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Sykes EME, Mateo-Estrada V, Engelberg R, Muzaleva A, Zhanel G, Dettman J, Chapados J, Gerdis S, Akineden Ö, Khan IUH, Castillo-Ramírez S, Kumar A. Phylogenomic and phenotypic analyses highlight the diversity of antibiotic resistance and virulence in both human and non-human Acinetobacter baumannii. mSphere 2024; 9:e0074123. [PMID: 38440986 PMCID: PMC10964423 DOI: 10.1128/msphere.00741-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Acinetobacter baumannii is a Gram-negative, opportunistic pathogen that causes infections in the immunocompromised. With a high incidence of muti-drug resistance, carbapenem-resistant A. baumannii is designated as a priority 1 pathogen by the WHO. The current literature has expertly characterized clinical isolates of A. baumannii. As the challenge of these infections has recently been classified as a One Health issue, we set out to explore the diversity of isolates from human and non-clinical sources, such as agricultural surface water, urban streams, various effluents from wastewater treatment plants, and food (tank milk); and, importantly, these isolates came from a wide geographic distribution. Phylogenomic analysis considering almost 200 isolates showed that our diverse set is well-differentiated from the main international clones of A. baumannii. We discovered novel sequence types in both hospital and non-clinical settings and five strains that overexpress the resistance-nodulation-division efflux pump adeIJK without changes in susceptibility reflected by this overexpression. Furthermore, we detected a bla ADC-79 in a non-human isolate despite its sensitivity to all antibiotics. There was no significant differentiation between the virulence profiles of clinical and non-clinical isolates in the Galleria mellonella insect model of virulence, suggesting that virulence is neither dependent on geographic origin nor isolation source. The detection of antibiotic resistance and virulence genes in non-human strains suggests that these isolates may act as a genetic reservoir for clinical strains. This endorses the notion that in order to combat multi-drug-resistant infection caused by A. baumannii, a One Health approach is required, and a deeper understanding of non-clinical strains must be achieved.IMPORTANCEThe global crisis of antibiotic resistance is a silent one. More and more bacteria are becoming resistant to all antibiotics available for treatment, leaving no options remaining. This includes Acinetobacter baumannii. This Gram-negative, opportunistic pathogen shows a high frequency of multi-drug resistance, and many strains are resistant to the last-resort drugs carbapenem and colistin. Research has focused on strains of clinical origin, but there is a knowledge gap regarding virulence traits, particularly how A. baumannii became the notorious pathogen of today. Antibiotic resistance and virulence genes have been detected in strains from animals and environmental locations such as grass and soil. As such, A. baumannii is a One Health concern, which includes the health of humans, animals, and the environment. Thus, in order to truly combat the antibiotic resistance crisis, we need to understand the antibiotic resistance and virulence gene reservoirs of this pathogen under the One Health continuum.
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Affiliation(s)
- Ellen M. E. Sykes
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Valeria Mateo-Estrada
- Programa de Genómica Evolutiva, Centro de Ciencias Génomicas, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Raelene Engelberg
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Muzaleva
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Zhanel
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeremy Dettman
- Ottawa Research and Development Centre (ORDC), Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - Julie Chapados
- Ottawa Research and Development Centre (ORDC), Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - Suzanne Gerdis
- Ottawa Research and Development Centre (ORDC), Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - Ömer Akineden
- Dairy Sciences, Institute of Veterinary Food Science, Justus-Liebig, University of Giessen, Giessen, Germany
| | - Izhar U. H. Khan
- Ottawa Research and Development Centre (ORDC), Agriculture and Agri-Food Canada, Ottawa, Ontario, Canada
| | - Santiago Castillo-Ramírez
- Programa de Genómica Evolutiva, Centro de Ciencias Génomicas, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Ayush Kumar
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Hughes SE, Aiyegbusi OL, McMullan C, Turner GM, Anderson N, Cruz Rivera S, Collis P, Glasby J, Lasserson D, Calvert M. Patient-reported outcomes in integrated health and social care: A scoping review. JRSM Open 2024; 15:20542704241232866. [PMID: 38529208 PMCID: PMC10962043 DOI: 10.1177/20542704241232866] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background Patient-reported outcomes (PROs) have potential to support integrated health and social care research and practice; however, evidence of their utilisation has not been synthesised. Objective To identify PRO measures utilised in integrated care and adult social care research and practice and to chart the evidence of implementation factors influencing their uptake. Design Scoping review of peer-reviewed literature. Data sources Six databases (01 January 2010 to 19 May 2023). Study selection Articles reporting PRO use with adults (18+ years) in integrated care or social care settings. Review methods We screened articles against pre-specified eligibility criteria; 36 studies (23%) were extracted in duplicate for verification. We summarised the data using thematic analysis and descriptive statistics. Results We identified 159 articles reporting on 216 PRO measures deployed in a social care or integrated care setting. Most articles used PRO measures as research tools. Eight (5.0%) articles used PRO measures as an intervention. Articles focused on community-dwelling participants (35.8%) or long-term care home residents (23.9%), with three articles (1.9%) focussing on integrated care settings. Stakeholders viewed PROs as feasible and acceptable, with benefits for care planning, health and wellbeing monitoring as well as quality assurance. Patient-reported outcome measure selection, administration and PRO data management were perceived implementation barriers. Conclusion This scoping review showed increasing utilisation of PROs in adult social care and integrated care. Further research is needed to optimise PROs for care planning, design effective training resources and develop policies and service delivery models that prioritise secure, ethical management of PRO data.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
| | | | - Jon Glasby
- School of Social Policy, University of Birmingham, Birmingham, UK
- IMPACT (Improving Adult Social Care Together), University of Birmingham, Birmingham, UK
| | - Daniel Lasserson
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Geriatric Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Blood and Transplant Research Unit in Precision Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
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Abel G, Froud R, Pitchforth E, Treadgold B, Hocking L, Sussex J, Elliott M, Campbell J. Informing the development of a scoring system for National Health Service Clinical Impact Awards; a Delphi process and simulated scoring exercise. JRSM Open 2024; 15:20542704231217887. [PMID: 38229596 PMCID: PMC10790597 DOI: 10.1177/20542704231217887] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Objectives To establish principles informing a new scoring system for the UK's Clinical Impact Awards and pilot a system based on those principles. Design A three-round online Delphi process was used to generate consensus from experts on principles a scoring system should follow. We conducted a shadow scoring exercise of 20 anonymised, historic applications using a new scoring system incorporating those principles. Setting Assessment of clinical excellence awards for senior doctors and dentists in England and Wales. Participants The Delphi panel comprised 45 members including clinical excellence award assessors and representatives of professional bodies. The shadow scoring exercise was completed by 24 current clinical excellence award assessors. Main outcome measures The Delphi panel rated the appropriateness of a series of items. In the shadow scoring exercise, a novel scoring system was used with each of five domains rated on a 0-10 scale. Results Consensus was achieved around principles that could underpin a future scoring system; in particular, a 0-10 scale with the lowest point on the scale reflecting someone operating below the expectations of their job plan was agreed as appropriate. The shadow scoring exercise showed similar levels of reliability between the novel scoring system and that used historically, but with potentially better distinguishing performance at higher levels of performance. Conclusions Clinical excellence awards represent substantial public spending and thus far the deployment of these funds has lacked a strong evidence base. We have developed a new scoring system in a robust manner which shows improvements over current arrangements.
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Affiliation(s)
- Gary Abel
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
| | | | - Emma Pitchforth
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
| | - Bethan Treadgold
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
| | | | | | | | - John Campbell
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
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Banzon T, Elklit A. Greenlandic norms for the parent-report and self-report versions of the Strengths and Difficulties Questionnaire (SDQ). Int J Circumpolar Health 2023; 82:2279790. [PMID: 37956158 PMCID: PMC10653636 DOI: 10.1080/22423982.2023.2279790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
The Strengths and Difficulties Questionnaire (SDQ) is a brief screening questionnaire of child behaviour, used to evaluate mental health. It is applicable for children 2-17 years, available to both parents and professionals, and exists in a self-report version available from the age of 11 years. This paper aims to generate Greenlandic norms on the self-report and parent-report versions of the SDQ. In 2023, the self-report version was translated, and a representative sample of children and adolescents completed the SDQ (N = 641). In 2008, the parent-report version was translated into Greenlandic and used in a study of children's well-being (N = 939). Data from both samples were analysed, generating normative scores. Results show significant differences between genders (effect sizes of .006-.145), and discrepancies between parent and self-report. Parents report higher total problems for boys, while self-reporting indicate higher total problems for girls. Cut-off values are higher for self-report norms than parent-report norms. Mean scores on the SDQ total score and subscales differ across age, area of living, caregiver constellation and caregiver's educational level (effect sizes of .011-.064). With the availability of Greenlandic norms, we anticipate further use of the SDQ in clinical practice and research settings, strengthening screening and assessment of children and adolescents.
