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Faksova K, Walsh D, Jiang Y, Griffin J, Phillips A, Gentile A, Kwong JC, Macartney K, Naus M, Grange Z, Escolano S, Sepulveda G, Shetty A, Pillsbury A, Sullivan C, Naveed Z, Janjua NZ, Giglio N, Perälä J, Nasreen S, Gidding H, Hovi P, Vo T, Cui F, Deng L, Cullen L, Artama M, Lu H, Clothier HJ, Batty K, Paynter J, Petousis-Harris H, Buttery J, Black S, Hviid A. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024; 42:2200-2211. [PMID: 38350768 DOI: 10.1016/j.vaccine.2024.01.100] [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: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries. METHODS Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5. RESULTS Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5. CONCLUSION This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified.
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Affiliation(s)
- K Faksova
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - J Griffin
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - A Gentile
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J C Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Z Grange
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - G Sepulveda
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Shetty
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - C Sullivan
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - Z Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Giglio
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J Perälä
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - H Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - P Hovi
- Department of Public Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland
| | - F Cui
- School of Public Health, Peking University, China
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - L Cullen
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Lu
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - H J Clothier
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - K Batty
- Auckland UniServices Limited at University of Auckland, New Zealand
| | - J Paynter
- School of Population Health, University of Auckland, New Zealand
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kwok CS, Phillips A, Mukherjee S, Patel MG, Hanif W. Missed Opportunities in Type 2 Diabetes Mellitus: A Narrative Review. Curr Diabetes Rev 2024; 20:CDR-EPUB-137367. [PMID: 38243953 DOI: 10.2174/0115733998274651231117101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a significant health problem around the world. OBJECTIVE This review aims to define missed opportunities and how they apply to patients with T2DM. METHOD This narrative review describes the natural history of T2DM and also describes where missed opportunities may arise. RESULTS Missed opportunities may relate to prevention, early detection, diagnosis, and treatment of diabetes. The cornerstone of T2DM prevention is the control of modifiable risk factors and lifestyle changes to potentially prevent diabetes. Early detection of T2DM is important as it is a chronic condition that can progress rapidly if untreated. Missed opportunities related to the diagnosis of T2DM draw attention to the heterogeneous presentation of diabetes. The condition can be incidentally identified in asymptomatic patients, so all healthcare professionals should be aware of the disease. Furthermore, it is not unexpected that patients with atypical symptoms may have a delay in diagnosis. The treatment-related missed opportunities in T2DM are broad and include self-care, education, remission of T2DM, risk factor management, prevention of complications, medication therapy and compliance, as well as individualized care. Considering patient pathways is a useful approach to evaluate missed opportunities in patient care. CONCLUSION Missed opportunities are a concept that is not often considered in diabetes care, which calls upon reflection of real-world activities and consideration of whether patient outcomes could have been improved with changes in decision-making. Future studies that aim to improve patient care should consider this concept.
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Affiliation(s)
- Chun Shing Kwok
- Department for Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
| | - Anne Phillips
- Department for Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
| | - Supriyo Mukherjee
- Research Centre for Diabetes Hypertension and Obesity (RCDHO), Samastipur, India
| | - Mahendra G Patel
- Department for Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
| | - Wasim Hanif
- Department for Post-Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
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Phillips A. Call to action on diabetes care: reaching communities facing health inequalities, health inequities and deprivation. Br J Nurs 2024; 33:16-20. [PMID: 38194328 DOI: 10.12968/bjon.2024.33.1.16] [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] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
This article presents evidence and policy on the importance of reaching out into local communities with inclusive approaches to try to reduce and prevent inequities and inequalities in diabetes care. The global emergency diabetes is causing and the risks and disproportionately high ethnic disparities are investigated. The article includes some suggestions on changing approaches to reduce health inequalities to enable diabetes care to become more accessible for those who need it the most.
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Affiliation(s)
- Anne Phillips
- Professor in Diabetes Care, Birmingham City University
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Phillips A, Jiang Y, Walsh D, Andrews N, Artama M, Clothier H, Cullen L, Deng L, Escolano S, Gentile A, Gidding G, Giglio N, Junker T, Huang W, Janjua N, Kwong J, Li J, Nasreen S, Naus M, Naveed Z, Pillsbury A, Stowe J, Vo T, Buttery J, Petousis-Harris H, Black S, Hviid A. Background rates of adverse events of special interest for COVID-19 vaccines: A multinational Global Vaccine Data Network (GVDN) analysis. Vaccine 2023; 41:6227-6238. [PMID: 37673715 DOI: 10.1016/j.vaccine.2023.08.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/23/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) project was established in 2021 under the multinational Global Vaccine Data Network (GVDN) consortium to facilitate the rapid assessment of the safety of newly introduced vaccines. This study analyzed data from GVDN member sites on the background incidence rates of conditions designated as adverse events of special interest (AESI) for COVID-19 vaccine safety monitoring. METHODS Eleven GVDN global sites obtained data from national or regional healthcare databases using standardized methods. Incident events of 13 pre-defined AESI were included for a pre-pandemic period (2015-19) and the first pandemic year (2020). Background incidence rates (IR) and 95% confidence intervals (CI) were calculated for inpatient and emergency department encounters, stratified by age and sex, and compared between pre-pandemic and pandemic periods using incidence rate ratios. RESULTS An estimated 197 million people contributed 1,189,652,926 person-years of follow-up time. Among inpatients in the pre-pandemic period (2015-19), generalized seizures were the most common neurological AESI (IR ranged from 22.15 [95% CI 19.01-25.65] to 278.82 [278.20-279.44] per 100,000 person-years); acute disseminated encephalomyelitis was the least common (<0.5 per 100,000 person-years at most sites). Pulmonary embolism was the most common thrombotic event (IR 45.34 [95% CI 44.85-45.84] to 93.77 [95% CI 93.46-94.08] per 100,000 person-years). The IR of myocarditis ranged from 1.60 [(95% CI 1.45-1.76) to 7.76 (95% CI 7.46-8.08) per 100,000 person-years. The IR of several AESI varied by site, healthcare setting, age and sex. The IR of some AESI were notably different in 2020 compared to 2015-19. CONCLUSION Background incidence of AESIs exhibited some variability across study sites and between pre-pandemic and pandemic periods. These findings will contribute to global vaccine safety surveillance and research.
