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Loughman J, Kobia-Acquah E, Lingham G, Butler J, Loskutova E, Mackey DA, Lee SSY, Flitcroft DI. Myopia outcome study of atropine in children: Two-year result of daily 0.01% atropine in a European population. Acta Ophthalmol 2024; 102:e245-e256. [PMID: 37694816 DOI: 10.1111/aos.15761] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE The Myopia Outcome Study of Atropine in Children (MOSAIC) is an investigator-led, double-masked, randomized controlled trial investigating the efficacy and safety of 0.01% atropine eye drops for managing myopia progression in a predominantly White, European population. METHODS Children aged 6-16 years with myopia were randomly allocated 2:1 to nightly 0.01% atropine or placebo eye drops in both eyes for 2 years. The primary outcome was cycloplegic spherical equivalent (SE) progression at 24 months. Secondary outcomes included axial length (AL) change, safety and acceptability. Linear mixed models with random intercepts were used for statistical analyses. RESULTS Of 250 participants enrolled, 204 (81.6%) completed the 24-month visit (136 (81.4%) treatment, 68 (81.9%) placebo). Baseline characteristics, drop-out and adverse event rates were similar between treatment and control groups. At 24 months, SE change was not significantly different between 0.01% atropine and placebo groups (effect = 0.10 D, p = 0.07), but AL growth was lower in the 0.01% atropine group, compared to the placebo group (-0.07 mm, p = 0.007). Significant treatment effects on SE (0.14 D, p = 0.049) and AL (-0.11 mm, p = 0.002) were observed in children of White, but not non-White (SE = 0.05 D, p = 0.89; AL = 0.008 mm, p = 0.93), ethnicity at 24 months. A larger treatment effect was observed in subjects least affected by COVID-19 restrictions (SE difference = 0.37 D, p = 0.005; AL difference = -0.17 mm, p = 0.001). CONCLUSIONS Atropine 0.01% was safe, well-tolerated and effective in slowing axial elongation in this European population. Treatment efficacy varied by ethnicity and eye colour, and potentially by degree of COVID-19 public health restriction exposure during trial participation.
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Affiliation(s)
- James Loughman
- Centre for Eye Research Ireland, School of Physics, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Emmanuel Kobia-Acquah
- Centre for Eye Research Ireland, School of Physics, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Gareth Lingham
- Centre for Eye Research Ireland, School of Physics, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - John Butler
- Centre for Eye Research Ireland, School of Physics, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- School of Mathematical Sciences, Technological University Dublin, Dublin, Ireland
| | - Ekaterina Loskutova
- Centre for Eye Research Ireland, School of Physics, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Samantha S Y Lee
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel I Flitcroft
- Centre for Eye Research Ireland, School of Physics, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
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Lynch S, Killeen SL, O'Brien E, Mullane K, Hokey E, Mealy G, McAuliffe FM. Diet quality and blood pressure among pregnant women with overweight or obesity: A secondary analysis of two randomized controlled trials. Acta Obstet Gynecol Scand 2024. [PMID: 38450653 DOI: 10.1111/aogs.14821] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Maternal obesity is a significant risk factor for hypertensive disorders of pregnancy. High diet quality may protect against this, yet data regarding the relationship between diet quality and blood pressure among pregnant women with raised body mass index (BMI) is limited. MATERIAL AND METHODS This is a secondary analysis (n = 543) of women with BMI ≥25 kg/m2 from two randomized controlled trials; PEARS (Pregnancy Exercise and nutrition Research Study with smartphone application support) and ROLO (Randomized cOntrol trial of LOw glycemic index diet to prevent macrosomia in euglycemic women). Blood pressure was measured at 10-18 weeks and 28 weeks of pregnancy. Mean arterial pressure was calculated as (diastolic blood pressure+ 1 3 × $$ +\frac{1}{3}\times $$ [systolic blood pressure - $$ - $$ diastolic blood pressure]). Diet quality was assessed using 3-day food diaries, and Alternative Healthy Eating Index for Pregnancy (AHEI-P) scores were generated, quantifying alignment of food intakes with dietary guidelines in first and early third trimesters. The cohort was divided based on AHEI-P tertiles to explore differences at an alpha significance value of <0.05. RESULTS The mean age of the group was 32.21 ± 4.39 years with a median body mass index (BMI) of 28.13 (IQR 3.47) kg/m2 . Mean arterial pressures in the first and third trimesters were 81.07 ± 9.00 mmHg and 82.33 ± 7.53 mmHg, respectively. Rates of elevated blood pressure (≥120/80 mmHg) were 22.33% in trimester 1 and 24.48% in early trimester 3. Mean AHEI-P scores in trimester 1 and early trimester 3 were 53.90 ± 10.43 and 54.05 ± 10.76, respectively. There was no correlation between AHEI-P score and blood pressure and no differences in blood pressure between AHEI-P tertiles at either timepoint (all P-values <0.05). A higher proportion of those with elevated early third trimester blood pressure had a BMI of ≥30 kg/m2 compared with those with normal blood pressure (40.31% vs 28.64%, P = 0.016). CONCLUSIONS While diet remains an important factor in maternal health and wellbeing, we did not find a relationship between diet quality as measured by AHEI-P and blood pressure among pregnant women with BMI ≥25 kg/m2 . High BMI remains a risk factor for hypertensive disorders of pregnancy.
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Affiliation(s)
- Sorcha Lynch
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin 2, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin 2, Ireland
| | - Eileen O'Brien
- School of Biological, Health and Sports Science, Technological University Dublin, Dublin, Ireland
| | - Kate Mullane
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin 2, Ireland
| | - Emma Hokey
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin 2, Ireland
| | - Grace Mealy
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin 2, Ireland
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Kobia-Acquah E, Flitcroft DI, Lingham G, Kerin E, Loughman J. Short-term effects of cyclopentolate and tropicamide eye drops on macular choroidal thickness in myopic children. Ophthalmic Physiol Opt 2024; 44:280-291. [PMID: 38037443 DOI: 10.1111/opo.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND To investigate the short-term effects of cyclopentolate and tropicamide eyedrops on choroidal thickness (ChT) in myopic children using placebo or low-dose atropine eyedrops. METHODS The analysis included 242 myopic individuals (7-19 years) enrolled in two randomised placebo-controlled clinical trials of low-dose atropine eyedrops. Cycloplegia was induced using either one drop of 1% cyclopentolate (n = 161), two drops of 1% cyclopentolate (n = 32) or two drops of 1% tropicamide (n = 49). ChT measurements were taken using swept-source optical coherence tomography before and 30 min after administering the cycloplegic eye drops. A subset of 51 participants underwent test-retest measurements prior to cycloplegia. RESULTS Mean changes in subfoveal ChT after two drops of tropicamide and one and two drops of cyclopentolate were -2.5 μm (p = 0.10), -4.3 μm (p < 0.001) and -9.6 μm (p < 0.001), respectively. Subfoveal ChT changes after one and two drops of cyclopentolate were significantly greater than the test-retest changes (test-retest mean change: -3.1 μm; p < 0.05), while the tropicamide group was not significantly different (p = 0.64). Choroidal thinning post-cyclopentolate was not significantly different between atropine and placebo treatment groups (p > 0.05 for all macular locations). The coefficient of repeatability (CoR) in the tropicamide group (range: 8.2-14.4 μm) was similar to test-retest (range: 7.5-12.2 μm), whereas greater CoR values were observed in the cyclopentolate groups (one drop: range: 10.8-15.3 μm; two drops: range: 12.2-24.6 μm). CONCLUSIONS Cyclopentolate eye drops caused dose-dependent choroidal thinning and increased variation in pre- to post-cycloplegia measurements compared with test-retest variability, whereas tropicamide did not. These findings have practical implications for ChT measurements when cyclopentolate is used, particularly for successive measurements.