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Affiliation(s)
- Trine Banzon
- The Danish National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
- LD research group, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Ask Elklit
- The Danish National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
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Naidoo R, Schoeman R. Burnout in emergency department staff: The prevalence and barriers to intervention. S Afr J Psychiatr 2023; 29:2095. [PMID: 37928941 PMCID: PMC10623583 DOI: 10.4102/sajpsychiatry.v29i0.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023] Open
Abstract
Background Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting. Aim This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions. Setting The study was conducted at Tygerberg Hospital, South Africa. Methods This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. Results A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience. Conclusion Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout. Contribution Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff.
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Affiliation(s)
- Reshen Naidoo
- Faculty of Economics and Management Sciences, Stellenbosch Business School, Cape Town, South Africa
| | - Renata Schoeman
- Faculty of Economics and Management Sciences, Stellenbosch Business School, Cape Town, South Africa
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Green A, Lyus R, Ocan M, Pollock AM, Brhlikova P. Registration of essential medicines in Kenya, Tanzania and Uganda: a retrospective analysis. J R Soc Med 2023; 116:331-342. [PMID: 37343667 PMCID: PMC10695152 DOI: 10.1177/01410768231181263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/25/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES To audit national drug registers (NDRs) in Kenya, United Republic of Tanzania and Uganda with respect to national Essential Medicine Lists (EMLs) and to conduct an analysis of highly registered products including a sub-analysis of highly registered antimicrobial products. DESIGN Retrospective analysis of registration of essential medicines and medicinal products on NDRs as of February 2018. SETTING Not applicable. PARTICIPANTS None. MAIN OUTCOME MEASURES Registration status of essential medicines by country, essential medicine status of registered products by country and medicines with more than 50 registrations across all three countries. RESULTS A high proportion of essential medicines are not registered: Kenya 28% (175/632), United Republic of Tanzania 50% (400/797) and Uganda 40% (266/663). Of registered products on the NDRs, more than half are not essential: Kenya 71% (4350/6151), United Republic of Tanzania 64% (2278/3590) and Uganda 58% (2268/3896). When the three NDRs were combined, there were 42 medicines with over 50 registered products, accounting for 30% (4153/13637) of products, many of which were non-essential. CONCLUSIONS Non-registration of essential medicines is a barrier to availability. Over-registration of medicines, particularly non-essential medicines, diverts regulatory resources towards registering non-priority and, sometimes, clinically sub-optimal medicines. The East African Community Medicines Registration Harmonization Project has the potential to improve access to key medicines if registration of essential medicines is prioritised and registration of non-essential medicines is restricted.
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Affiliation(s)
- A Green
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - R Lyus
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - M Ocan
- Department of Pharmacology and Therapeutics, Makerere University, Republic of Uganda, Kampala, PO Box 7062
| | - AM Pollock
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - P Brhlikova
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
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Tan C, Wang J, Cao G, Chen C, Yin J, Lu J, Qiu J. Reliability and validity of the Chinese version of the Athens insomnia scale for non-clinical application in Chinese athletes. Front Psychol 2023; 14:1183919. [PMID: 37780167 PMCID: PMC10540192 DOI: 10.3389/fpsyg.2023.1183919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose This study aimed to revise and examine the reliability and validity of the Chinese version of the Athens Insomnia Scale for Non-clinical Application (AIS-NCA) among Chinese athletes. Additionally, the study tested the scale in non-athlete individuals with similar sleep management practices to further analyze its cultural specificity among Chinese athletes and make preliminary inferences about its applicability in other Chinese populations. Methods Four hundred twenty-six Chinese professional athletes and 779 high school students participated in this research. Both athletes and students were divided into two parallel groups for exploratory and confirmatory factor analyses. Additionally, three athlete samples and one student sample were established for reliability and validity assessments. Among athletes, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Athlete Sleep Screening Questionnaire, and the Warwick-Edinburgh Mental Well-Being Scale were employed to evaluate convergent and discriminant validity. Re-test reliability was evaluated at intervals of 1 and 2 weeks. In the case of students, convergent and discriminant validity were tested using the Pittsburgh Sleep Quality Index and the General Self-Efficacy Scale, with re-test reliability assessed at two-week intervals. Results The Chinese version of the AIS-NCA consists of six items, categorized into two dimensions: sleep problems and daytime functioning. This structure explained 65.08% (athletes) and 66.22% (students) of the variance. Confirmatory factor analysis revealed good model fit, with values of χ2/df = 2.217, CFI = 0.975, AGFI = 0.929, TLI = 0.953, and RMSEA = 0.076 among athletes, and χ2/df = 3.037, CFI = 0.979, AGFI = 0.947, TLI = 0.961, and RMSEA = 0.072 among students. The scale demonstrated a reasonable degree of measurement invariance. The overall scale and two subscales exhibited strong reliability and validity among athletes. Similar results in terms of reliability and validity were also observed within the student sample. Conclusion The Chinese version of the AIS-NCA shows promise as an assessment tool for evaluating the sleep quality of Chinese athletes. It effectively captures both sleep-related concerns and daytime functionality within the athlete population. The scale demonstrates solid reliability and validity in professional athletes and holds potential for application across various other demographic groups in China.
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Affiliation(s)
- Chenhao Tan
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Jinhao Wang
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Guohuan Cao
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Chao Chen
- No.1 High School Affiliated to Tongji University, Shanghai, China
| | - Jun Yin
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Jiaojiao Lu
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Jun Qiu
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
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Abstract
The aim of this paper was to assess the association between non-clinical factors and Caesarean delivery in Uganda. Self-reported data from the individual recode file were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a sub sample of 9929 women aged 15-49 with a recent birth in the last 5 years preceding the survey. Chi-square tests and multivariate comlementary log-log regression models were used to examine the relationship between non-clinical factors and Caesarean section delivery. About one in ten (7%) of the women aged 15-49 had Caesarean deliveries. Non-clinical factors which were significantly associated with Caesarean section delivery include advanced maternal age, having the first birth compared to subsequent births, having 1-3 children compared to 4 or more children, higher level of women's education relative to no education, being in the middle, richer, and richest wealth quintile compared to the poorest quintile. In conclusion, evidence suggests that the trend in Caesarean delivery can be attributed partially to non-clinical factors including advanced maternal age, birth order, parity, women's education level, and wealth quintile. Thus, efforts to address the trend in Caesarean section delivery, need to take account of non-clinical factors.
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Affiliation(s)
| | - Charles Lwanga
- Population Studies, School of Statistics and Planning, Makerere University, Uganda
| | | | - Ishmael Kalule-Sabiti
- Population Research and Training Unit, North-West University (Mafikeng Campus), South Africa
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Bashir SR, Raza S, Kocaman V, Qamar U. Clinical Application of Detecting COVID-19 Risks: A Natural Language Processing Approach. Viruses 2022; 14:v14122761. [PMID: 36560764 PMCID: PMC9781729 DOI: 10.3390/v14122761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The clinical application of detecting COVID-19 factors is a challenging task. The existing named entity recognition models are usually trained on a limited set of named entities. Besides clinical, the non-clinical factors, such as social determinant of health (SDoH), are also important to study the infectious disease. In this paper, we propose a generalizable machine learning approach that improves on previous efforts by recognizing a large number of clinical risk factors and SDoH. The novelty of the proposed method lies in the subtle combination of a number of deep neural networks, including the BiLSTM-CNN-CRF method and a transformer-based embedding layer. Experimental results on a cohort of COVID-19 data prepared from PubMed articles show the superiority of the proposed approach. When compared to other methods, the proposed approach achieves a performance gain of about 1-5% in terms of macro- and micro-average F1 scores. Clinical practitioners and researchers can use this approach to obtain accurate information regarding clinical risks and SDoH factors, and use this pipeline as a tool to end the pandemic or to prepare for future pandemics.