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Affiliation(s)
- A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - N Andrews
- UK Health Security Agency, London, UK
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Clothier
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - L Cullen
- Public Health Scotland, Edinburgh, Scotland, UK
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - A Gentile
- Hospital de Niños Ricardo Gutierrez Epidemiology Department Buenos Aires City, Argentina
| | - G Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney Northern Clinical School, Australia
| | - N Giglio
- Hospital de Niños Ricardo Gutierrez Epidemiology Department Buenos Aires City, Argentina
| | - T Junker
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - W Huang
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan; National Taiwan University Children's Hospital, Taipei, Taiwan
| | - N Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - J Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J Li
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Z Naveed
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - J Stowe
- UK Health Security Agency, London, UK
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland; Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Associate Professor, School of Population Health, University of Auckland, New Zealand
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Louie JK, Keh C, Agraz-Lara R, Phillips A, Graves S. Highlighting the characteristics of TB disease in older people. Int J Tuberc Lung Dis 2023; 27:478-480. [PMID: 37231601 DOI: 10.5588/ijtld.22.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- J K Louie
- San Francisco Department of Public Health, San Francisco, CA, USA, University of California, San Francisco, San Francisco, CA, USA
| | - C Keh
- University of California, San Francisco, San Francisco, CA, USA
| | - R Agraz-Lara
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - A Phillips
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - S Graves
- San Francisco Department of Public Health, San Francisco, CA, USA
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Margulescu AD, Thomas DE, Kakoudaki M, Cranch H, O'Dea J, Davies G, Phillips A, Green AS, Rees P, Barry JP. Incidence of atrial and ventricular arrhythmias in patients with CIEDs and COVID-19. Eur Heart J 2022. [PMCID: PMC9619561 DOI: 10.1093/eurheartj/ehac544.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background It remains unclear whether COVID-19 infection is associated with increased arrhythmia burden in patients with cardiac implantable electronic devices (CIEDs). Methods We identified 46 patients tested positive for COVID-19 between 01/03/2020 and 31/05/2021 in our cohort of 1209 patients with CIED (3.8%). Data on arrhythmia burden during a 9 week period (a 4 week “pre-infection” period: P1, the week before the positive Covid-19 test: P2, and the 4 weeks afterwards: P3) was accessible in 35 patients. Results 83% of patients were not hospitalised. Five patients (14.3%) (all non-hospitalised) had high rate atrial (HRA) events, 4 of which exclusively during P1 and/or P2. Thirty-two non-sustained VT (NSVT) episodes were recorded in 8 patients, one degenerating in VF requiring ICD shock (occurring in P2). One patient had frequent NSVT each week. After exclusion of this outlier, a numerical 4-fold increase in weekly NSVT episodes was observed between P1 and P3 (Patients with NSVT: 0.07±0.12 vs. 0.29±0.17 episodes/week, p=0.057; entire cohort: 0.015±0.060 vs. 0.059±0.138 episodes/week, p=0.16) (Figure 1). In P3, hospitalised patients had a trend towards higher NSVT burden vs. non-hospitalised patients (2/6 (33.3%) vs. 4/29 (13.8%), p=0.27) which was not apparent before the positive Covid-19 test. Conclusion Our single-centre experience suggests that COVID-19 infection may result in an increase in VA but not atrial arrhythmia burden in patients with CIED. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- A D Margulescu
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - D E Thomas
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - M Kakoudaki
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - H Cranch
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - J O'Dea
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - G Davies
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - A Phillips
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - A S Green
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - P Rees
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - J P Barry
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
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Smallwood KG, Crockett S, Huang V, Cullimore V, Davies J, Satti G, Phillips A. Changing patterns of referral into a family history clinic and detection of ovarian cancer: a retrospective 10-year review. J OBSTET GYNAECOL 2022; 42:2652-2658. [PMID: 35980980 DOI: 10.1080/01443615.2022.2111253] [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] [Indexed: 01/06/2023]
Abstract
This study examines whether a change in the criteria for genetic testing for ovarian cancer risk changed the nature of referrals into our Familial Cancer service. This is a retrospective review of 273 women who underwent risk reducing surgery (RRS). The primary outcome was to establish whether there was an increase in women having RRS with a confirmed genetic mutation. Secondary outcomes included the incidence of occult cancer and of subsequent primary peritoneal cancer. The results showed an increase in women being offered RRS based on genetic diagnosis; 91% versus 32% before the criteria change. Four occult malignancies (1.5%) and two peritoneal cancers (0.7%) were noted.We have demonstrated a change in the nature of referrals to the familial cancer service from perceived risk to genetic diagnosis. We can now counsel women more accurately. With a defined risk we are enabling them to make an informed decision regarding risk reduction.