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Affiliation(s)
- Emmanuel Kobia-Acquah
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Daniel Ian Flitcroft
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
| | - Gareth Lingham
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Eoin Kerin
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
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Millar SR, Perry IJ, Phillips CM. Anthropometric measures, predicted visceral adipose tissue and biomarkers of chronic inflammation. Eur J Clin Invest 2024; 54:e14104. [PMID: 37814451 DOI: 10.1111/eci.14104] [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: 07/18/2023] [Revised: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Evidence has linked low-grade systemic inflammation and visceral adipose tissue (VAT) with development of chronic conditions. Cytokines and select proteins released by VAT may promote a low-grade inflammatory response. A number of equations have been developed to estimate VAT levels. In this study, we compared predicted VAT equation relationships with biomarkers of inflammation. METHODS This was a cross-sectional study of 2038 men and women aged 46-73 years. Correlation and linear regression analyses were performed to examine inflammatory biomarker relationships with four commonly assessed anthropometric measures and 10 predicted VAT equations. RESULTS Compared with anthropometric measures, predicted VAT equations were found to explain a greater proportion of variance in CRP (R2 = .075, p = .001), IL-6 (R2 = .060, p = .001), TNF-α (R2 = .017, p = .005), resistin (R2 = .011, p = .012), monocyte (R2 = .027, p = .001), eosinophil (R2 = .012, p = .01) and basophil (R2 = .015, p = .002) levels in males, and a greater variance in concentrations of C3 (R2 = .175, p = .001), IL-6 (R2 = .090, p = .001), TNF-α (R2 = .036, p = .001), adiponectin (R2 = .121, p = .001), the adiponectin-to-leptin ratio (R2 = .444, p = .001), resistin (R2 = .025, p = .001), white blood cell count (R2 = .057, p = .001), neutrophils (R2 = .061, p = .001) and lymphocytes (R2 = .020, p = .001) in females. CONCLUSION Equations for assessing VAT levels might be useful to characterise metabolic health. Further studies that examine predicted VAT relationships with disease and mortality outcomes are warranted.
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Affiliation(s)
- Seán R Millar
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine M Phillips
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Smith V, Delaney H, Hunter A, Torgerson D, Treweek S, Gamble C, Mills N, Stanbury K, Dempsey E, Daly M, O'Shea J, Weatherup K, Deshpande S, Ryan MA, Lowe J, Black G, Devane D. The development and acceptability of an educational and training intervention for recruiters to neonatal trials: the TRAIN project. BMC Med Res Methodol 2023; 23:265. [PMID: 37951890 PMCID: PMC10638723 DOI: 10.1186/s12874-023-02086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Suboptimal or slow recruitment affects 30-50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to develop and assess the acceptability of an education and training intervention for recruiters to neonatal trials. In this paper, we report the development and acceptability of TRAIN. METHODS TRAIN involved three sequential phases, with each phase contributing information to the subsequent phase(s). These phases were 1) evidence synthesis (systematic review of the effectiveness of training interventions and a content analysis of the format, content, and delivery of identified interventions), 2) intervention development using a Partnership (co-design/co-creation) approach, and 3) intervention acceptability assessments with recruiters to neonatal trials. RESULTS TRAIN, accompanied by a comprehensive intervention manual, has been designed for online or in-person delivery. TRAIN can be offered to recruiters before trial recruitment begins or as refresher sessions during a trial. The intervention consists of five core learning outcomes which are addressed across three core training units. These units are the trial protocol (Unit 1, 50 min, trial-specific), understanding randomisation (Unit 2, 5 min, trial-generic) and approaching and engaging with parents (Unit 3, 70 min, trial-generic). Eleven recruiters to neonatal trials registered to attend the acceptability assessment training workshops, although only four took part. All four positively valued the training Units and resources for increasing recruiter preparedness, knowledge, and confidence. More flexibility in how the training is facilitated, however, was noted (e.g., training divided across two workshops of shorter duration). Units 2 and 3 were considered beneficial to incorporate into Good Clinical Practice Training or as part of induction training for new staff joining neonatal units. CONCLUSION TRAIN offers a comprehensive co-produced training and education intervention for recruiters to neonatal trials. TRAIN was deemed acceptable, with minor modification, to neonatal trial recruiters. The small number of recruiters taking part in the acceptability assessment is a limitation. Scale-up of TRAIN with formal piloting and testing for effectiveness in a large cluster randomised trial is required.
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Affiliation(s)
- V Smith
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland.
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland.
| | - H Delaney
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
| | - A Hunter
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - D Torgerson
- York Trials Unit, University of York, York, YO10 5DD, UK
| | - S Treweek
- Health Services Research Unit, Trial Forge, University of Aberdeen, Aberdeen, UK
| | - C Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - N Mills
- QuinteT, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K Stanbury
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Dempsey
- INFANT Centre, University College Cork, Cork, Ireland
| | - M Daly
- Irish Neonatal Health Alliance, Public and Patient Involvement Contributor, Bray, Co-Wicklow, Ireland
| | - J O'Shea
- Public and Patient Involvement Contributor, Royal Hospital for Children, Glasgow, UK
| | - K Weatherup
- Public and Patient Involvement Contributor, Oxford, UK
| | | | - M A Ryan
- INFANT Centre, University College Cork, Cork, Ireland
| | - J Lowe
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - G Black
- Royal Hospital for Children and Young People, Edinburgh, UK
| | - D Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Callanan S, Killeen SL, Delahunt A, Cooney N, Cushion R, McKenna MJ, Crowley RK, Twomey PJ, Kilbane MT, McDonnell CM, Phillips CM, Cody D, McAuliffe FM. The impact of macrosomia on cardiometabolic health in preteens: findings from the ROLO longitudinal birth cohort study. Nutr Metab (Lond) 2023; 20:37. [PMID: 37667333 PMCID: PMC10476328 DOI: 10.1186/s12986-023-00759-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Macrosomia (birthweight ≥ 4 kg or ≥ 4.5 kg) is strongly associated with a predisposition to childhood obesity, which in turn is linked with adverse cardiometabolic health. Despite this, there is a lack of longitudinal investigation on the impact of high birthweight on cardiometabolic outcomes in youth. The preteen period represents an important window of opportunity to further explore this link, to potentially prevent cardiometabolic profiles worsening during puberty. METHODS This is a secondary analysis of 9-11-year-olds (n = 405) born to mothers in the ROLO longitudinal birth cohort study, who previously delivered an infant with macrosomia. Preteens were dichotomised into those born with and without macrosomia, using two common cut-off criteria (birthweight ≥ 4 kg (n = 208) and < 4 kg; ≥ 4.5 kg (n = 65) and < 4.5 kg). Cardiometabolic health was assessed using anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance (20-m shuttle run test), and non-fasting serum biomarkers for a subgroup (n = 213). Statistical comparisons between the two groups were explored using independent t-tests, Mann-Whitney U tests, and Chi-square tests. Crude and adjusted linear regression models investigated associations between macrosomia and preteen cardiometabolic outcomes. RESULTS In total, 29.3% (n = 119) of preteens had overweight/obesity based on their BMI z-score. Preteens born ≥ 4 kg had lower median (IQR) C3 concentrations (1.38 (1.22, 1.52) g/L vs. 1.4 (1.26, 1.6) g/L, p = 0.043) and lower median (IQR) ICAM-1 concentrations (345.39 (290.34, 394.91) ng/mL vs. 387.44 (312.91, 441.83) ng/mL, p = 0.040), than those born < 4 kg. Those born ≥ 4.5 kg had higher mean (SD) BMI z-scores (0.71 (0.99) vs. 0.36 (1.09), p = 0.016), and higher median (IQR) lean mass (24.76 (23.28, 28.51) kg vs. 23.87 (21.9, 26.79) kg, p = 0.021), than those born < 4.5 kg. Adjusted linear regression analyses revealed birthweight ≥ 4 kg was negatively associated with C3 concentration (g/L) (B = - 0.095, 95% CI = - 0.162, - 0.029, p = 0.005) and birthweight ≥ 4.5 kg was positively associated with weight z-score (B = 0.325, 95% CI = 0.018, 0.633, p = 0.038), height z-score (B = 0.391, 95% CI = 0.079, 0.703, p = 0.014), lean mass (kg) (B = 1.353, 95% CI = 0.264, 2.442, p = 0.015) and cardiorespiratory endurance (B = 0.407, 95% CI = 0.006, 0.808, p = 0.047). CONCLUSION This study found no strong evidence to suggest that macrosomia is associated with adverse preteen cardiometabolic health. Macrosomia alone may not be a long-term cardiometabolic risk factor. Trial registration ISRCTN54392969 registered at www.isrctn.com .