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Affiliation(s)
- Syed Raza Bashir
- Department of Computer Science, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Shaina Raza
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Correspondence:
| | | | - Urooj Qamar
- Institute of Business & Information Technology, University of the Punjab, Lahore 54590, Pakistan
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Greupink R, van Hove H, Mhlanga F, Theunissen P, Colbers A. Non-clinical considerations for supporting accelerated inclusion of pregnant women in pre-licensure clinical trials with anti-HIV agents. J Int AIDS Soc 2022; 25 Suppl 2:e25914. [PMID: 35851570 PMCID: PMC9294860 DOI: 10.1002/jia2.25914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/28/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction To allow the continued participation of women enrolled in pre‐licensure clinical trials who become pregnant, and to potentially enrol pregnant women in clinical trials, non‐clinical developmental and reproductive toxicology studies (DART) are essential. Generally during pharmaceutical development, DART studies are conducted late during clinical development, leading to the exclusion of pregnant women from enrolment and withdrawal of women becoming pregnant during pre‐licensure trials. Discussion Completing all DART studies prior to or early during the conduct of phase 3 trials (i.e. earlier than current common practice) can accelerate and facilitate the inclusion of women who become pregnant during pre‐licensure trials to remain on study drug and to potentially enrol pregnant women more rapidly. Promoting complementary strategies, such as alternative combinations of DART study designs and physiologically based pharmacokinetic modelling, could better inform drug dosing and safety in pregnancy at an earlier stage in drug development. The interpretation of the results of non‐clinical DART studies is often complex. Institutional review boards/ethics committees should have access to relevant expertise for interpretation and application of results of non‐clinical developmental and reproductive toxicity studies. Clear communication and thorough understanding of non‐clinical findings and the overall benefit–risk profile of the product are critical to review protocols and determine if women who become pregnant during a clinical trial could continue on study drug and/or to enrol pregnant women in the trial. The informed consent document should be well written so that participants can make an informed decision to stay on study drug or participate in a trial during pregnancy. Ultimately, the decision to allow women who become pregnant during pre‐licensure trials to remain on study will depend on the totality of the evidence and benefit–risk considerations. Conclusions We propose that industry completes non‐clinical reproductive toxicity studies prior to or early during the conduct of phase 3 trials in HIV drug development, especially for priority agents, and potentially uses alternative DART study design strategies to achieve this goal.
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Affiliation(s)
- Rick Greupink
- Department of Pharmacology and ToxicologyRadboud Institute of Molecular Life SciencesNijmegenNetherlands
| | - Hedwig van Hove
- Department of Pharmacology and ToxicologyRadboud Institute of Molecular Life SciencesNijmegenNetherlands
| | - Felix Mhlanga
- UZ‐UCSF Collaborative Study in Women's Health ZimbabweHarareZimbabwe
| | | | - Angela Colbers
- Department of PharmacyRadboud Institute for Health SciencesNijmegenNetherlands
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Knibbs V, Manley S. Being away from home for cancer treatment: a qualitative study of patient experience and supportive care needs during radiation therapy. J Med Radiat Sci 2022; 69:336-347. [PMID: 35373930 PMCID: PMC9442298 DOI: 10.1002/jmrs.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/12/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Supportive care needs (SCN) refer to support required by patients and their families to better cope with cancer. Many rural radiation therapy (RT) patients stay away from home for significant periods, which can lead to the negative effects of both social isolation and cultural disparity. They may demonstrate complex SCN. This study aimed to explore experiences of being away from home by considering patient perspectives of their own SCN. The objectives were to provide a deeper understanding of how these patients think and feel and present a foundation of patient-centred insights for further research. METHODS Thirteen patients participated in semi-structured interviews; all stayed away from home for RT at the North Coast Cancer Institute for >3 days a week for >3 weeks. The data were subject to interpretive phenomenological analysis: a thorough process of understanding and analysis that is accompanied by reflection to improve researcher transparency. RESULTS Two themes influenced patient experiences of their care: values and identity, and expectations. Patients discussed the value they place on rural life, community connections and health care and referred to information for managing expectations. SCN discussed fell into practical, physical and psycho-social needs. CONCLUSIONS Experiences of culturally appropriate patient-centred supportive care improve control and confidence. Patient well-being is influenced by compassionate, caring and respectful connections with others. Several practical ways of managing expectations and promoting the psycho-social well-being of patients are discussed, for example, tailored packing lists and easy access to green spaces. Future research can be shaped by lived experiences.
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Affiliation(s)
- Vanessa Knibbs
- North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Stephen Manley
- North Coast Cancer Institute, Lismore, New South Wales, Australia
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12
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Ellis R, Brennan PA, Lee AJ, Scrimgeour DS, Cleland J. Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: a retrospective cohort study. J R Soc Med 2022; 115:257-272. [PMID: 35171739 PMCID: PMC9234885 DOI: 10.1177/01410768221079018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective A recent independent review on diversity and inclusivity highlighted concerns
that barriers to surgical career progression exist for some groups of
individuals and not others. Group-level differences in performance at the
Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS)
examinations have been identified but are yet to be investigated. We aimed
to characterise the relationship between sociodemographic differences and
performance at MRCS. Design Retrospective cohort study. Setting Secondary care. Participants All UK MRCS candidates attempting Part A (n = 5780) and Part
B (n = 2600) between 2013 and 2019 with linked
sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk). Main outcome measures Chi-square tests established univariate associations with MRCS performance.
Multiple logistic regression identified independent predictors of success,
adjusted for medical school performance. Results Statistically significant differences in MRCS pass rates were found according
to gender, ethnicity, age, graduate status, educational background and
socioeconomic status (all p < 0.05). After adjusting for
prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence
interval [CI] 1.87–2.92) or a non-graduate (OR 1.98, 95% CI 1.44–2.74) were
independent predictors of MRCS Part A success and being a non-graduate (OR
1.77, 95% CI 1.15–2.71) and having attended a fee-paying school (OR 1.51,
95% CI 1.08–2.10) were independent predictors of Part B success. Black and
minority ethnic groups were significantly less likely to pass MRCS Part B at
their first attempt (OR 0.41, 95% CI 0.18–0.92 for Black candidates and OR
0.49, 95% CI 0.35–0.69 for Asian candidates) compared to White
candidates. Conclusions There is significant group-level differential attainment at MRCS, likely to
represent the accumulation of privilege and disadvantage experienced by
individuals throughout their education and training. Those leading surgical
education now have a responsibility to identify and address the causes of
these attainment differences.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK.,Urology Department, Nottingham University Hospitals, Nottingham, NG5 1PB, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, AB24 3FX, UK
| | - Duncan Sg Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK.,Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore
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13
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Abstract
Objectives This study focuses on pre-disposing factors associated with sensory experiences of the deceased (SED), also called bereavement hallucinations. Even though SED are common among older widowed adults, our knowledge of these experiences is still limited.Method Survey responses were obtained from 310 older widowed participants (M = 70.05 ± 8.39), complemented with data from Danish national registers.Results Hierarchical logistic regression analysis revealed four significant pre-disposing factors: prior experiences of SED in the context of previous significant bereavements (OR = 4.72), a history of interpersonal trauma (OR = 5.8), high pre-death relationship closeness (OR = 2.76) and stronger religious/spiritual worldview (OR = 1.12). No association to registered mental health diagnosis was identified.Conclusion: SED may be considered an interpersonal experience, which may be more likely to occur if the pre-death relationship is described as very close and if the bereaved has previously experienced interpersonal trauma. We argue that SED should not necessarily be considered an indication of neurodegenerative or psychiatric diseases.
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Affiliation(s)
- Karina Stengaard Kamp
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | | | | | - Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
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14
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Opoku-Acheampong AA, Rosenkranz RR, Adhikari K, Muturi N, Logan C, Kidd T. Tools for Assessing Cardiovascular Disease Risk Factors in Underserved Young Adult Populations: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph182413305. [PMID: 34948914 PMCID: PMC8707965 DOI: 10.3390/ijerph182413305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease (CVD, i.e., disease of the heart and blood vessels) is a major cause of death globally. Current assessment tools use either clinical or non-clinical factors alone or in combination to assess CVD risk. The aim of this review was to critically appraise, compare, and summarize existing non-clinically based tools for assessing CVD risk factors in underserved young adult (18–34-year-old) populations. Two online electronic databases—PubMed and Scopus—were searched to identify existing risk assessment tools, using a combination of CVD-related keywords. The search was limited to articles available in English only and published between January 2008 and January 2019. Of the 10,383 studies initially identified, 67 were eligible. In total, 5 out of the 67 articles assessed CVD risk in underserved young adult populations. A total of 21 distinct CVD risk assessment tools were identified; six of these did not require clinical or laboratory data in their estimation (i.e., non-clinical). The main non-clinically based tools identified were the Heart Disease Fact Questionnaire, the Health Beliefs Related to CVD-Perception measure, the Healthy Eating Opinion Survey, the Perception of Risk of Heart Disease Scale, and the WHO STEPwise approach to chronic disease factor surveillance (i.e., the STEPS instrument).
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Affiliation(s)
- Audrey A. Opoku-Acheampong
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS 66506, USA; (A.A.O.-A.); (R.R.R.)
| | - Richard R. Rosenkranz
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS 66506, USA; (A.A.O.-A.); (R.R.R.)
| | - Koushik Adhikari
- Department of Food Science and Technology, College of Agricultural & Environmental Sciences, University of Georgia, Griffin, GA 30223, USA;
| | - Nancy Muturi
- A. Q. Miller School of Journalism and Mass Communication, Kansas State University, Manhattan, KS 66506, USA;
| | - Cindy Logan
- Academic Services, Hale Library, Kansas State University, Manhattan, KS 66506, USA;
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS 66506, USA; (A.A.O.-A.); (R.R.R.)