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Affiliation(s)
- K G Smallwood
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - S Crockett
- Department of Familial Cancer, University Hospitals of Derby and Burton, Derby, UK
| | - V Huang
- Medical School, University of Nottingham, Nottingham, UK
| | - V Cullimore
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - J Davies
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - G Satti
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
| | - A Phillips
- Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton, Derby, UK
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Rotow J, Yoh K, Powderly J, Shimizu T, Perets R, Paz-Ares L, Phillips A, Souers A, Ansell P, Jin J, Badawi M, Saab R, Morrison-Thiele G, Jeffries S, Neagu Aristide M, Carneiro B, Papadopoulos K. 1185TiP First-in-human phase I study of ABBV-637 as monotherapy and in combination in patients with relapsed and refractory solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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9
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Adamson M, Hadipour AL, Uyulan C, Erguzel T, Cerezci O, Kazemi R, Phillips A, Seenivasan S, Shah S, Tarhan N. Sex differences in rTMS treatment response: A deep learning-based EEG investigation. Brain Behav 2022; 12:e2696. [PMID: 35879921 PMCID: PMC9392544 DOI: 10.1002/brb3.2696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study aimed to investigate sex differences in response to repetitive transcranial magnetic stimulation (rTMS) in Major Depressive Disorder (MDD) patients. Identifying the factors that mediate treatment response to rTMS in MDD patients can guide clinicians to administer more appropriate, reliable, and personalized interventions. METHODS In this paper, we developed a novel pipeline based on convolutional LSTM-based deep learning (DL) to classify 25 female and 25 male patients based on their rTMS treatment response. RESULTS Five different classification models were generated, namely pre-/post-rTMS female (model 1), pre-/post-rTMS male (model 2), pre-rTMS female responder versus pre-rTMS female nonresponders (model 3), pre-rTMS male responder vs. pre-rTMS male nonresponder (model 4), and pre-rTMS responder versus nonresponder of both sexes (model 5), achieving 93.3%, 98%, 95.2%, 99.2%, and 96.6% overall test accuracy, respectively. CONCLUSION These results indicate the potential of our approach to be used as a response predictor especially regarding sex-specific antidepressant effects of rTMS in MDD patients.
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Affiliation(s)
- M Adamson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.,Department of Rehabilitation Service, VA Palo Alto Healthcare System, Palo Alto, California
| | - A L Hadipour
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - C Uyulan
- Department of Mechanical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | - T Erguzel
- Faculty of Engineering and Natural Sciences, Üsküdar University, Istanbul, Turkey
| | - O Cerezci
- Faculty of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - R Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - A Phillips
- Department of Rehabilitation Service, VA Palo Alto Healthcare System, Palo Alto, California
| | - S Seenivasan
- Department of Rehabilitation Service, VA Palo Alto Healthcare System, Palo Alto, California
| | - S Shah
- Department of Rehabilitation Service, VA Palo Alto Healthcare System, Palo Alto, California
| | - N Tarhan
- Faculty of Humanities and Social Sciences, Üsküdar University, Istanbul, Turkey
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Bueser T, Phillips A, Kirkby C, Partridge J, Kearl F, Moss L, Evans C, Sanders J. A programme to support resilience and clinical excellence in inherited cardiac conditions nurses based in the hospital and charity sector during the COVID-19 pandemic and beyond. Eur J Cardiovasc Nurs 2022. [PMCID: PMC9384355 DOI: 10.1093/eurjcn/zvac060.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Burdett Trust for Nursing
Background
The COVID-19 pandemic affected health care systems profoundly. Inherited cardiac condition (ICC) specialist nurses were redeployed to intensive care or acute settings which either left services with no nurse or a single nurse manning a normally busy service (Bueser 2020). An exponential rise in patients reaching out to patient support charities was seen (Charity Today 2020) and at the peak of the pandemic, nurses based at an ICC charity dealt with 599 inquiries which was a 328% increase in activity. The toll on the mental health of nurses during the pandemic is well documented and programmes have been suggested to address this which includes peer support and psychological support by clinical psychologists
Purpose
The aim was to develop and strengthen collaborations between ICC specialist nurses in a tertiary hospital and those working in the community charity sector; and provide peer and psychological support to enable consistent high quality patient care.
Methods
The project was based on Wenger’s (1999) Communities of Practice (COP) framework model of situational learning, collaboration among peers, working to a common purpose. To develop the counselling aspect, a psychotherapist led a scoping exercise with the group. The 4Rs Skilled Helper Programme (SHP) of reflective learning, supervision and continuing professional development was then adapted as a bespoke programme - combining 30 hours of formal counselling, communication and reflective learning skills with equal attention to the normative, formative and restorative components of support and development needed to ensure practitioner health and wellbeing and the safety and quality of patient care
Results
Nine ICC nurses from a tertiary hospital and 3 from the charity sector participated in the project. Nine nurses undertook the tailored 4RS SHP course, adapting Egan's 3 stage problem-solving, decision-making and opportunity development framework as the vehicle for personalised, psychosocial, time-sensitive decision-making and informed consent for patients, and for the identification of support and development strategies that represent the 'best fit' for both clients and practitioners in their particular social and organisational circumstances. Counselling supervision is ongoing on a whole group, team and individual basis and provides opportunities to discuss collaborations, gain support for challenging clinical cases and work situations; and promoting psychological well-being.
Conclusions
The COP established through this project alongside the development of a bespoke counselling course and psychological supervision is an exemplar of how nurses can be empowered to continue to provide excellent care despite challenging circumstances. The 4RS SHP course also specifically addresses the competency needs for ICC nurses as move towards a genomics-driven, personalised health care delivery model.