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Affiliation(s)
- Sophie Callanan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Anna Delahunt
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Nessa Cooney
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Rosemary Cushion
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Malachi J McKenna
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Rachel K Crowley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Patrick J Twomey
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - Mark T Kilbane
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - Ciara M McDonnell
- Department of Paediatric Endocrinology and Diabetes, Children's Health Ireland, Temple Street and Tallaght, Dublin, Ireland
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Declan Cody
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland.
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Geraghty AA, O'Brien EC, Callanan S, Mehegan J, McAuliffe FM. Cardiovascular fitness is associated with child adiposity at 5 years of age: findings from the ROLO longitudinal birth cohort study. BMC Pediatr 2023; 23:345. [PMID: 37420167 PMCID: PMC10329307 DOI: 10.1186/s12887-023-04157-0] [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: 01/08/2023] [Accepted: 06/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Cardiovascular fitness is strongly linked with metabolic risk; however, research is limited in preschool children. Although there is currently no simple validated measure of fitness in preschool children, heart rate recovery has been highlighted as an easily accessible and non-invasive predictor of cardiovascular risk in school-aged children and adolescents. We aimed to investigate whether heart rate recovery was associated with adiposity and blood pressure in 5-year-olds. STUDY DESIGN This is a secondary analysis of 272 5-year-olds from the ROLO (Randomised cOntrol trial of LOw glycaemic index diet in pregnancy to prevent recurrence of macrosomia) Kids study. Three-minute step tests were completed by 272 participants to determine heart rate recovery duration. Body mass index (BMI), circumferences, skinfold thickness, heart rate, and blood pressure were collected. Independent t-tests, Mann-Whitney U, and Chi-square tests were used to compare participants. Linear regression models examined associations between heart rate recovery and child adiposity. Confounders included child sex, age at study visit, breastfeeding, and perceived effort in the step test. RESULTS The median (IQR) age at the study visit was 5.13 (0.16) years. 16.2% (n = 44) had overweight and 4.4% (n = 12) had obesity based on their BMI centile. Boys had a quicker mean (SD) heart rate recovery after the step test than girls (112.5 (47.7) seconds vs. 128.8 (62.5) seconds, p = 0.02). Participants with a slower recovery time (> 105 s) had higher median (IQR) sum of skinfolds (35.5 (11.8) mm vs. 34.0 (10.0) mm, p = 0.02) and median (IQR) sum of subscapular and triceps skinfold (15.6 (4.4) mm vs. 14.4 (4.0) mm, p = 0.02) compared to participants with a quicker recovery time. After adjusting for confounders (child sex, age at study visit, breastfeeding, effort in the step test), linear regression analyses revealed heart rate recovery time after stepping was positively associated with sum of skinfolds (B = 0.034, 95% CI: 0.01, 0.06, p = 0.007). CONCLUSION Child adiposity was positively associated with heart rate recovery time after the step test. A simple stepping test could be used as a non-invasive and inexpensive fitness tool in 5-year-olds. Additional research is needed to validate the ROLO Kids step test in preschool children.
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Affiliation(s)
- Aisling A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sophie Callanan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - John Mehegan
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Millington-Ward S, Chadderton N, Finnegan LK, Post IJM, Carrigan M, Nixon R, Humphries MM, Humphries P, Kenna PF, Palfi A, Farrar GJ. RPE-Directed Gene Therapy Improves Mitochondrial Function in Murine Dry AMD Models. Int J Mol Sci 2023; 24:ijms24043847. [PMID: 36835257 PMCID: PMC9968062 DOI: 10.3390/ijms24043847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
Age-related macular degeneration (AMD) is the most common cause of blindness in the aged population. However, to date there is no effective treatment for the dry form of the disease, representing 85-90% of cases. AMD is an immensely complex disease which affects, amongst others, both retinal pigment epithelium (RPE) and photoreceptor cells and leads to the progressive loss of central vision. Mitochondrial dysfunction in both RPE and photoreceptor cells is emerging as a key player in the disease. There are indications that during disease progression, the RPE is first impaired and RPE dysfunction in turn leads to subsequent photoreceptor cell degeneration; however, the exact sequence of events has not as yet been fully determined. We recently showed that AAV delivery of an optimised NADH-ubiquinone oxidoreductase (NDI1) gene, a nuclear-encoded complex 1 equivalent from S. cerevisiae, expressed from a general promoter, provided robust benefit in a variety of murine and cellular models of dry AMD; this was the first study employing a gene therapy to directly boost mitochondrial function, providing functional benefit in vivo. However, use of a restricted RPE-specific promoter to drive expression of the gene therapy enables exploration of the optimal target retinal cell type for dry AMD therapies. Furthermore, such restricted transgene expression could reduce potential off-target effects, possibly improving the safety profile of the therapy. Therefore, in the current study, we interrogate whether expression of the gene therapy from the RPE-specific promoter, Vitelliform macular dystrophy 2 (VMD2), might be sufficient to rescue dry AMD models.
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Affiliation(s)
- Sophia Millington-Ward
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
- Correspondence:
| | - Naomi Chadderton
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Laura K. Finnegan
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Iris J. M. Post
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Matthew Carrigan
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Rachel Nixon
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Marian M. Humphries
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Pete Humphries
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - Paul F. Kenna
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
- The Research Foundation, Royal Victoria Eye and Ear Hospital, D02 XK51 Dublin, Ireland
| | - Arpad Palfi
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
| | - G. Jane Farrar
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, D02 VF25 Dublin, Ireland
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9
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Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman E. The development and validation of a dashboard prototype for real-time suicide mortality data. Front Digit Health 2022; 4:909294. [PMID: 36065333 PMCID: PMC9440192 DOI: 10.3389/fdgth.2022.909294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction/Aim Data visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface. Materials and Methods Individual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface. Results Using the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence. Discussion The challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making. Conclusions The results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.