- Correspondence: ; Tel.: +1-(785)-532-0154
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15
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Gurdasani D, Bhatt S, Costello A, Denaxas S, Flaxman S, Greenhalgh T, Griffin S, Hyde Z, Katzourakis A, McKee M, Michie S, Ratmann O, Reicher S, Scally G, Tomlinson C, Yates C, Ziauddeen H, Pagel C. Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis. J R Soc Med 2021; 114:513-524. [PMID: 34723680 PMCID: PMC8649477 DOI: 10.1177/01410768211052589] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To offer a quantitative risk-benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. SETTING England. DESIGN Following the risk-benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. PARTICIPANTS All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. MAIN OUTCOME MEASURES Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12-17 year olds in England over a 16-week period under different estimates of future case incidence. RESULTS At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. CONCLUSIONS Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.
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Affiliation(s)
| | | | | | | | | | | | | | - Zoë Hyde
- University of Western Australia,
Crawley WA 6009, Australia
| | | | - Martin McKee
- London School of Hygiene and Tropical
Medicine, London WC1E 7HT, UK
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16
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Hiam L, Minton J, McKee M. What can lifespan variation reveal that life expectancy hides? Comparison of five high-income countries. J R Soc Med 2021; 114:389-399. [PMID: 33955790 PMCID: PMC8358556 DOI: 10.1177/01410768211011742] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/04/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In most countries, life expectancy at birth (e0) has improved for many decades. Recently, however, progress has stalled in the UK and Canada, and reversed in the USA. Lifespan variation, a complementary measure of mortality, increased a few years before the reversal in the USA. To assess whether this measure offers additional meaningful insights, we examine what happened in four other high-income countries with differing life expectancy trends. DESIGN We calculated life disparity (a specific measure of lifespan variation) in five countries -- USA, UK, France, Japan and Canada -- using sex- and age specific mortality rates from the Human Mortality Database from 1975 to 2017 for ages 0--100 years. We then examined trends in age-specific mortality to identify the age groups contributing to these changes. SETTING USA, UK, France, Japan and Canada. PARTICIPANTS aggregate population data of the above nations. MAIN OUTCOME MEASURES Life expectancy at birth, life disparity and age-specific mortality. RESULTS The stalls and falls in life expectancy, for both males and females, seen in the UK, USA and Canada coincided with rising life disparity. These changes may be driven by worsening mortality in middle-age (such as at age 40). France and Japan, in contrast, continue on previous trajectories. CONCLUSIONS Life disparity is an additional summary measure of population health providing information beyond that signalled by life expectancy at birth alone.
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Affiliation(s)
- Lucinda Hiam
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, UK
| | - Jon Minton
- Public Health Scotland, Edinburgh, Scotland
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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17
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Zamorano González B, Peña Cárdenas F, Pinto-Cortez C, Narváez YV, Martínez JIV, Ramos LAR. Unemployment and mental health in a community population from a border city in Mexico. Work 2021; 69:957-967. [PMID: 34219690 PMCID: PMC8385510 DOI: 10.3233/wor-213527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The constant changes in the global economy generate instability in the markets, favoring the closing of companies, dismissals of personnel, job losses. Unemployment has been associated with adverse psychological effects, serving as a predictor of poor mental health. OBJECTIVE The main goal was to analyze the relation between work status and mental health. METHODS A cross-sectional, quantitative study was carried out with a sample of community population, inhabitants of the urban area of a Mexican city. The sample consisted of 1351 participants, being 577 men (43%) and 774 women (57%) with an average age of 41.46 (SD = 17.00). The participants were selected by a quota sampling, in 13 representative points of Matamoros' city urban area. Home surveys were applied; the Spanish version of the Symptom Checklist 90 (SCL-90) was used for mental health assessment. RESULTS The model explaining the relation between work status and mental health (GFI) was significant (p < 0.01). Unemployment was related to higher scores in all sub-scales of psychopathologies evaluated by the SCL-90, in comparison with the rest of work status categories. CONCLUSIONS The unemployed, followed by housewives, presented indicators of poorer mental health, while the retired and those in strikes or lockouts showed the best mental health indexes.
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Affiliation(s)
| | | | | | | | | | - Luc A Ruíz Ramos
- Universidad Autónoma de Tamaulipas, Ciudad Victoria, Tamaulipas, Mexico
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18
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Ellis R, Cleland J, Scrimgeour D, Lee AJ, Brennan PA. The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study. J R Soc Med 2021; 115:58-68. [PMID: 34269623 DOI: 10.1177/01410768211032573] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Despite rising numbers of doctors in the workforce with disabilities, little is known about the impact of disabilities on postgraduate performance. To ensure all groups are treated fairly in surgical training, it is essential to know whether any attainment differences exist in markers of surgical performance. To address this gap, we assessed the impact of disabilities on performance on the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS). DESIGN Retrospective cohort study. SETTING Secondary care. PARTICIPANTS All UK MRCS candidates attempting Part A (n = 9600) and Part B (n = 4560) between 2007 and 2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. MAIN OUTCOME MEASURES Chi-square tests and correlation coefficients established univariate associations with MRCS performance, while multiple logistic regressions identified independent predictors of success. RESULTS Though MRCS Part B pass rates were similar (p = 0.339), candidates with registered disabilities had significantly lower first-attempt Part A pass rates (46.3% vs. 59.8%, p < 0.001). Candidates with disabilities also performed less well in examinations taken throughout school and medical school, and after adjusting for prior academic performance and sociodemographic predictors of success, logistic regression found that candidates with disabilities were no less likely to pass MRCS than their peers (odds ratio 1.04, 95% confidence interval 0.66 to 1.62). No significant variation was found in MRCS performance between type of disability or degree of limitations caused by disability (p > 0.05). CONCLUSION Although candidates with registered disabilities performed less well in formal, written examinations, our data indicate that they are as likely to pass MRCS at first attempt as their peers who achieved similar grades at high school and medical school. In order to enable equity in career progression, further work is needed to investigate the causes of attainment differences in early career assessments.
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Affiliation(s)
- R Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.,Urology Department, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - J Cleland
- 371018Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Dsg Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.,Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - A J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, UK
| | - P A Brennan
- Department of Maxillo-Facial Surgery, 112006Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
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19
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O'Neill A, Stapley E, Stock S, Merrick H, Humphrey N. Adolescents' Understanding of What Causes Emotional Distress: A Qualitative Exploration in a Non-clinical Sample Using Ideal-Type Analysis. Front Public Health 2021; 9:673321. [PMID: 34109149 PMCID: PMC8181134 DOI: 10.3389/fpubh.2021.673321] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is increased interest in early intervention and prevention of mental health difficulties during adolescence; thus, we are seeing increased efforts to optimize well-being during this epoch. Positive emotional experiences are a central component of overall well-being. However, research exploring what adolescents perceive to be the cause(s) of their emotional difficulties is lacking. Improving understanding of this issue within non-clinical adolescent groups may provide useful insight into how to develop strategies to support young people as they navigate emotional difficulties. Objectives: The aim of this research was to explore if meaningful categories of perceived cause(s) for emotional distress exist for non-clinical adolescent groups. Methods: The data for this study were drawn from interviews across 6 sites in England conducted as part of the 5-year national evaluation of the HeadStart Learning Programme. The sample comprised of 32 young people aged 11–12 years from the first annual wave of qualitative data collection in 2017. Ideal type analysis—a qualitative form of person-centered analysis—was used to construct a typology of adolescents perceived cause(s) for emotional distress. Findings: We identified five distinct categories of perceived cause: (1) perceived lack of control; (2) unfair treatment; (3) others, their actions and judgements as the catalyst; (4) concerns for self and others; and, (5) self as cause. Conclusions: Our findings illustrate that distinct categories for perceived cause of emotional distress exist among adolescents considered to be “at risk” of developing mental health difficulties, which provides a foundation for future necessary work seeking to investigate the possible link between perceived cause for emotional distress and help-seeking behavior among sub-clinical groups.
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Affiliation(s)
- Alisha O'Neill
- Department of Education, The University of Manchester, Manchester, United Kingdom
| | - Emily Stapley
- Evidence Based Practice Unit (Anna Freud National Centre for Children and Families and University College London), London, United Kingdom
| | - Sarah Stock
- Evidence Based Practice Unit (Anna Freud National Centre for Children and Families and University College London), London, United Kingdom
| | - Hannah Merrick
- Evidence Based Practice Unit (Anna Freud National Centre for Children and Families and University College London), London, United Kingdom
| | - Neil Humphrey
- Department of Education, The University of Manchester, Manchester, United Kingdom
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20
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Sattar K, Akram A, Ahmad T, Bashir U. Professionalism development of undergraduate medical students: Effect of time and transition. Medicine (Baltimore) 2021; 100:e23580. [PMID: 33655905 PMCID: PMC7939229 DOI: 10.1097/md.0000000000023580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023] Open
Abstract
Changeover phases are essential and inevitable times in professional life, which let the learners adapt and grasp emerging opportunities for learning based on the past experiences with the catering of novel creativity as required in the present as well as emerging time. This study was carried out to examine the effectiveness of a professionalism course, during the transition from a non-clinical to clinical setting, within the context of undergraduate medical education.This observational study was conducted during 2019 to 2020, with pre- and post-professionalism course evaluation. We used the Dundee Poly-professionalism inventory-1: Academic Integrity, among the undergraduate medical students.Our results are based on the medical student's professional progress with the transition from 2nd year to 3rd year. During the 1st phase of the study, the participants at their Pre-Professionalism Course (PrPC) level in their 2nd medical year (only attended the introductory lectures for professionalism), showed a good understanding of professionalism. For the 2nd phase, when the same students, at their Post-Professionalism Course (PoPC) level, in their 3rd year (completed professionalism course) filled the same survey and it was found that there was no decline in their understanding of the topic, even after more than a year. They were even more aware of the significance of professionalism in their clinical settings.Despite a year gap, the understanding of professionalism among students was stable. Results helped us infer that time laps did not affect the professionalism concept learned earlier; rather during clinical settings, students become more aware of professionalism.