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Affiliation(s)
- T Bueser
- St Bartholomew's Hospital , London , United Kingdom of Great Britain & Northern Ireland
| | - A Phillips
- Alan Phillips Associates , Manchester , United Kingdom of Great Britain & Northern Ireland
| | - C Kirkby
- St Bartholomew's Hospital, Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - J Partridge
- Cardiomyopathy UK , London , United Kingdom of Great Britain & Northern Ireland
| | - F Kearl
- St Bartholomew's Hospital, Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - L Moss
- St Bartholomew's Hospital, Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - C Evans
- Cardiomyopathy UK , London , United Kingdom of Great Britain & Northern Ireland
| | - J Sanders
- St Bartholomews and Queen Mary University, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
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11
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Seenivasan S, Adamson M, Phillips A. Deep learning approach to evaluate sex differences in response to neuromodulation in Major Depressive Disorder. Eur Psychiatry 2022. [PMCID: PMC9567195 DOI: 10.1192/j.eurpsy.2022.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Identifying the factors that mediate treatment response to rTMS in MDD patients can guide clinicians to administer more appropriate, reliable, and personalized interventions. Objectives The present study aimed to investigate sex differences in response to repetitive transcranial magnetic stimulation (rTMS) in Major Depressive Disorder (MDD) patients. Methods In this paper, we developed a novel pipeline based on convolutional LSTM-based deep learning (DL) to classify 25 female and 25 male subjects based on their rTMS treatment response. Results Five different classification models were generated, namely pre/post-rTMS female (model 1), pre/post-rTMS male (model 2), pre-rTMS female responder vs. pre-rTMS female non-responders (model 3), pre-rTMS male responder vs. pre-rTMS male non-responder (model 4), and pre-rTMS responder vs. non-responder of both sexes (model 5), achieving 93.3%, 98%, 95.2%, 99.2%, and 96.6% overall test accuracy, respectively. Conclusions These results indicate the potential of our approach to be used as a response predictor especially regarding sex-specific antidepressant effects of rTMS in MDD patients. Disclosure No significant relationships.
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12
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Csipke E, Lammas F, Phillips A, Dopson S, Joyce E, Wykes T. The organisational climate of NHS Early Intervention Services (EIS) for psychosis: A qualitative analysis. Eur Psychiatry 2022. [PMCID: PMC9566072 DOI: 10.1192/j.eurpsy.2022.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Cognitive remediation (CR) therapy for psychosis significantly improves recovery but is yet to be widely implemented in UK National Health Service and it is likely to be of greatest value if implemented early. Organisational climate within teams in the health services is one factor likely to affect CR implementation into Early Intervention Services (EIS), that serve those with a first episode. Objectives To understand the organisational climate within UK NHS EIS and the barriers and facilitators for the introduction of CR. Methods We conducted semi structured interviews with 42 EIS members of four teams in four NHS Mental Heath Trusts. Results There were differences between teams, including involvement in decision making, leadership style, and willingness to adopt CR. Resource shortages were considered the main implementation barrier across all teams. The evidence for CR benefits and the recognition of a clinical need was the main facilitator. Teams with more democratic leadership, involving all team members in decision making, and knowledge of both the evidence base and need for CR, may feel better able to successfully incorporate it into their service. Conclusions Engaging team members in the implementation process through cooperative and consultative decision-making can stimulate a flattened hierarchical structure, empowering staff to overcome existing and new NHS pressures and effectively deliver evidence-based care. The consideration of local conditions and organisational micro-climates mediate the successful implementation of new interventions and is needed in addition to generic, context-free variables such as resources before new interventions can be introduced. Disclosure No significant relationships.
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13
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Tosoni S, Voruganti I, Lajkosz K, Mustafa S, Phillips A, Kim SJ, Wong RKS, Willison D, Virtanen C, Heesters A, Liu FF. Patient consent preferences on sharing personal health information during the COVID-19 pandemic: "the more informed we are, the more likely we are to help". BMC Med Ethics 2022; 23:53. [PMID: 35596210 PMCID: PMC9122733 DOI: 10.1186/s12910-022-00790-z] [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: 12/21/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rapid ethical access to personal health information (PHI) to support research is extremely important during pandemics, yet little is known regarding patient preferences for consent during such crises. This follow-up study sought to ascertain whether there were differences in consent preferences between pre-pandemic times compared to during Wave 1 of the COVID-19 global pandemic, and to better understand the reasons behind these preferences.
Methods A total of 183 patients in the pandemic cohort completed the survey via email, and responses were compared to the distinct pre-pandemic cohort (n = 222); all were patients of a large Canadian cancer center. The survey covered (a) broad versus study-specific consent; (b) opt-in versus opt-out contact approach; (c) levels of comfort sharing with different recipients; (d) perceptions of commercialization; and (e) options to track use of information and be notified of results. Four focus groups (n = 12) were subsequently conducted to elucidate reasons motivating dominant preferences. Results Patients in the pandemic cohort were significantly more comfortable with sharing all information and biological samples (90% vs. 79%, p = 0.009), sharing information with the health care institution (97% vs. 83%, p < 0.001), sharing information with researchers at other hospitals (85% vs. 70%, p < 0.001), sharing PHI provincially (69% vs. 53%, p < 0.002), nationally (65% vs. 53%, p = 0.022) and internationally (48% vs. 39%, p = 0.024) compared to the pre-pandemic cohort. Discomfort with sharing information with commercial companies remained unchanged between the two cohorts (50% vs. 51% uncomfortable, p = 0.58). Significantly more pandemic cohort patients expressed a wish to track use of PHI (75% vs. 61%, p = 0.007), and to be notified of results (83% vs. 70%, p = 0.012). Thematic analysis uncovered that transparency was strongly desired on outside PHI use, particularly when commercialization was involved. Conclusions In pandemic times, patients were more comfortable sharing information with all parties, except with commercial entities, where levels of discomfort (~ 50%) remained unchanged. Focus groups identified that the ability to track and receive results of studies using one’s PHI is an important way to reduce discomfort and increase trust. These findings meaningfully inform wider discussions on the use of personal health information for research during global crises. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00790-z.