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Affiliation(s)
- R. Benson
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
- Correspondence: Ruth Benson
| | - C. Brunsdon
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - J. Rigby
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - P. Corcoran
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
| | - M. Ryan
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - P. Dodd
- National Office for Suicide Prevention, Health Service Executive, Dublin, Ireland
| | - D. Hennebry
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
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10
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McHugh S, Presseau J, Luecking CT, Powell BJ. Examining the complementarity between the ERIC compilation of implementation strategies and the behaviour change technique taxonomy: a qualitative analysis. Implement Sci 2022; 17:56. [PMID: 35986333 PMCID: PMC9389676 DOI: 10.1186/s13012-022-01227-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Efforts to generate evidence for implementation strategies are frustrated by insufficient description. The Expert Recommendations for Implementing Change (ERIC) compilation names and defines implementation strategies; however, further work is needed to describe the actions involved. One potentially complementary taxonomy is the behaviour change techniques (BCT) taxonomy. We aimed to examine the extent and nature of the overlap between these taxonomies. METHODS Definitions and descriptions of 73 strategies in the ERIC compilation were analysed. First, each description was deductively coded using the BCT taxonomy. Second, a typology was developed to categorise the extent of overlap between ERIC strategies and BCTs. Third, three implementation scientists independently rated their level of agreement with the categorisation and BCT coding. Finally, discrepancies were settled through online consensus discussions. Additional patterns of complementarity between ERIC strategies and BCTs were labelled thematically. Descriptive statistics summarise the frequency of coded BCTs and the number of strategies mapped to each of the categories of the typology. RESULTS Across the 73 strategies, 41/93 BCTs (44%) were coded, with 'restructuring the social environment' as the most frequently coded (n=18 strategies, 25%). There was direct overlap between one strategy (change physical structure and equipment) and one BCT ('restructuring physical environment'). Most strategy descriptions (n=64) had BCTs that were clearly indicated (n=18), and others where BCTs were probable but not explicitly described (n=31) or indicated multiple types of overlap (n=15). For some strategies, the presence of additional BCTs was dependent on the form of delivery. Some strategies served as examples of broad BCTs operationalised for implementation. For eight strategies, there were no BCTs indicated, or they did not appear to focus on changing behaviour. These strategies reflected preparatory stages and targeted collective cognition at the system level rather than behaviour change at the service delivery level. CONCLUSIONS This study demonstrates how the ERIC compilation and BCT taxonomy can be integrated to specify active ingredients, providing an opportunity to better understand mechanisms of action. Our results highlight complementarity rather than redundancy. More efforts to integrate these or other taxonomies will aid strategy developers and build links between existing silos in implementation science.
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Affiliation(s)
- Sheena McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - Justin Presseau
- School of Epidemiology & Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Courtney T Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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11
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Velde HM, Reurink J, Held S, Li CHZ, Yzer S, Oostrik J, Weeda J, Haer-Wigman L, Yntema HG, Roosing S, Pauleikhoff L, Lange C, Whelan L, Dockery A, Zhu J, Keegan DJ, Farrar GJ, Kremer H, Lanting CP, Damme M, Pennings RJE. Usher syndrome type IV: clinically and molecularly confirmed by novel ARSG variants. Hum Genet 2022; 141:1723-1738. [PMID: 35226187 PMCID: PMC9556359 DOI: 10.1007/s00439-022-02441-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 12/16/2022]
Abstract
AbstractUsher syndrome (USH) is an autosomal recessively inherited disease characterized by sensorineural hearing loss (SNHL) and retinitis pigmentosa (RP) with or without vestibular dysfunction. It is highly heterogeneous both clinically and genetically. Recently, variants in the arylsulfatase G (ARSG) gene have been reported to underlie USH type IV. This distinct type of USH is characterized by late-onset RP with predominantly pericentral and macular changes, and late onset SNHL without vestibular dysfunction. In this study, we describe the USH type IV phenotype in three unrelated subjects. We identified three novel pathogenic variants, two novel likely pathogenic variants, and one previously described pathogenic variant in ARSG. Functional experiments indicated a loss of sulfatase activity of the mutant proteins. Our findings confirm that ARSG variants cause the newly defined USH type IV and support the proposed extension of the phenotypic USH classification.
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Affiliation(s)
- Hedwig M. Velde
- Hearing and Genes, Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Janine Reurink
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Sebastian Held
- Department of Biochemistry, University of Kiel, Kiel, Germany
| | - Catherina H. Z. Li
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Suzanne Yzer
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Jaap Oostrik
- Hearing and Genes, Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Jack Weeda
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Lonneke Haer-Wigman
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Helger G. Yntema
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Susanne Roosing
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Laurenz Pauleikhoff
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens Lange
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laura Whelan
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Adrian Dockery
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
- Next Generation Sequencing Laboratory, Pathology Department, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julia Zhu
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - David J. Keegan
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - G. Jane Farrar
- The School of Genetics and Microbiology, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Hannie Kremer
- Hearing and Genes, Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Cornelis P. Lanting
- Hearing and Genes, Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Markus Damme
- Department of Biochemistry, University of Kiel, Kiel, Germany
| | - Ronald J. E. Pennings
- Hearing and Genes, Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
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12
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Morrissey EC, Casey B, Hynes L, Dinneen SF, Byrne M. Supporting self-management and clinic attendance in young adults with type 1 diabetes: development of the D1 Now intervention. Pilot Feasibility Stud 2021; 7:186. [PMID: 34641975 PMCID: PMC8513171 DOI: 10.1186/s40814-021-00922-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Self-management of type 1 diabetes (T1D) is complex and can be particularly challenging for young adults. This is reflected in the high blood glucose values and rates of clinic non-attendance in this group. There is a gap for a theory-based intervention informed by key stakeholder opinions to support and improve self-management in young adults with T1D. PURPOSE The aim of the work was to systematically co-develop an evidence-based and stakeholder-led intervention to support self-management and clinic engagement in young adults living with T1D in Ireland. Co-development was led by the Young Adult Panel. METHODS The Behaviour Change Wheel was used to guide the development. Five evidence sources were used to inform the process. An iterative co-design process was used with the Young Adult Panel. Initial intervention components were refined and feasibility tested using qualitative methods. RESULTS Environmental restructuring, education and training were selected as appropriate intervention functions. The co-design process, along with qualitative refinement and feasibility work, led to the final intervention content which consisted of 17 behaviour change techniques. The final D1 Now intervention consists of three components: a support worker, an agenda setting tool and an interactive messaging service. CONCLUSIONS The D1 Now intervention is now at pilot evaluation stage. Its transparent and systematic development will facilitate evaluation and future replications.
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Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Bláthín Casey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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13
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Troy E, Tilbury MA, Power AM, Wall JG. Nature-Based Biomaterials and Their Application in Biomedicine. Polymers (Basel) 2021; 13:3321. [PMID: 34641137 PMCID: PMC8513057 DOI: 10.3390/polym13193321] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023] Open
Abstract
Natural polymers, based on proteins or polysaccharides, have attracted increasing interest in recent years due to their broad potential uses in biomedicine. The chemical stability, structural versatility, biocompatibility and high availability of these materials lend them to diverse applications in areas such as tissue engineering, drug delivery and wound healing. Biomaterials purified from animal or plant sources have also been engineered to improve their structural properties or promote interactions with surrounding cells and tissues for improved in vivo performance, leading to novel applications as implantable devices, in controlled drug release and as surface coatings. This review describes biomaterials derived from and inspired by natural proteins and polysaccharides and highlights their promise across diverse biomedical fields. We outline current therapeutic applications of these nature-based materials and consider expected future developments in identifying and utilising innovative biomaterials in new biomedical applications.