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Affiliation(s)
- Kamran Sattar
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ashfaq Akram
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Computer Science and Information Technology, NIMS University, Jaipur, Rajasthan, India
| | - Ulfat Bashir
- Department of Medical Education, Riphah International University, Islamabad, Pakistan
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21
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Wong MCS, Huang J, Wong SH, Yuen-Chun Teoh J. The potential effectiveness of the WHO International Health Regulations capacity requirements on control of the COVID-19 pandemic: a cross-sectional study of 114 countries. J R Soc Med 2021; 114:121-131. [PMID: 33557662 PMCID: PMC7944559 DOI: 10.1177/0141076821992453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We examined if the WHO International Health Regulations (IHR) capacities were associated with better COVID-19 pandemic control. DESIGN Observational study. SETTING Population-based study of 114 countries. PARTICIPANTS General population. MAIN OUTCOME MEASURES For each country, we extracted: (1) the maximum rate of COVID-19 incidence increase per 100,000 population over any 5-day moving average period since the first 100 confirmed cases; (2) the maximum 14-day cumulative incidence rate since the first case; (3) the incidence and mortality within 30 days since the first case and first COVID-19-related death, respectively. We retrieved the 13 country-specific International Health Regulations capacities and constructed linear regression models to examine whether these capacities were associated with COVID-19 incidence and mortality, controlling for the Human Development Index, Gross Domestic Product, the population density, the Global Health Security index, prior exposure to SARS/MERS and Stringency Index. RESULTS Countries with higher International Health Regulations score were significantly more likely to have lower incidence (β coefficient -24, 95% CI -35 to -13) and mortality (β coefficient -1.7, 95% CI -2.5 to -1.0) per 100,000 population within 30 days since the first COVID-19 diagnosis. A similar association was found for the other incidence outcomes. Analysis using different regression models controlling for various confounders showed a similarly significant association. CONCLUSIONS The International Health Regulations score was significantly associated with reduction in rate of incidence and mortality of COVID-19. These findings inform design of pandemic control strategies, and validated the International Health Regulations capacities as important metrics for countries that warrant evaluation and improvement of their health security capabilities.
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Affiliation(s)
- Martin CS Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Jeremy Yuen-Chun Teoh
- Office of Global Engagement Chinese University of Hong Kong, Hong Kong SAR 999077, China
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
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22
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Nampijja M, Sembajjwe W, Mpairwe H, Mpango R, Kinyanda E. Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study. Wellcome Open Res 2021; 6:217. [PMID: 36873715 PMCID: PMC9975401 DOI: 10.12688/wellcomeopenres.17005.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background: There is limited data on the burden of mental disorders among children in the general population in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using respectively descriptive statistics, and univariable and multivariable logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. Among the exposure variables examined in this study, including asthma, age, sex, grade of schooling, type of school and maternal and father's education and family socio-economic status, only asthma was associated with the disorders (MDD). Conclusions: The relatively high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.
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Affiliation(s)
- Margaret Nampijja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Harriet Mpairwe
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, London, WC1E 7HT, UK., UK
| | - Richard Mpango
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Eugene Kinyanda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Psychiatry, College of Health Sciences, Makerere University, Kampala,, Kampala, P.O. Box 7072, Kampala, Uganda
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Nampijja M, Sembajjwe W, Mpairwe H, Mpango R, Kinyanda E. Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study. Wellcome Open Res 2021; 6:217. [PMID: 36873715 PMCID: PMC9975401 DOI: 10.12688/wellcomeopenres.17005.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: There is limited data on the burden of mental disorders among children in the general population in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using respectively descriptive statistics, and univariable and multivariable logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. Among the exposure variables examined in this study, including asthma, age, sex, grade of schooling, type of school and maternal and father's education and family socio-economic status, only asthma was associated with the disorders (MDD). Conclusions: The relatively high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.
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Affiliation(s)
- Margaret Nampijja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Harriet Mpairwe
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, London, WC1E 7HT, UK., UK
| | - Richard Mpango
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Eugene Kinyanda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Psychiatry, College of Health Sciences, Makerere University, Kampala,, Kampala, P.O. Box 7072, Kampala, Uganda
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Nampijja M, Sembajjwe W, Mpairwe H, Mpango R, Kinyanda E. Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study. Wellcome Open Res 2021; 6:217. [PMID: 36873715 PMCID: PMC9975401 DOI: 10.12688/wellcomeopenres.17005.1] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: There is limited data on the burden of mental disorders among 'healthy' children in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using percentages and logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. None of the factors examined were associated with the disorders. Conclusions: The unexpectedly high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.
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Affiliation(s)
- Margaret Nampijja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Harriet Mpairwe
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, London, WC1E 7HT, UK., UK
| | - Richard Mpango
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Eugene Kinyanda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Psychiatry, College of Health Sciences, Makerere University, Kampala,, Kampala, P.O. Box 7072, Kampala, Uganda
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Drennan VM, Calestani M, Taylor F, Halter M, Levenson R. Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study. JRSM Open 2020; 11:2054270420969572. [PMID: 33294201 PMCID: PMC7705788 DOI: 10.1177/2054270420969572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.
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Affiliation(s)
- Vari M Drennan
- Centre for Health & Social Care Research, Joint Faculty, Kingston University & St. George's University, London, UK
| | - Melania Calestani
- School of Allied Health, Midwifery and Social Care, Joint Faculty, Kingston and St. George's University, London, UK
| | - Francesca Taylor
- Centre for Health & Social Care Research, Joint Faculty, Kingston University & St. George's University, London, UK
| | - Mary Halter
- Centre for Health & Social Care Research, Joint Faculty, Kingston University & St. George's University, London, UK
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Peckham AD, Modavi K, Johnson SL. Looking on the bright side and seeing it vividly: interpretation bias and involuntary mental imagery are related to risk for bipolar disorder. Behav Cogn Psychother 2020; 48:203-15. [PMID: 31597584 DOI: 10.1017/S1352465819000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Involuntary mental imagery is elevated among people with bipolar disorder, and has been shown to shape biases in interpretation of ambiguous information. However, it is not clear whether biases in interpretation of ambiguous scenarios can be observed in those at risk for bipolar disorder, or whether involuntary imagery is related to such a bias. AIMS In the present study, we extended a prominent model of bipolar cognition to an at-risk sample. We specifically tested whether positive interpretation bias and involuntary mental imagery are linked to a greater risk of bipolar disorder. METHOD Young adults (N = 169) completed measures of risk for bipolar disorder (the Hypomanic Personality Scale [HPS]), interpretation bias, and involuntary mental imagery. RESULTS Higher scores on the HPS were significantly correlated with more positive interpretations of ambiguous scenarios (β = 0.29, p <. 01) and more frequent involuntary mental imagery (β = 0.22, p < .01). There was no evidence of an interaction between interpretation bias and mental imagery in predicting HPS score, β = .04, p = .62. CONCLUSIONS Further research is warranted to determine if intrusive imagery or interpretation bias influence the development of bipolar disorder over time in those at risk.
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Hayhoe B, Cowling TE, Pillutla V, Garg P, Majeed A, Harris M. Integrating a nationally scaled workforce of community health workers in primary care: a modelling study. J R Soc Med 2018; 111:453-461. [PMID: 30286301 PMCID: PMC6295943 DOI: 10.1177/0141076818803443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To model cost and benefit of a national community health worker workforce. DESIGN Modelling exercise based on all general practices in England. SETTING United Kingdom National Health Service Primary Care. PARTICIPANTS Not applicable. DATA SOURCES Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. MAIN OUTCOME MEASURES We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. RESULTS Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. CONCLUSION A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.