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Affiliation(s)
- Sarah Tosoni
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Indu Voruganti
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 2M9, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Shahbano Mustafa
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 2M9, Canada
| | | | - S Joseph Kim
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Rebecca K S Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 2M9, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Donald Willison
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carl Virtanen
- University Health Network Digital, Toronto, ON, Canada
| | - Ann Heesters
- Department of Bioethics, University Health Network, Toronto, ON, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Fei-Fei Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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14
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Johnson SB, Lucivero F, Zimmermann BM, Stendahl E, Samuel G, Phillips A, Hangel N. Ethical Reasoning During a Pandemic: Results of a Five Country European Study. AJOB Empir Bioeth 2022; 13:67-78. [PMID: 35262468 DOI: 10.1080/23294515.2022.2040645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: There has been no work that identifies the hidden or implicit normative assumptions on which participants base their views during the COVID-19 pandemic, and their reasoning and how they reach moral or ethical judgements. Our analysis focused on participants' moral values, ethical reasoning and normative positions around the transmission of SARS-CoV-2.Methods: We analyzed data from 177 semi-structured interviews across five European countries (Germany, Ireland, Italy, Switzerland and the United Kingdom) conducted in April 2020.Results: Findings are structured in four themes: ethical contention in the context of normative uncertainty; patterns of ethical deliberation when contemplating restrictions and measures to reduce viral transmission; moral judgements regarding "good" and "bad" people; using existing structures of meaning for moral reasoning and ethical judgement.Discussion: Moral tools are an integral part of people's reaction to and experience of a pandemic. 'Moral preparedness' for the next phases of this pandemic and for future pandemics will require an understanding of the moral values and normative concepts citizens use in their own decision-making. Three important elements of this preparedness are: conceptual clarity over what responsibility or respect mean in practice; better understanding of collective mindsets and how to encourage them; and a situated, rather than universalist, approach to the development of normative standards.
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Affiliation(s)
- S B Johnson
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - F Lucivero
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - B M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
| | - E Stendahl
- University College Dublin, Dublin, Ireland
| | - G Samuel
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - A Phillips
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - N Hangel
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
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15
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Thandi G, Phillips A, Greenberg N, Maguire N, Fear NT. Evaluation of the Warrior Programme intervention among UK ex-service personnel. Occup Med (Lond) 2021; 72:91-98. [PMID: 34951474 DOI: 10.1093/occmed/kqab153] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research has shown that of the myriad services available to veterans in the UK, very few have been independently evaluated. This report presents the results of a randomized controlled trial assessing the impact of Time Line Therapy™ delivered by the Warrior Programme (a third-sector organization). AIMS This study was aimed to determine if the intervention is effective in reducing emotional and functional difficulties in ex-service personnel. METHODS A mixed-design analysis of variance model was used to investigate whether the Warrior Programme had a statistically significant impact on self-reported scores. The intervention and control group provided data on measures prior to and immediately after the intervention, and at 3-month follow-up. RESULTS Those in the intervention group (n = 23) reported statistically significant improvements in self-reported scores immediately following intervention: the Clinical Outcomes in Routine Evaluation (CORE) scores (CORE global distress mean difference [MD] = 45.0, 95% confidence interval [CI] 31-60) (CORE subjective well-being MD = 5.9, 95% CI 3.5-8.3) (CORE functioning MD = 16.7, 95% CI 11.4-21.9) (CORE problems/symptoms MD = 19.4, 95% CI 13.1-25.7), general self-efficacy (MD = -9.8, 95% CI -13.6 to -6.8), anxiety (MD = 8.6, 95% CI 5.2-12.1), depression (MD = 10, 95% CI 6.6-13.5), post-traumatic stress disorder (MD = 26.3, 95% CI 17-25) and functional impairment (MD = 11.1, 95% CI 5.3-16.8) over time, compared to the control group (n = 29). However, score improvement was not sustained over time or statistically significant at follow-up. CONCLUSIONS The Warrior Programme was effective in reducing emotional and functional difficulties in ex-service personnel immediately after the intervention, but the effect was not sustained at 3-month follow-up.