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Affiliation(s)
- Eoin Troy
- Microbiology, College of Science and Engineering, National University of Ireland, NUI Galway, H91 TK33 Galway, Ireland; (E.T.); (M.A.T.)
| | - Maura A. Tilbury
- Microbiology, College of Science and Engineering, National University of Ireland, NUI Galway, H91 TK33 Galway, Ireland; (E.T.); (M.A.T.)
- SFI Centre for Medical Devices (CÚRAM), NUI Galway, H91 TK33 Galway, Ireland
| | - Anne Marie Power
- Zoology, School of Natural Sciences, NUI Galway, H91 TK33 Galway, Ireland;
| | - J. Gerard Wall
- Microbiology, College of Science and Engineering, National University of Ireland, NUI Galway, H91 TK33 Galway, Ireland; (E.T.); (M.A.T.)
- SFI Centre for Medical Devices (CÚRAM), NUI Galway, H91 TK33 Galway, Ireland
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14
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Miler JA, Carver H, Masterton W, Parkes T, Maden M, Jones L, Sumnall H. What treatment and services are effective for people who are homeless and use drugs? A systematic 'review of reviews'. PLoS One 2021; 16:e0254729. [PMID: 34260656 PMCID: PMC8279330 DOI: 10.1371/journal.pone.0254729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People who experience homelessness and those vulnerably housed experience disproportionately high rates of drug use and associated harms, yet barriers to services and support are common. We undertook a systematic 'review of reviews' to investigate the effects of interventions for this population on substance use, housing, and related outcomes, as well as on treatment engagement, retention and successful completion. METHODS AND FINDINGS We searched ten electronic databases from inception to October 2020 for reviews and syntheses, conducted a grey literature search, and hand searched reference lists of included studies. We selected reviews that synthesised evidence on any type of treatment or intervention that reported substance use outcomes for people who reported being homeless. We appraised the quality of included reviews using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the Scale for the Assessment of Narrative Review Articles. Our search identified 843 citations, and 25 reviews met the inclusion criteria. Regarding substance use outcomes, there was evidence that harm reduction approaches lead to decreases in drug-related risk behaviour and fatal overdoses, and reduce mortality, morbidity, and substance use. Case management interventions were significantly better than treatment as usual in reducing substance use among people who are homeless. The evidence indicates that Housing First does not lead to significant changes in substance use. Evidence regarding housing and other outcomes is mixed. CONCLUSIONS People who are homeless and use drugs experience many barriers to accessing healthcare and treatment. Evidence regarding interventions designed specifically for this population is limited, but harm reduction and case management approaches can lead to improvements in substance use outcomes, whilst some housing interventions improve housing outcomes and may provide more stability. More research is needed regarding optimal treatment length as well as qualitative insights from people experiencing or at risk of homelessness.
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Affiliation(s)
- Joanna Astrid Miler
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Michelle Maden
- Institute of Population Health Sciences, University of Liverpool, Liverpool, England
| | - Lisa Jones
- Public Health Institute, Liverpool John Moores University, Liverpool, England
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, England
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15
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Kelly P, Weimar C, Lemmens R, Murphy S, Purroy F, Arsovska A, Bornstein NM, Czlonkowska A, Fischer U, Fonseca AC, Forbes J, Hill MD, Jatuzis D, Kõrv J, Kruuse C, Mikulik R, J Nederkoorn P, O’Donnell M, Sandercock P, Tanne D, Tsivgoulis G, Walsh C, Williams D, Zedde M, Price CI. Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) - study protocol for a randomised controlled trial. Eur Stroke J 2021; 6:222-228. [PMID: 34414298 PMCID: PMC8370082 DOI: 10.1177/2396987320972566] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inflammation contributes to unstable atherosclerotic plaque and stroke. In randomised trials in patients with coronary disease, canukinumab (an interleukin-1B antagonist) and colchicine (a tubulin inhibitor with pleiotropic anti-inflammatory effects) reduced recurrent vascular events.Hypothesis: Anti-inflammatory therapy with low-dose colchicine plus usual care will reduce recurrent vascular events in patients with non-severe, non-cardioembolic stroke and TIA compared with usual care alone. DESIGN CONVINCE is a multi-centre international (in 17 countries) Prospective, Randomised Open-label, Blinded-Endpoint assessment (PROBE) controlled Phase 3 clinical trial in 3154 participants. The intervention is colchicine 0.5 mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Included patients are at least 40 years, with non-severe ischaemic stroke (modified Rankin score ≤3) or high-risk TIA (ABCD2 > 3, or positive DWI, or cranio-cervical artery stenosis) within 72 hours-28 days of randomisation, with qualifying stroke/TIA most likely caused by large artery stenosis, lacunar disease, or cryptogenic embolism. Exclusions are stroke/TIA caused by cardio-embolism or other defined cause (e.g. dissection), contra-indication to colchicine (including potential drug interactions), or incapacity for participation in a clinical trial. The anticipated median follow-up will be 36 months. The primary analysis will be by intention-to-treat. OUTCOME The primary outcome is time to first recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation with unstable angina (non-fatal or fatal). SUMMARY CONVINCE will provide high-quality randomised data on the efficacy and safety of anti-inflammatory therapy with colchicine for secondary prevention after stroke. SCHEDULE First-patient first-visit was December 2016. Recruitment to complete in 2021, follow-up to complete in 2023.
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Affiliation(s)
- Peter Kelly
- Mater University Hospital and University College Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - Christian Weimar
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, University Duisburg-Essen, Essen, Germany
| | - Robin Lemmens
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Sean Murphy
- Mater University Hospital and University College Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Hospitalt Universitari Arnau de Vilanova de Lleida, Spain
- Universitat de Lleida, Biomedical Research Institute of Lleida (IRBLleida) , Universitat de Lleida (UdL), Spain
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University “Ss Cyril and Methodius”, Skopje, North Macedonia
| | | | - Anna Czlonkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Urs Fischer
- Stroke Centre and Clinical Trial Unit, University of Bern, Bern, Switzerland
| | - Ana Catarina Fonseca
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - John Forbes
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Michael D Hill
- University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
| | - Dalius Jatuzis
- Centre of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | | | - Robert Mikulik
- International Clinical Research Center and Neurology Department, St. Anne’s University Hospital and Masaryk University Brno, Czech Republic
| | - Paul J Nederkoorn
- Amsterdam University Medical Centers (AUMC), Department of Neurology | Location AMC, Amsterdam, The Netherlands
| | - Martin O’Donnell
- HRB Clinical Research Facility Galway and National University of Ireland Galway, Ireland
| | | | - David Tanne
- Centre for Clinical Brain Sciences, University of Edinburgh UK
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” Hospital, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece
| | - Cathal Walsh
- Mathematics Applications Consortium for Science and Industry and Health Research Institute, University of Limerick, Ireland
| | - David Williams
- RCSI University of Medicine and Health Sciences and Beaumont Hospital, Dublin, Ireland
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria locale-IRCCS di Reggio Emilia, Italy
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Masterson C, Horie S, McCarthy SD, Gonzalez H, Byrnes D, Brady J, Fandiño J, Laffey JG, O'Toole D. Hypercapnia in the critically ill: insights from the bench to the bedside. Interface Focus 2021; 11:20200032. [PMID: 33628425 PMCID: PMC7898152 DOI: 10.1098/rsfs.2020.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 01/16/2023] Open
Abstract
Carbon dioxide (CO2) has long been considered, at best, a waste by-product of metabolism, and at worst, a toxic molecule with serious health consequences if physiological concentration is dysregulated. However, clinical observations have revealed that 'permissive' hypercapnia, the deliberate allowance of respiratory produced CO2 to remain in the patient, can have anti-inflammatory effects that may be beneficial in certain circumstances. In parallel, studies at the cell level have demonstrated the profound effect of CO2 on multiple diverse signalling pathways, be it the effect from CO2 itself specifically or from the associated acidosis it generates. At the whole organism level, it now appears likely that there are many biological sensing systems designed to respond to CO2 concentration and tailor respiratory and other responses to atmospheric or local levels. Animal models have been widely employed to study the changes in CO2 levels in various disease states and also to what extent permissive or even directly delivered CO2 can affect patient outcome. These findings have been advanced to the bedside at the same time that further clinical observations have been elucidated at the cell and animal level. Here we present a synopsis of the current understanding of how CO2 affects mammalian biological systems, with a particular emphasis on inflammatory pathways and diseases such as lung specific or systemic sepsis. We also explore some future directions and possibilities, such as direct control of blood CO2 levels, that could lead to improved clinical care in the future.