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Affiliation(s)
- Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Thomas E Cowling
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Virimchi Pillutla
- Department of Medicine, School of Clinical Sciences, Monash University, VIC 3168 Australia
| | - Priya Garg
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
- Centre for Health Policy, Institute of Global Health Innovation, St Marys Hospital, London W2 1NY, UK
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Rahalkar H, Cetintas HC, Salek S. Quality, Non-clinical and Clinical Considerations for Biosimilar Monoclonal Antibody Development: EU, WHO, USA, Canada, and BRICS-TM Regulatory Guidelines. Front Pharmacol 2018; 9:1079. [PMID: 30364154 PMCID: PMC6192287 DOI: 10.3389/fphar.2018.01079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim was to critically evaluate well-established regulatory agencies mAb biosimilar guidelines for development and marketing authorization about quality, efficacy and safety and compare to BRICS-TM regulations to identify challenges. Materials and Methods: The current valid guidelines of EMA, WHO, USFDA, BGTD/HC, ICH, and BRICS-TM were obtained from official websites and comparative qualitative review was performed. Results: The review revealed that Health Canada uses mAb specific guidelines from EMA or USFDA when necessary. The BRICS agencies (except Russia) have incorporated some or most of the WHO SBP TRS and related annexes in similar national biotechnological/biological guidelines; however, gaps or insufficient information have been identified. The Russian Federation has issued general product registration guideline/s with very brief information about mAbs. The TMMDA (Turkey) has published an updated biosimilar guideline which parallels those of the EMA and the ones from WHO; however, no mAb specific guidelines are published. COFEPRIS (Mexico) has published a biotechnological/biological product registration guideline with no information about mAb. The SAHPRA biosimilar guideline has an annex on mAbs which focuses on non-clinical and clinical aspects. The comparative evaluation of BRICS-TM agencies indicates a gap pertaining to clarification for physico-chemical characterization, manufacturing process, overages and compatibility requirements between biological substances and excipients specifically on mAbs. In vitro assay requirements seem quite aligned with those of WHO, whereas in vivo studies mostly have disparity in terms of necessity, type of studies as well as design and criteria. Clinical safety and efficacy studies are indicated in emerging regulatory agencies, however detailed information pertaining to design, size of populations, requirements for primary and secondary endpoints, clarity and evaluation criteria differ. In general, BRICS-TM agencies allow extrapolation of indications provided that pre-defined conditions are met. Interchangeability, switching and substitution of biosimilars are not defined in most of BRIC-TM guidelines whereas South Africa, by law, allows neither interchangeability nor substitution. Pediatric research remains questionable across BRICS-TM. Conclusions: EMA, USFDA guidelines are broadly aligned with WHO and in addition, they also contain specific requirements pertaining to their own region. BRICS-TM has considerably less defined mAb specific biosimilar development and comparability parameters in their published guidelines.
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Affiliation(s)
- Hasumati Rahalkar
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
- Department of Regulatory Sciences, Metina PharmConsulting Pvt Ltd, Mumbai, India
| | - Hacer Coskun Cetintas
- Department of Marketing Authorization of Medicines, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Bird T, Mansell W, Wright J, Gaffney H, Tai S. Manage Your Life Online: A Web-Based Randomized Controlled Trial Evaluating the Effectiveness of a Problem-Solving Intervention in a Student Sample. Behav Cogn Psychother 2018; 46:570-82. [PMID: 29366432 DOI: 10.1017/S1352465817000820] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence for the efficacy of computer-based psychological interventions is growing. A number of such interventions have been found to be effective, especially for mild to moderate cases. They largely rely on psychoeducation and 'homework tasks', and are specific to certain diagnoses (e.g. depression). AIMS This paper presents the results of a web-based randomized controlled trial of Manage Your Life Online (MYLO), a program that uses artificial intelligence to engage the participant in a conversation across any problem topic. METHOD Healthy volunteers (n = 213) completed a baseline questionnaire and were randomized to the MYLO program or to an active control condition where they used the program ELIZA, which emulates a Rogerian psychotherapist. Participants completed a single session before completing post-study and 2-week follow-up measures. RESULTS Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression post-intervention, and again 2 weeks later, but MYLO was not found to be more effective than ELIZA. MYLO was rated as significantly more helpful than ELIZA, but there was no main effect of intervention on problem resolution. CONCLUSIONS Findings are consistent with those of a previous smaller, laboratory-based trial and provide support for the acceptability and effectiveness of MYLO delivered over the internet for a non-clinical sample. The lack of a no-treatment control condition means that the effect of spontaneous recovery cannot be ruled out.
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Martínez Muñoz L. Non-Clinical Contribution to Clinical Trials during Lead Optimization Phase. Behav Sci (Basel) 2018; 8:bs8010017. [PMID: 29364181 PMCID: PMC5791035 DOI: 10.3390/bs8010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/02/2022] Open
Abstract
This manuscript comments on guidelines related to requirements for clinical trials for new drugs and the importance of considering regulatory criteria in the planning phase, in order to enhance the utility of data generated in basic research. Suggestions are made for optimizing regulatory management to improve the likelihood of acceptance of pre-clinical data prior to Clinical Phase I trials (early clinical trials).
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Abstract
The relationship between emotion regulation difficulties and restrictive eating has not been established in non-clinical samples. In this study, undergraduates (n = 98) provided information regarding general and specific emotion regulation difficulties on the Difficulties in Emotion Regulation Scale (DERS) and whether they had engaged in recent restrictive eating. Generalized linear models were used to determine if individuals endorsing versus denying recent restrictive eating differed on emotion regulation problems. Results indicated that individuals endorsing restrictive eating had elevated DERS Total (p < .001), Goals (p = .001), Impulse (p < .001), and Strategies (p < .001) scores. Results remained primarily unchanged after controlling for the related construct of dietary restraint. Findings indicate that endorsement of restrictive eating among non-clinical individuals is uniquely associated with emotion regulation deficits, especially those reflecting emotional under-control. Interventions targeting emotion regulation may enhance prevention and treatment of restrictive eating across severity.
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Affiliation(s)
- Ann F Haynos
- a Department of Psychiatry , University of Minnesota , Minneapolis , MN , USA
| | - Shirley B Wang
- b Department of Psychology , The College of New Jersey , Ewing , NJ , USA
| | - Alan E Fruzzetti
- c Department of Psychiatry , Harvard Medical School , Boston , MA , USA
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Abstract
OBJECTIVES To evaluate the impact and challenges of implementing a Food for Life approach within three pilot NHS sites in 2014/2015 in England. Food for Life is an initiative led by the Soil Association, a non-governmental organisation in the UK that aims to encourage a healthy, sustainable food culture across communities. DESIGN A case-study approach was undertaken using semi-structured interviews with staff and key stakeholders together with analysis of relevant documents such as meeting minutes, strategic plans and reports. SETTING Three NHS Trusts in England. PARTICIPANTS Staff and key stakeholders. MAIN OUTCOME MEASURES Synthesis of key findings from semi-structured interviews and analysis of relevant documents. RESULTS Key themes included the potential to influence contracting processes; measuring quality; food for staff and visitors; the role of food in hospitals, and longer term sustainability and impact. Participants reported that adopting the Food for Life approach had provided enormous scope to improve the quality of food in hospital settings and had provided levers and external benchmarks for use in contracting to help drive up standards of the food provided by external contractors for patients and staff. This was demonstrated by the achievement of an FFLCM for staff and visitor catering in all three organisations. CONCLUSIONS Participants all felt that the importance of food in hospitals is not always recognised. Engagement with Food for Life can produce a significant change in the focus on food within hospitals, and help to improve the quality of food and mealtime experience for staff, visitors and patients.
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Affiliation(s)
- Selena Gray
- UWE, Department of Health and Social Sciences, Bristol BS16 1GW, UK
| | - Judy Orme
- UWE, Department of Health and Social Sciences, Bristol BS16 1GW, UK
| | - Hannah Pitt
- Cardiff University, Sustainable Places Research Institute, Cardiff, UK
| | - Matthew Jones
- UWE, Department of Health and Social Sciences, Bristol BS16 1GW, UK
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Smith F, Goldacre MJ, Lambert TW. Adverse effects on health and wellbeing of working as a doctor: views of the UK medical graduates of 1974 and 1977 surveyed in 2014. J R Soc Med 2017; 110:198-207. [PMID: 28504070 DOI: 10.1177/0141076817697489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To report on any adverse effects on health and wellbeing of working as a doctor, as described by senior doctors. Design Questionnaires sent in 2014 to all medical graduates of 1974 and 1977. Participants 3695 UK medical graduates. Setting United Kingdom. Main outcome measures Statements about adverse effects upon health, wellbeing and career. Results The aggregated response rate from contactable doctors was 84.6% (3695/4369). In response to the question 'Do you feel that working as a doctor has had any adverse effects on your own health or wellbeing?', 44% of doctors answered 'yes'. More GPs (47%) than hospital doctors (42%) specified that this was the case. Three-quarters of doctors who answered 'yes' cited 'stress/work-life balance/workload' as an adverse effect, and 45% mentioned illness. In response to the statement 'The NHS of today is a good employer when doctors become ill themselves', 28% of doctors agreed, 29% neither agreed nor disagreed and 43% disagreed. More women doctors (49%) than men doctors (40%) disagreed with this statement. More general practitioners (49%) disagreed than hospital doctors (37%). Conclusions Chronic stress and illness, which these doctors attributed to their work, were widely reported. Although recent changes may have alleviated some of these issues, there are lessons for the present and future if the NHS is to ensure that its medical workforce receives the support which enables current doctors to enjoy a full and satisfying career and to contribute fully to health service provision in the UK. Older doctors, in particular, need support to be able to continue successfully in their careers.