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Affiliation(s)
- G Thandi
- King's Centre for Military Health Research, King's College London, UK.,Academic Department of Military Mental Health, King's College London, UK
| | - A Phillips
- King's Centre for Military Health Research, King's College London, UK.,Academic Department of Military Mental Health, King's College London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, UK.,Academic Department of Military Mental Health, King's College London, UK
| | - N Maguire
- Department of Psychology, University of Southampton, Southampton, UK
| | - N T Fear
- King's Centre for Military Health Research, King's College London, UK.,Academic Department of Military Mental Health, King's College London, UK
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16
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Davies J, Honeyman L, Hartshorn K, Dasgupta J, Phillips A, Kolhe S. 473 The significance of single versus multiple polyps at hysteroscopy in post menopausal bleeding. Diagnostics (Basel) 2021. [DOI: 10.1136/ijgc-2021-esgo.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Purakal J, Seidenfeld J, Tupetz A, Vissoci J, Silva L, Fiorino C, Phillips A, Limkakeng A, Staton C. 94EMF COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis. Ann Emerg Med 2021. [PMCID: PMC8536271 DOI: 10.1016/j.annemergmed.2021.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Purakal J, Seidenfeld J, Tupetz A, Vissoci J, Silva L, Limkakeng A, Fiorino C, Phillips A, Staton C. 30EMF COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis. Ann Emerg Med 2021. [PMCID: PMC8335433 DOI: 10.1016/j.annemergmed.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Abstract
OBJECTIVES Studies investigating the safety of hormone replacement therapy in cervical cancer have predominantly included patients with squamous disease. Pathological studies have identified estrogen receptor positivity in cervical adenocarcinomas. A recent small case-control study suggested a trend towards reduced survival with hormone replacement therapy in cervical adenocarcinomas. Our objective was to determine if hormone replacement therapy use in patients treated for cervical adenocarcinomas is detrimental to survival. STUDY DESIGN A retrospective review of all women under the age of 50 with stage 1B-2B cervical adenocarcinomas diagnosed between 1 November 2000 and 24 September 2019. Women were categorised into three groups: ovaries conserved (OVCON); or iatrogenic menopause with (IM-HRT) or without (IM-NOHRT) hormone replacement therapy. Hormone replacement therapy use was defined on an intention to treat basis. Statistical analysis was performed using Kaplan-Meier and Cox proportional hazards methods. MAIN OUTCOME MEASURES Overall (OS), disease specific (DSS) and progression free (PFS) survival. RESULTS A total of 58 women (mean age 38.5 ± 6.6) were included in the study of whom 25 (43.1%) had OVCON, 20 (34.4%) had IM-HRT and 13 (22.4%) had IM-NOHRT. No menopause-associated deaths occurred. Although five-year DSS was 73% in IM-NOHRT compared to 95% in IM-HRT and 95% in OVCON, these differences were not statistically significant. Five-year PFS was 68% in IM-NOHRT compared to 90% in IM-HRT and 81% in OVCON but again, these differences were not statistically significant. CONCLUSION In this small study, hormone replacement therapy does not appear to be detrimental to survival in cervical adenocarcinomas. There is a trend towards improved survival with hormone replacement therapy. Larger studies are required to substantiate these findings.
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Affiliation(s)
- A Richardson
- Department of Gynaecology, 4490University Hospitals of Leicester NHS Trust, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L Watson
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - M Persic
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - A Phillips
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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20
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Yang B, Li M, Phillips A, Li L, Ali U, Li Q, Lu S, Hong Y, Wang X, Guo L. Nonspecific phospholipase C4 hydrolyzes phosphosphingolipids and sustains plant root growth during phosphate deficiency. Plant Cell 2021; 33:766-780. [PMID: 33955494 PMCID: PMC8136900 DOI: 10.1093/plcell/koaa054] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 05/07/2023]
Abstract
Phosphate is a vital macronutrient for plant growth, and its availability in soil is critical for agricultural sustainability and productivity. A substantial amount of cellular phosphate is used to synthesize phospholipids for cell membranes. Here, we identify a key enzyme, nonspecific phospholipase C4 (NPC4) that is involved in phosphosphingolipid hydrolysis and remodeling in Arabidopsis during phosphate starvation. The level of glycosylinositolphosphorylceramide (GIPC), the most abundant sphingolipid in Arabidopsis thaliana, decreased upon phosphate starvation. NPC4 was highly induced by phosphate deficiency, and NPC4 knockouts in Arabidopsis decreased the loss of GIPC and impeded root growth during phosphate starvation. Enzymatic analysis showed that NPC4 hydrolyzed GIPC and displayed a higher activity toward GIPC as a substrate than toward the common glycerophospholipid phosphatidylcholine. NPC4 was associated with the plasma membrane lipid rafts in which GIPC is highly enriched. These results indicate that NPC4 uses GIPC as a substrate in planta and the NPC4-mediated sphingolipid remodeling plays a positive role in root growth in Arabidopsis response to phosphate deficiency.
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Affiliation(s)
- Bao Yang
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Maoyin Li
- Department of Biology, University of Missouri-St. Louis, St. Louis, Missouri, USA
- Donald Danforth Plant Science Center, St. Louis, Missouri, USA
| | - Anne Phillips
- Donald Danforth Plant Science Center, St. Louis, Missouri, USA
| | - Long Li
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Usman Ali
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Qing Li
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Shaoping Lu
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Yueyun Hong
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Xuemin Wang
- Department of Biology, University of Missouri-St. Louis, St. Louis, Missouri, USA
- Donald Danforth Plant Science Center, St. Louis, Missouri, USA
- Author for correspondence: (L.G) and (X.W.)
| | - Liang Guo
- National Key Laboratory of Crop Genetic Improvement, Huazhong Agricultural University, Wuhan, Hubei, China
- Author for correspondence: (L.G) and (X.W.)
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21
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Abstract
In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the ‘test, track and trace’ approach of containing the spread of the novel coronavirus. These technologies include mobile ‘contact tracing’ applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for ‘genuine participation’ in public health interventions and emphasises the need to take citizen’s knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees’ range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK.