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McDonnell T, Nicholson E, Conlon C, Barrett M, Cummins F, Hensey C, McAuliffe E. Assessing the Impact of COVID-19 Public Health Stages on Paediatric Emergency Attendance. Int J Environ Res Public Health 2020; 17:ijerph17186719. [PMID: 32942698 PMCID: PMC7558983 DOI: 10.3390/ijerph17186719] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 01/29/2023]
Abstract
This study outlines the impact of COVID-19 on paediatric emergency department (ED) utilisation and assesses the extent of healthcare avoidance during each stage of the public health response strategy. Records from five EDs and one urgent care centre in Ireland, representing approximately 48% of national annual public paediatric ED attendances, are analysed to determine changes in characteristics of attendance during the three month period following the first reported COVID-19 case in Ireland, with reference to specific national public health stages. ED attendance reduced by 27–62% across all categories of diagnosis in the Delay phase and remained significantly below prior year levels as the country began Phase One of Reopening, with an incident rate ratio (IRR) of 0.58. The decrease was predominantly attributable to reduced attendance for injury and viral/viral induced conditions resulting from changed living conditions imposed by the public health response. However, attendance for complex chronic conditions also reduced and had yet to return to pre-COVID levels as reopening began. Attendances referred by general practitioners (GPs) dropped by 13 percentage points in the Delay phase and remained at that level. While changes in living conditions explain much of the decrease in overall attendance and in GP referrals, reduced attendance for complex chronic conditions may indicate avoidance behaviour and continued surveillance is necessary.
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Affiliation(s)
- Thérèse McDonnell
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
- Correspondence: ; Tel.: +353-1-716-6689
| | - Emma Nicholson
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
| | - Ciara Conlon
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
| | - Michael Barrett
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland;
- Women’s and Children’s Health, School of Medicine, University College Dublin, D04 C7X2 Dublin, Ireland
- National Children’s Research Centre, D12 N512 Dublin, Ireland
| | - Fergal Cummins
- REDSPOT (Retrieval, Emergency and Disaster Medicine Research and Development), Emergency Department, Limerick University Hospital, V94 F858 Limerick, Ireland;
| | - Conor Hensey
- Children’s Health Ireland at Temple Street, D01 XD99 Dublin, Ireland;
| | - Eilish McAuliffe
- Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland; (E.N.); (C.C.); (E.M.)
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Arensman E, Troya MI, Nicholson S, Sadath A, Cully G, Ramos Costa AP, Benson R, Corcoran P, Griffin E, Williamson E, Eustace J, Shiely F, Browne J, Rigby J, Jeffers A, Cassidy E. Study protocol for the implementation and evaluation of the Self-harm Assessment and Management for General Hospitals programme in Ireland (SAMAGH). BMC Health Serv Res 2020; 20:590. [PMID: 32600390 PMCID: PMC7322837 DOI: 10.1186/s12913-020-05254-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous self-harm is one of the strongest predictors of future self-harm and suicide. Increased risk of repeated self-harm and suicide exists amongst patients presenting to hospital with high-risk self-harm and major self-harm repeaters. However, so far evidence-based training in the management of self-harm for mental health professionals is limited. Within this context, we aim to develop, implement and evaluate a training programme, SAMAGH, Self-harm Assessment and Management Programme for General Hospitals in Ireland. SAMAGH aims to (a) reduce hospital-based self-harm repetition rates and (b) increase rates of mental health assessments being conducted with self-harm patients. We also aim to evaluate the training on self-harm knowledge, attitudes, and skills related outcomes of healthcare professionals involved in the training. METHODS/DESIGN The study will be conducted in three phases. First, the SAMAGH Training Programme has been developed, which comprises two parts: 1) E-learning Programme and 2) Simulation Training. Second, SAMAGH will be delivered to healthcare professionals from general hospitals in Ireland. Third, an outcome and process evaluation will be conducted using a pre-post design. The outcome evaluation will be conducted using aggregated data from the National Self-Harm Registry Ireland (NSHRI) on self-harm repetition rates from all 27 public hospitals in Ireland. Aggregated data based on the 3-year average (2016, 2017, 2018) self-harm repetition rates prior to the implementation of the SAMAGH will be used as baseline data, and NSHRI data from 6 and 12 months after the implementation of SAMAGH will be used as follow-up. For the process evaluation, questionnaires and focus groups will be administered and conducted with healthcare professionals who completed the training. DISCUSSION This study will contribute to the evidence base regarding the effectiveness of an evidence informed training programme that aims to reduce repeated hospital self-harm presentations and to improve compliance with self-harm assessment and management. This study is also expected to contribute to self-harm and suicide training with the possibility of being translated to other settings. Its feasibility will be evaluated through a process evaluation.
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Affiliation(s)
- Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland.
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland.
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.