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Affiliation(s)
- Fay Smith
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Theunissen PT, Beken S, Beyer BK, Breslin WJ, Cappon GD, Chen CL, Chmielewski G, De Schaepdrijver L, Enright B, Foreman JE, Harrouk W, Hew KW, Hoberman AM, Hui JY, Knudsen TB, Laffan SB, Makris SL, Martin M, McNerney ME, Siezen CL, Stanislaus DJ, Stewart J, Thompson KE, Tornesi B, Van der Laan JW, Weinbauer GF, Wood S, Piersma AH. Comparison of rat and rabbit embryo-fetal developmental toxicity data for 379 pharmaceuticals: on the nature and severity of developmental effects. Crit Rev Toxicol 2016; 46:900-910. [PMID: 27848393 PMCID: PMC8865449 DOI: 10.1080/10408444.2016.1224807] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Regulatory non-clinical safety testing of human pharmaceuticals typically requires embryo–fetal developmental toxicity (EFDT) testing in two species (one rodent and one non-rodent). The question has been raised whether under some conditions EFDT testing could be limited to one species, or whether the testing in a second species could be decided on a case-by-case basis. As part of a consortium initiative, we built and queried a database of 379 compounds with EFDT studies (in both rat and rabbit animal models) conducted for marketed and non-marketed pharmaceuticals for their potential for adverse developmental and maternal outcomes, including EFDT incidence and the nature and severity of adverse findings. Manifestation of EFDT in either one or both species was demonstrated for 282 compounds (74%). EFDT was detected in only one species (rat or rabbit) in almost a third (31%, 118 compounds), with 58% (68 compounds) of rat studies and 42% (50 compounds) of rabbit studies identifying an EFDT signal. For 24 compounds (6%), fetal malformations were observed in one species (rat or rabbit) in the absence of any EFDT in the second species. In general, growth retardation, fetal variations, and malformations were more prominent in the rat, whereas embryo–fetal death was observed more often in the rabbit. Discordance across species may be attributed to factors such as maternal toxicity, study design differences, pharmacokinetic differences, and pharmacologic relevance of species. The current analysis suggests that in general both species are equally sensitive on the basis of an overall EFDT LOAEL comparison, but selective EFDT toxicity in one species is not uncommon. Also, there appear to be species differences in the prevalence of various EFDT manifestations (i.e. embryo–fetal death, growth retardation, and dysmorphogenesis) between rat and rabbit, suggesting that the use of both species has a higher probability of detecting developmental toxicants than either one alone.
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Affiliation(s)
- Peter T Theunissen
- a Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,b Medicines Evaluation Board , Utrecht , The Netherlands.,c Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences Utrecht (HU) , Utrecht , The Netherlands
| | - Sonja Beken
- d Federal Agency for Medicines and Health Products , Brussels , Belgium
| | | | - William J Breslin
- f Lilly Research Laboratories , Lilly Corporate Center , Indianapolis , IN , USA
| | - Gregg D Cappon
- g Pfizer Worldwide Research & Development , Groton , CT , USA
| | - Connie L Chen
- h ILSI-Health and Environmental Sciences Institute , Washington , DC , USA
| | | | | | | | | | - Wafa Harrouk
- m U.S. Food & Drug Administration , Silver Spring , MD , USA
| | - Kok-Wah Hew
- n Takeda Pharmaceutical Company , Deerfield , IL , USA
| | - Alan M Hoberman
- o Charles-River Laboratories, Preclinical Services , Horsham , PA , USA
| | | | - Thomas B Knudsen
- q U.S. Environmental Protection Agency, National Center for Computational Toxicology, Research Triangle Park , NC , USA
| | - Susan B Laffan
- r Safety Assessment, GlaxoSmithKline , King of Prussia , PA , USA
| | - Susan L Makris
- s U.S. Environmental Protection Agency, National Center for Environmental Assessment , Washington , DC , USA
| | - Matt Martin
- q U.S. Environmental Protection Agency, National Center for Computational Toxicology, Research Triangle Park , NC , USA
| | | | | | | | - Jane Stewart
- u Drug Safety & Metabolism, AstraZeneca , Macclesfield , UK
| | - Kary E Thompson
- t Drug Safety Evaluation, Bristol-Myers Squibb , New Brunswick , NJ , USA
| | | | - Jan Willem Van der Laan
- a Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,b Medicines Evaluation Board , Utrecht , The Netherlands
| | | | - Sandra Wood
- w Merck Research Laboratories , Upper Gwynedd , Pennsylvania , USA
| | - Aldert H Piersma
- a Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,x Institute for Risk Assessment Sciences, Faculty of Veterinary Sciences , Utrecht University , Utrecht , The Netherlands
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Elander M, Boll JB, Hojman AS, Rasmussen AD. Gelucire and Gelucire-PEG400 formulations; tolerability in species used for non-clinical safety testing after oral (gavage) dosing. J Appl Toxicol 2016; 36:1430-6. [PMID: 26849184 DOI: 10.1002/jat.3296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/22/2015] [Accepted: 01/01/2016] [Indexed: 11/08/2022]
Abstract
The selection of a vehicle for oral formulations of compounds to be used in non-clinical safety studies is a challenge for poorly soluble compounds. Typically a compromise between solubility and tolerability has to be reached. Vehicle tolerability data are not readily available for a number of vehicles, and a series of oral tolerability studies were, therefore, conducted with Gelucire and Gelucire:PEG400 formulations in rats, dogs and minipigs in order to determine tolerable daily dose volumes in these species. Gelucire and Gelucire:PEG400 formulations were assessed in studies for up to 5 days in minipigs, 7 days in rats and up to 39 weeks in dogs. Gastrointestinal side effects in terms of soft and/or liquid faeces were noted in all species, but the sensitivity to these effects differed between species with the dog being the most sensitive. It was concluded that Gelucire:PEG400 (90:10) was tolerated in Beagle dogs when administered at 1 ml kg(-1) once daily for 39 weeks, and 100% Gelucire was tolerated in the rat and the minipig when administered once daily at 5 ml kg(-1) for 5 days. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mikael Elander
- Department of Regulatory Toxicology & Safety Assessment, H. Lundbeck A/S, Ottiliavej 9, DK, 2500, Valby, Denmark.
| | - Jette B Boll
- Pharmaceutical Science & CMC Biologics, H. Lundbeck A/S, Ottiliavej 9, DK, 2500, Valby, Denmark
| | - Anne S Hojman
- Department of Regulatory Toxicology & Safety Assessment, H. Lundbeck A/S, Ottiliavej 9, DK, 2500, Valby, Denmark
| | - Allan D Rasmussen
- Department of Regulatory Toxicology & Safety Assessment, H. Lundbeck A/S, Ottiliavej 9, DK, 2500, Valby, Denmark
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Wheeler SQ, Greenberg ME, Mahlmeister L, Wolfe N. Safety of clinical and non-clinical decision makers in telephone triage: a narrative review. J Telemed Telecare 2015; 21:305-22. [PMID: 25761468 DOI: 10.1177/1357633x15571650] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/20/2014] [Indexed: 11/17/2022]
Abstract
Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard.
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Affiliation(s)
- Sheila Q Wheeler
- Assistant Clinical Professor Northern Arizona University 3895 N. Business Center Dr. Ste 120 Tucson, Arizona 85705, USA
| | - Mary E Greenberg
- President, Mahlmeister and Associates Clinical Professor University of California San Francisco San Francisco, California 1567 Winding Way Belmont, California 94002, USA
| | | | - Nicole Wolfe
- Department of Social and Behavioral Sciences 3333 California St, Suite 455 San Francisco, CA 94118, USA
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Jones DR, McBlane JW, McNaughton G, Rajakumaraswamy N, Wydenbach K. A regulatory perspective of clinical trial applications for biological products with particular emphasis on Advanced Therapy Medicinal Products (ATMPs). Br J Clin Pharmacol 2013; 76:203-9. [PMID: 23216470 PMCID: PMC3731595 DOI: 10.1111/bcp.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/23/2012] [Indexed: 12/20/2022] Open
Abstract
The safety of trial subjects is the tenet that guides the regulatory assessment of a Clinical Trial Authorization application and applies equally to trials involving small molecules and those with biological/biotechnological products, including Advanced Therapy Medicinal Products. The objective of a regulator is to ensure that the potential risk faced by a trial subject is outweighed by the potential benefit to them from taking part in the trial. The focus of the application review is to assess whether risks have been identified and appropriate steps taken to alleviate these as much as possible. Other factors are also taken into account during a review, such as regulatory requirements, and emerging non-clinical and clinical data from other trials on the same or similar products. This paper examines the regulatory review process of a Clinical Trial Authorization application from the perspectives of Quality, Non-Clinical and Clinical Regulatory Assessors at the Medicines and Healthcare products Regulatory Agency. It should be noted that each perspective has highlighted specific issues from their individual competence and that these can be different between the disciplines.
