduate Education, Moscow, Russia
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