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Affiliation(s)
- G. Samuel
- Department of Global Health and Social Medicine, King’s College, London, UK
| | - S. L. Roberts
- Institute for Global Health, University College London (UCL), London, UK
| | - A. Fiske
- Institute of History and Ethics in Medicine, Technical University Munich, Munich, Germany
| | - F. Lucivero
- Ethox Centre, University of Oxford, Oxford, UK
| | - S. McLennan
- Institute of History and Ethics in Medicine, Technical University Munich, Munich, Germany
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - A. Phillips
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - S. Hayes
- Vienna School of International Studies, Diplomatische Akademie Wien, Vienna, Austria
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22
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Mulchandani R, Sibal B, Phillips A, Suleman S, Banerjee A, Teagle R, Foulkes S, Spence K, Edeghere O. A large outbreak of measles in the West Midlands, England, 2017-2018: descriptive epidemiology, control measures and lessons learnt. Epidemiol Infect 2021; 149:e114. [PMID: 33866992 PMCID: PMC8161374 DOI: 10.1017/s0950268821000868] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/05/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
In November 2017, eight confirmed measles cases were reported to Public Health England from a hospital in the West Midlands. A multidisciplinary Incident Management Team (IMT) was established to determine the extent of the problem and coordinate an outbreak response. Between 1 November 2017 and 4 June 2018, a total of 116 confirmed and 21 likely measles cases were linked to this outbreak; just under half (43%) were aged over 15 years of age. Fifty-five of the confirmed cases were hospitalised (48%) and no deaths were reported. At the start of the outbreak, cases were mostly individuals of Romanian origin; the outbreak subsequently spread to the wider population. Over the 8-month response, the IMT conducted the following control measures: extensive contact tracing, immediate provision of post-exposure prophylaxis, community engagement amongst specific high-risk groups, MMR awareness raising including catch-up campaigns and enhanced vaccination services at selected GP surgeries. Key challenges to the effective control measures included language difficulties limiting community engagement; delays in diagnosis, notification and appropriate isolation of cases; limited resources for contact tracing across multiple high-risk settings (including GPs and hospitals) and lack of timely data on vaccine coverage in sub-groups of the population to guide public health action.
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Affiliation(s)
- R. Mulchandani
- UK Field Epidemiology Training Programme (UK-FETP), Public Health England, London, UK
- Field Service Midlands, National Infection Service, Public Health England, Birmingham, UK
| | - B. Sibal
- National Port Health Team, Public Health England, London, UK
| | - A. Phillips
- West Midlands Health Protection Team, Public Health England, Birmingham, UK
| | - S. Suleman
- Field Service Midlands, National Infection Service, Public Health England, Birmingham, UK
| | - A. Banerjee
- Midlands Screening and Immunisation Team, Public Health England, Birmingham, UK
| | - R. Teagle
- Field Service Midlands, National Infection Service, Public Health England, Birmingham, UK
| | - S. Foulkes
- Field Service Midlands, National Infection Service, Public Health England, Birmingham, UK
| | - K. Spence
- West Midlands Health Protection Team, Public Health England, Birmingham, UK
| | - O. Edeghere
- Field Service Midlands, National Infection Service, Public Health England, Birmingham, UK
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23
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Phillips A, Edmonds M. ACT NOW in diabetes and foot assessments: an essential service. Br J Community Nurs 2021; 26:116-120. [PMID: 33719551 DOI: 10.12968/bjcn.2021.26.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Phillips
- Associate Professor in Diabetes Care, Birmingham City University; Co-chair of iDEAL Diabetes
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24
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Phillips A. Optimising strategies to diagnose intestinal schistosomaisis in low prevalence areas and the trace controversy. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Harden L, Jones N, Whelan C, Phillips A, Simms A, Greenberg N. A systematic review of psychological training or interventions given to UK military personnel prior to deployment. BMJ Mil Health 2020; 167:63-69. [PMID: 33109732 DOI: 10.1136/bmjmilitary-2019-001296] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions. METHODS A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24. RESULTS 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found. CONCLUSIONS Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics.
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Affiliation(s)
- Larissa Harden
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - C Whelan
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
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Jones N, Jones M, Greenberg N, Phillips A, Simms A, Wessely S. UK military women: mental health, military service and occupational adjustment. Occup Med (Lond) 2020; 70:235-242. [DOI: 10.1093/occmed/kqaa019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Recently, the UK Armed Forces have revised the ground close combat role to include women.
Aims
To assess the potential mental health impact of this initiative we examined gender differences in deployment patterns, work strain, occupational factors, mental health, alcohol use and help-seeking following operational deployment.
Methods
The study was a secondary analysis of self-report survey data; 8799 men (88%) and 1185 women (12%) provided data. A sub-sample (47%, n = 4659) provided data concerning post-deployment help-seeking. The latter consisted of 408 women (8.8%) and 4251 men (91%).
Results
With the exception of alcohol misuse, which was significantly lower for women, women reported significantly more common mental disorder symptoms, subjective depression and self-harm. Women were significantly more likely to seek help from healthcare providers. Men were significantly more likely to have deployed operationally and for longer cumulative periods. Subjective work strain, but not job control, was significantly lower for women whose military careers were significantly shorter. Post-traumatic stress disorder (PTSD) symptom intensity was similar to men.