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Affiliation(s)
- David R Jones
- Clinical Trials Unit, Medicines and Healthcare products Regulatory Agency (MHRA), London, UK.
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de Leede-Smith S, Barkus E. A comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Front Hum Neurosci 2013; 7:367. [PMID: 23882203 PMCID: PMC3712258 DOI: 10.3389/fnhum.2013.00367] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/25/2013] [Indexed: 12/27/2022] Open
Abstract
Over the years, the prevalence of auditory verbal hallucinations (AVHs) have been documented across the lifespan in varied contexts, and with a range of potential long-term outcomes. Initially the emphasis focused on whether AVHs conferred risk for psychosis. However, recent research has identified significant differences in the presentation and outcomes of AVH in patients compared to those in non-clinical populations. For this reason, it has been suggested that auditory hallucinations are an entity by themselves and not necessarily indicative of transition along the psychosis continuum. This review will examine the presentation of auditory hallucinations across the life span, as well as in various clinical groups. The stages described include childhood, adolescence, adult non-clinical populations, hypnagogic/hypnopompic experiences, high schizotypal traits, schizophrenia, substance induced AVH, AVH in epilepsy, and AVH in the elderly. In children, need for care depends upon whether the child associates the voice with negative beliefs, appraisals and other symptoms of psychosis. This theme appears to carry right through to healthy voice hearers in adulthood, in which a negative impact of the voice usually only exists if the individual has negative experiences as a result of their voice(s). This includes features of the voices such as the negative content, frequency, and emotional valence as well as anxiety and depression, independently or caused by voices presence. It seems possible that the mechanisms which maintain AVH in non-clinical populations are different from those which are behind AVH presentations in psychotic illness. For example, the existence of maladaptive coping strategies in patient populations is one significant difference between clinical and non-clinical groups which is associated with a need for care. Whether or not these mechanisms start out the same and have differential trajectories is not yet evidenced. Future research needs to focus on the comparison of underlying factors and mechanisms that lead to the onset of AVH in both patient and non-clinical populations.
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van Meer PJK, Kooijman M, Brinks V, Gispen-de Wied CC, Silva-Lima B, Moors EHM, Schellekens H. Immunogenicity of mAbs in non-human primates during nonclinical safety assessment. MAbs 2013; 5:810-6. [PMID: 23924803 DOI: 10.4161/mabs.25234] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The immunogenicity of biopharmaceuticals used in clinical practice remains an unsolved challenge in drug development. Non-human primates (NHPs) are often the only relevant animal model for the development of monoclonal antibodies (mAbs), but the immune response of NHPs to therapeutic mAbs is not considered to be predictive of the response in humans because of species differences. In this study, we accessed the drug registration files of all mAbs registered in the European Union to establish the relative immunogenicity of mAbs in NHPs and humans. The incidence of formation of antidrug-antibodies in NHPs and patients was comparable in only 59% of the cases. In addition, the type of antidrug-antibody response was different in NHP and humans in 59% of the cases. Humanization did not necessarily reduce immunogenicity in humans. Immunogenicity interfered with the safety assessment during non-clinical drug development when clearing or neutralizing antibodies were formed. While important to interpret the study results, immunogenicity reduced the quality of NHP data in safety assessment. These findings confirm that the ability to compare relative immunogenicity of mAbs in NHPs and humans is low. Furthermore, immunogenicity limits the value of informative NHP studies.
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Affiliation(s)
- Peter J K van Meer
- Utrecht Institute of Pharmaceutical Sciences; Department of Pharmaceutics; Utrecht University; Utretcht, the Netherlands
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Kompus K, Falkenberg LE, Bless JJ, Johnsen E, Kroken RA, Kråkvik B, Larøi F, Løberg EM, Vedul-Kjelsås E, Westerhausen R, Hugdahl K. The role of the primary auditory cortex in the neural mechanism of auditory verbal hallucinations. Front Hum Neurosci 2013. [PMID: 23630479 DOI: 10.3389/fnhum.2013.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Auditory verbal hallucinations (AVHs) are a subjective experience of "hearing voices" in the absence of corresponding physical stimulation in the environment. The most remarkable feature of AVHs is their perceptual quality, that is, the experience is subjectively often as vivid as hearing an actual voice, as opposed to mental imagery or auditory memories. This has lead to propositions that dysregulation of the primary auditory cortex (PAC) is a crucial component of the neural mechanism of AVHs. One possible mechanism by which the PAC could give rise to the experience of hallucinations is aberrant patterns of neuronal activity whereby the PAC is overly sensitive to activation arising from internal processing, while being less responsive to external stimulation. In this paper, we review recent research relevant to the role of the PAC in the generation of AVHs. We present new data from a functional magnetic resonance imaging (fMRI) study, examining the responsivity of the left and right PAC to parametrical modulation of the intensity of auditory verbal stimulation, and corresponding attentional top-down control in non-clinical participants with AVHs, and non-clinical participants with no AVHs. Non-clinical hallucinators showed reduced activation to speech sounds but intact attentional modulation in the right PAC. Additionally, we present data from a group of schizophrenia patients with AVHs, who do not show attentional modulation of left or right PAC. The context-appropriate modulation of the PAC may be a protective factor in non-clinical hallucinations.
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Affiliation(s)
- Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway
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41
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Kompus K, Falkenberg LE, Bless JJ, Johnsen E, Kroken RA, Kråkvik B, Larøi F, Løberg EM, Vedul-Kjelsås E, Westerhausen R, Hugdahl K. The role of the primary auditory cortex in the neural mechanism of auditory verbal hallucinations. Front Hum Neurosci 2013; 7:144. [PMID: 23630479 PMCID: PMC3633947 DOI: 10.3389/fnhum.2013.00144] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/02/2013] [Indexed: 12/21/2022] Open
Abstract
Auditory verbal hallucinations (AVHs) are a subjective experience of “hearing voices” in the absence of corresponding physical stimulation in the environment. The most remarkable feature of AVHs is their perceptual quality, that is, the experience is subjectively often as vivid as hearing an actual voice, as opposed to mental imagery or auditory memories. This has lead to propositions that dysregulation of the primary auditory cortex (PAC) is a crucial component of the neural mechanism of AVHs. One possible mechanism by which the PAC could give rise to the experience of hallucinations is aberrant patterns of neuronal activity whereby the PAC is overly sensitive to activation arising from internal processing, while being less responsive to external stimulation. In this paper, we review recent research relevant to the role of the PAC in the generation of AVHs. We present new data from a functional magnetic resonance imaging (fMRI) study, examining the responsivity of the left and right PAC to parametrical modulation of the intensity of auditory verbal stimulation, and corresponding attentional top-down control in non-clinical participants with AVHs, and non-clinical participants with no AVHs. Non-clinical hallucinators showed reduced activation to speech sounds but intact attentional modulation in the right PAC. Additionally, we present data from a group of schizophrenia patients with AVHs, who do not show attentional modulation of left or right PAC. The context-appropriate modulation of the PAC may be a protective factor in non-clinical hallucinations.
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Affiliation(s)
- Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway
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du Plessis J, Stefaniak A, Eloff F, John S, Agner T, Chou TC, Nixon R, Steiner M, Franken A, Kudla I, Holness L. International guidelines for the in vivo assessment of skin properties in non-clinical settings: Part 2. transepidermal water loss and skin hydration. Skin Res Technol 2013; 19:265-78. [PMID: 23331328 DOI: 10.1111/srt.12037] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, representing a non-clinical environment, can be highly variable and difficult to control, thereby presenting unique measurement challenges not typically encountered in clinical settings. METHODS An expert working group convened a workshop as part of the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals (OEESC) to develop basic guidelines and best practices (based on existing clinical guidelines, published data, and own experiences) for the in vivo measurement of transepidermal water loss (TEWL) and skin hydration in non-clinical settings with specific reference to the workplace as a worst-case scenario. RESULTS Key elements of these guidelines are: (i) to minimize or recognize, to the extent feasible, the influences of relevant endogenous-, exogenous-, environmental- and measurement/instrumentation-related factors; (ii) to measure TEWL with a closed-chamber type instrument; (iii) report results as a difference or percent change (rather than absolute values); and (iv) accurately report any notable deviations from this guidelines. CONCLUSION It is anticipated that these guidelines will promote consistent data reporting, which will facilitate inter-comparison of study results.
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Affiliation(s)
- Johan du Plessis
- School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, North-West province 2520, South Africa.
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