| | - M Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Anvar Sadath
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Grace Cully
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Ruth Benson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Eve Griffin
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Eileen Williamson
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Joe Eustace
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- Health Research Board Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - Frances Shiely
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- Health Research Board Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Jan Rigby
- Centre for Health Geoinformatics & Department of Geography, Maynooth University, Maynooth, Ireland
| | - Anne Jeffers
- National Clinical Programme for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm, Office of the National Clinical Advisor and Group Lead, Dr. Steeven's Hospital, Dublin, Ireland
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
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19
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O'Toole SA, Spillane C, Huang Y, Fitzgerald MC, Ffrench B, Mohamed B, Ward M, Gallagher M, Kelly T, O'Brien C, Ruttle C, Bogdanska A, Martin C, Mullen D, Connolly E, McGarrigle SA, Kennedy J, O'Leary JJ. Circulating tumour cell enumeration does not correlate with Miller-Payne grade in a cohort of breast cancer patients undergoing neoadjuvant chemotherapy. Breast Cancer Res Treat 2020; 181:571-580. [PMID: 32378053 PMCID: PMC7220879 DOI: 10.1007/s10549-020-05658-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
Purpose The association between pathological complete response (pCR) in patients receiving neoadjuvant chemotherapy (NAC) for breast cancer and Circulating Tumour Cells (CTCs) is not clear. The aim of this study was to assess whether CTC enumeration could be used to predict pathological response to NAC in breast cancer as measured by the Miller–Payne grading system. Methods Twenty-six patients were recruited, and blood samples were taken pre- and post-NAC. CTCs were isolated using the ScreenCell device and stained using a modified Giemsa stain. CTCs were enumerated by 2 pathologists and classified as single CTCs, doublets, clusters/microemboli and correlated with the pathological response as measured by the Miller–Payne grading system. χ2 or ANOVA was performed in SPSS 24.0 statistics software for associations. Results 89% of patients had invasive ductal carcinoma (IDC) and 11% invasive lobular carcinoma (ILC). At baseline 85% of patients had CTCs present, median 7 (0–161) CTCs per 3 ml of whole blood. Post-chemotherapy, 58% had an increase in CTCs. This did not correlate with the Miller–Payne grade of response. No significant association was identified between the number of CTCs and clinical characteristics; however, we did observe a correlation between pre-treatment CTC counts and body mass index, p < 0.05. Conclusions Patients with a complete response to NAC still had CTCs present, suggesting enumeration is not sufficient to aid surgery stratification. Additional characterisation and larger studies are needed to further characterise CTCs isolated pre- and post-chemotherapy. Long-term follow-up of these patients will determine the significance of CTCs in NAC breast cancer patients. Electronic supplementary material The online version of this article (10.1007/s10549-020-05658-7) contains supplementary material, which is available to authorized users.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Cohort Studies
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoadjuvant Therapy/mortality
- Neoplasm Grading
- Neoplastic Cells, Circulating/drug effects
- Neoplastic Cells, Circulating/pathology
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Survival Rate
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Affiliation(s)
- Sharon A O'Toole
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland.
- Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland.
- Trinity St James's Cancer Institute, Dublin 8, Ireland.
| | - Cathy Spillane
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Yanmei Huang
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Marie C Fitzgerald
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Brendan Ffrench
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Bashir Mohamed
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Mark Ward
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Michael Gallagher
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Tanya Kelly
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Cathal O'Brien
- Cancer Molecular Diagnostics, St. James's Hospital, Dublin 8, Ireland
| | - Carmel Ruttle
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Anna Bogdanska
- Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland
| | - Cara Martin
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Dorinda Mullen
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
| | - Elizabeth Connolly
- Trinity St James's Cancer Institute, Dublin 8, Ireland
- Department of Surgery, St James's Hospital, Dublin 8, Ireland
| | - Sarah A McGarrigle
- Trinity St James's Cancer Institute, Dublin 8, Ireland
- Department of Surgery, St James's Hospital, Dublin 8, Ireland
| | - John Kennedy
- Trinity St James's Cancer Institute, Dublin 8, Ireland
- HOPE Directorate, St. James's Hospital, Dublin 8, Ireland
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin 8, Ireland
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20
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Gallagher AL, Galvin R, Robinson K, Murphy CA, Conway PF, Perry A. The characteristics, life circumstances and self-concept of 13 year olds with and without disabilities in Ireland: A secondary analysis of the Growing Up in Ireland (GUI) study. PLoS One 2020; 15:e0229599. [PMID: 32168358 PMCID: PMC7069612 DOI: 10.1371/journal.pone.0229599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Population-based studies provide important data to inform policy and service planning for vulnerable children in society. The aim of this study was to characterise social and educational circumstances and self-concept among a nationally representative sample of 13 year olds with developmental disabilities in Ireland. METHODS A cross-sectional, secondary analysis of data collected from the Growing Up in Ireland (GUI) study was conducted. Descriptive statistics were used to calculate the reported prevalence of disabilities as reported by parents. Differences across the groups (those with and without disabilities) were analysed in relation to gender, socio-economic and school factors. Special education support received in school was described. The association between low self-concept scores (as measured by the Piers Harris Self-Concept Scales 2) and disability type was examined by use of multi-level logistic regression. RESULTS Seventeen percent (17.36%) of the sample was reported to have a diagnosis of one or more developmental disabilities. Those with a disability were more likely to live in poorer households, have poorer health status, to experience more episodes of bullying at school, and to have more negative views of school (p<0.05) than their typically-developing peers. Forty nine percent of children with developmental disabilities were not receiving support in school as reported by parents. Discrepancies in the nature of support received were identified across disability types. Adjusting for individual and school level factors, a disability diagnosis was associated with increased odds of low self-concept scores on three of five self-concept domains. Further associations were identified which differed across disability type. CONCLUSIONS The findings show that 13 year olds with a disability in Ireland have complex social and educational needs. Findings also suggest significant levels of unmet educational need across this age group. Apparent inequities in access to support in school require further investigation. Reliable measures to provide robust prevalence figures about childhood disabilities in Ireland are needed.
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Affiliation(s)
- Aoife Lily Gallagher
- Health Research Institute, School of Allied Health, University of Limerick, Ireland
| | - Rose Galvin
- Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Ireland
| | - Katie Robinson
- Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Ireland
| | - Carol-Anne Murphy
- Health Research Institute, School of Allied Health, University of Limerick, Ireland
| | | | - Alison Perry
- Health Research Institute, School of Allied Health, University of Limerick, Ireland
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21
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Horie S, Gaynard S, Murphy M, Barry F, Scully M, O'Toole D, Laffey JG. Cytokine pre-activation of cryopreserved xenogeneic-free human mesenchymal stromal cells enhances resolution and repair following ventilator-induced lung injury potentially via a KGF-dependent mechanism. Intensive Care Med Exp 2020; 8:8. [PMID: 32025852 PMCID: PMC7002627 DOI: 10.1186/s40635-020-0295-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Human mesenchymal stem/stromal cells (hMSCs) represent a promising therapeutic strategy for ventilator-induced lung injury (VILI) and acute respiratory distress syndrome. Translational challenges include restoring hMSC efficacy following cryopreservation, developing effective xenogeneic-free (XF) hMSCs and establishing true therapeutic potential at a clinically relevant time point of administration. We wished to determine whether cytokine pre-activation of cryopreserved, bone marrow-derived XF-hMSCs would enhance their capacity to facilitate injury resolution following VILI and elucidate mechanisms of action. METHODS Initially, in vitro studies examined the potential for the secretome from cytokine pre-activated XF-hMSCs to attenuate pulmonary epithelial injury induced by cyclic mechanical stretch. Later, anaesthetised rats underwent VILI and, 6 h following injury, were randomized to receive 1 × 107 XF-hMSC/kg that were (i) naive fresh, (ii) naive cryopreserved, (iii) cytokine pre-activated fresh or (iv) cytokine pre-activated cryopreserved, while control animals received (v) vehicle. The extent of injury resolution was measured at 24 h after injury. Finally, the role of keratinocyte growth factor (KGF) in mediating the effect of pre-activated XF-hMSCs was determined in a pulmonary epithelial wound repair model. RESULTS Pre-activation enhanced the capacity of the XF-hMSC secretome to decrease stretch-induced pulmonary epithelial inflammation and injury. Both pre-activated fresh and cryopreserved XF-hMSCs enhanced resolution of injury following VILI, restoring oxygenation, improving lung compliance, reducing lung leak and improving resolution of lung structural injury. Finally, the secretome of pre-activated XF-hMSCs enhanced epithelial wound repair, in part via a KGF-dependent mechanism. CONCLUSIONS Cytokine pre-activation enhanced the capacity of cryopreserved, XF-hMSCs to promote injury resolution following VILI, potentially via a KGF-dependent mechanism.
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Affiliation(s)
- Shahd Horie
- Anaesthesia, School of Medicine, National University of Ireland, Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Sean Gaynard
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Mary Murphy
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Medicine, School of Medicine, National University of Ireland, Galway, Ireland
| | - Frank Barry
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Medicine, School of Medicine, National University of Ireland, Galway, Ireland
| | - Michael Scully
- Anaesthesia, School of Medicine, National University of Ireland, Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daniel O'Toole
- Anaesthesia, School of Medicine, National University of Ireland, Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - John G Laffey
- Anaesthesia, School of Medicine, National University of Ireland, Galway, Ireland.
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
- Department of Anaesthesia, Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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22
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Hayes C, Ciblis A, Darker C, Dougall N, Vance J, O’Connell N, Dobbie F, Loudon K, Burke E, Devane D, Bauld L. We Can Quit2 (WCQ2): a community-based intervention on smoking cessation for women living in disadvantaged areas of Ireland-study protocol for a pilot cluster randomised controlled trial. Pilot Feasibility Stud 2019; 5:138. [PMID: 31788324 PMCID: PMC6875165 DOI: 10.1186/s40814-019-0511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/01/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in Ireland with almost 6000 smokers dying each year from smoking-related diseases. The 'We Can Quit2' (WCQ2) study is a pilot pragmatic two-arm, parallel-group, cluster randomised trial that aims to explore the feasibility and acceptability of trial processes including recruitment and to estimate parameters to inform sample size estimates needed for an effectiveness trial. This future trial will assess the effectiveness of a community-based smoking cessation intervention for women living in disadvantaged areas on short- and medium-term cessation rates. METHODS/DESIGN Four matched pairs of districts (eight clusters) selected by area level of deprivation, geographical proximity, and eligibility for free medical services will be randomised to receive either WCQ (behavioural support + access to Nicotine Replacement Therapy (NRT)) delivered over 12 weeks by trained Community Facilitators (CFs) or to a form of usual care, a one-to-one smoking cessation service delivered by Smoking Cessation Officers from Ireland's national health service, the Health Service Executive (HSE). Within each cluster, 24-25 women will be recruited (97 per arm; 194 in total) in 4 phases with consent obtained prior to cluster randomisation. The outcome measures will assess feasibility and acceptability of trial processes, including randomisation. Outcome data for a future definitive intervention (biochemically validated smoking abstinence) will be collected at end of programme (12 weeks) and at 6 months. WCQ2 has an embedded process evaluation using both qualitative and quantitative methods. This will be conducted (semi-structured client and CF interviews, intervention delivery checklist, and diary) to explore acceptability of trial processes, intervention fidelity, trial context, and implementation. Trial processes will be assessed against domains of the PRECIS-2 wheel to inform a future definitive trial design. DISCUSSION Data from this pilot trial will inform the design and sample size for a full cluster randomised trial to determine the effectiveness of an intervention tailored to disadvantaged women in improving smoking cessation rates. It will provide transferable learning on the systems and implementation strategies needed to support effective design of future pragmatic community-based trials which address health promotion interventions for women in disadvantaged communities. TRIAL REGISTRATION Concurrent to publication. Controlled trials ISRCTN74721694.
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Affiliation(s)
- Catherine Hayes
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Aurelia Ciblis
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Catherine Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Joanne Vance
- Irish Cancer Society, 43/45 Northumberland Road, Ballsbridge, Dublin 4, Ireland
| | - Nicola O’Connell
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, EH8 9AG UK
| | | | - Emma Burke
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH 74 Ireland
| | - Declan Devane
- HRB Trials Methodology Research Network & School of Nursing & Midwifery, NUI Galway, Galway, Ireland
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, EH8 9AG UK
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Wiese A, Galvin E, Merrett C, Korotchikova I, Slattery D, Prihodova L, Hoey H, O’Shaughnessy A, Cotter J, O’Farrell J, Horgan M, Bennett D. Doctors' attitudes to, beliefs about, and experiences of the regulation of professional competence: a scoping review protocol. Syst Rev 2019; 8:213. [PMID: 31439022 PMCID: PMC6706919 DOI: 10.1186/s13643-019-1132-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/18/2019] [Accepted: 08/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Historically, individual doctors were responsible for maintaining their own professional competence. More recently, changing patient expectations, debate about the appropriateness of professional self-regulation, and high-profile cases of malpractice have led to a move towards formal regulation of professional competence (RPC). Such programmes require doctors to demonstrate that they are fit to practice, through a variety of means. Participation in RPC is now part of many doctors' professional lives, yet it remains a highly contested area. Cost, limited evidence of impact, and lack of relevance to practice are amongst the criticisms cited. Doctors' attitudes towards RPC, their beliefs about its objectives and effectiveness, and their experiences of trying to meet its requirements can impact engagement with the process. We aim to conduct a scoping review to map the empirical literature in this area, to summarise the key findings, and to identify gaps for future research. METHODS We will conduct our review following the six phases outlined by Arksey and O'Malley, and Levac. We will search seven electronic databases: Academic Search Complete, Business Source Complete, CINAHL, PsycINFO, PubMed, Social Sciences Full Text, and SocINDEX for relevant publications, and the websites of medical regulatory and educational organisations for documents. We will undertake backward and forward citation tracking of selected studies and will consult with international experts regarding key publications. Two researchers will independently screen papers for inclusion and extract data using a piloted data extraction tool. Data will be collated to provide a descriptive summary of the literature. A thematic analysis of the key findings will be presented as a narrative summary of the literature. DISCUSSION We believe that this review will be of value to those tasked with the design and implementation of RPC programmes, helping them to maximise doctors' commitment and engagement, and to researchers, pointing to areas that would benefit from further enquiry. This research is timely; internationally existing programmes are evolving, new programmes are being initiated, and many jurisdictions do not yet have programmes in place. There is an opportunity for learning across different programmes and from the experiences of established programmes. Our review will support that learning. SYSTEMATIC REVIEW REGISTRATION PROSPERO does not register scoping reviews.
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Affiliation(s)
- Anél Wiese
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Emer Galvin
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Charlotte Merrett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Irina Korotchikova
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | | | | | - Hilary Hoey
- Royal College of Physicians of Ireland, Dublin, Ireland
| | | | | | | | - Mary Horgan
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
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Flannery C, Dahly D, Byrne M, Khashan A, McHugh S, Kenny LC, McAuliffe F, Kearney PM. Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study. BMJ Open 2019; 9:e025003. [PMID: 31227527 PMCID: PMC6596951 DOI: 10.1136/bmjopen-2018-025003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy. DESIGN This is a secondary analysis of data from a prospective cohort study. SETTING The study was conducted in Cork, Ireland. PARTICIPANTS Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks' gestation. PRIMARY AND SECONDARY OUTCOMES The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks' gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models. RESULTS From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups: low PA (n=393), moderate PA (n=960) and high PA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low). CONCLUSION The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy. TRIAL REGISTRATION NUMBER ACTRN 12607000551493.
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Affiliation(s)
- Caragh Flannery
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland
- Health Research Board, Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Molly Byrne
- School of Psychology, Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women’s and Children’s Health, University of Liverpool School of Life Sciences, Liverpool, UK
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, University College Dublin, Dublin, Ireland
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