Conclusions
With the exception of PTSD and alcohol misuse, UK military women experience more mental health-related problems than military men. This finding was not related to the more arduous aspects of military service as women served for shorter times, deployed less and for shorter cumulative periods and were less likely to report work-related stress.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - M Jones
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - S Wessely
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. British military women: combat exposure, deployment and mental health. Occup Med (Lond) 2019; 69:549-558. [PMID: 31404463 DOI: 10.1093/occmed/kqz103] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. AIMS To explore the mental health impact of combat exposure among military women. METHODS Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. RESULTS Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70-2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11-2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53-0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49-0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53-0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84-1.77). Overall, outcomes were minimally impacted by level of combat exposure. CONCLUSIONS Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK.,King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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Laut K, Kirk O, Rockstroh J, Phillips A, Ledergerber B, Gatell J, Gazzard B, Horban A, Karpov I, Losso M, d'Arminio Monforte A, Pedersen C, Ristola M, Reiss P, Scherrer AU, de Wit S, Aho I, Rasmussen LD, Svedhem V, Wandeler G, Pradier C, Chkhartishvili N, Matulionyte R, Oprea C, Kowalska JD, Begovac J, Miró JM, Guaraldi G, Paredes R, Raben D, Podlekareva D, Peters L, Lundgren JD, Mocroft A. The EuroSIDA study: 25 years of scientific achievements. HIV Med 2019; 21:71-83. [PMID: 31647187 DOI: 10.1111/hiv.12810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/11/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 01/19/2023]
Abstract
The EuroSIDA study was initiated in 1994 and follows adult people living with HIV (PLHIV) in 100 collaborating clinics across 35 countries covering all European regions, Israel and Argentina. The study aims to study the long-term virological, immunological and clinical outcomes of PLHIV and to monitor temporal changes and regional differences in outcomes across Europe. Annually collected data include basic demographic characteristics, information on AIDS- and non-AIDS-related clinical events, and details about antiretroviral therapy (ART), hepatitis C treatment and other medications, in addition to a range of laboratory values. The summer 2016 data set held data from a total of 23 071 individuals contributing 174 481 person-years of follow-up, while EuroSIDA's unique plasma repository held over 160 000 samples. Over the past 25 years, close to 300 articles have been published in peer-reviewed journals (h-index 52), covering a range of scientific focus areas, including monitoring of clinical and virological outcomes, ART uptake, efficacy and adverse events, the influence of hepatitis virus coinfection, variation in the quality of HIV care and management across settings and regions, and biomarker research. Recognizing that there remain unresolved issues in the clinical care and management of PLHIV in Europe, EuroSIDA was one of the cohorts to found The International Cohort Consortium of Infectious Disease (RESPOND) cohort consortium on infectious diseases in 2017. In celebration of the EuroSIDA study's 25th anniversary, this article aims to summarize key scientific findings and outline current and future scientific focus areas.
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Affiliation(s)
- K Laut
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - O Kirk
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - A Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, University College London, London, UK
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Gatell
- Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Gazzard
- St Stephen's Clinic, Chelsea and Westminster Hospital, London, UK
| | - A Horban
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | - I Karpov
- Department of Infectious Diseases, Belarus State Medical University, Minsk, Belarus
| | - M Losso
- Latin America Coordination of Academic Clinical Research, Buenos Aires, Argentina
| | - A d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Saint Paul and Charles, University of Milan, Milan, Italy
| | - C Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - M Ristola
- Helsinki University Hospital, Helsinki, Finland
| | - P Reiss
- Division of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam and Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - A U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S de Wit
- CHU Saint-Pierre, Brussels, Belgium
| | - I Aho
- Helsinki University Hospital, Helsinki, Finland
| | - L D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - V Svedhem
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - N Chkhartishvili
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - R Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - C Oprea
- 'Victor Babes' Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - J D Kowalska
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | - J Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - J M Miró
- Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - G Guaraldi
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - R Paredes
- Infectious Diseases Unit &, IrsiCaixa AIDS Research Institute, Germans Trias Hospital, Badalona, Spain
| | - D Raben
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D Podlekareva
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Peters
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J D Lundgren
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, University College London, London, UK
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Chia P, Cao D, Gan H, Reilly E, Phillips A, John T, Scott A. P2.06-10 ABT-806 Derived Antibody Drug Conjugates (ADCs) Inhibit Growth of Malignant Mesothelioma In-Vivo. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lucas S, Kumar S, Leach MJ, Phillips A. Parent use of complementary medicine remedies and services for the management of respiratory tract infection in children: a qualitative study. J Multidiscip Healthc 2019; 12:749-766. [PMID: 31571893 PMCID: PMC6750007 DOI: 10.2147/jmdh.s216687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/15/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is increasing globally, in both adults and children. A common condition where CAM is used in children is acute respiratory tract infection (ARTI). However, limited information exists regarding specific CAM modalities used in children, and the factors that influence a parent's decision to use CAM for ARTI in children. This research aimed to address this knowledge gap. METHOD This research used a qualitative descriptive approach. Parents residing in Greater Melbourne, Australia, who had children aged from 0-12 years, and had used CAM for treating ARTI in their children in the last 12 months, were eligible to participate. Parents' perspectives were captured using individual semi-structured interviews, which were then transcribed verbatim. Data were analysed using content analysis. RESULTS Twenty-four families were interviewed. Several strategies to improve trustworthiness were implemented. Three themes underpinning the parents' decision to use CAM emerged from the data: safety, internal drivers and external drivers. Parents used a breadth of different treatments, predominantly food as medicine, followed by aromatherapy and other CAM remedies typically found in the kitchen, to manage ARTI in their children. Parents often used both CAM practitioners and mainstream medicine to manage ARTI in their children. While mainstream medicine was typically used to rule out any sinister pathology, CAM was often used as a frontline treatment option, with food as medicine (e.g. soups) dominating. This was due in part to concerns regarding the negative aspects of pharmaceutical use. Parents utilised a diverse range of information sources to inform their decision-making, including friends, families and the internet; traditional sources of research evidence were generally not used. CONCLUSION Child safety was a major factor influencing a primary carer's decision to utilise CAM for ARTI. The safety and effectiveness of remedies utilised by parents now warrants further investigation.
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Affiliation(s)
- S Lucas
- School of Health Sciences, Department of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - S Kumar
- School of Health Sciences, Department of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - MJ Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - A Phillips
- School of Health Sciences, Department of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Abstract
BACKGROUND Although there is currently little research data to support the contention, concerns have been raised about possible traumatic stressors inherent to Remotely Piloted Aircraft System (RPAS) operator roles. Factors such as exposure to visually traumatic events compounded by long working hours and blurred boundaries between military and civilian life have been cited as potential stressors. Robust research into the well-being of RPAS operators is scarce and mostly samples US personnel. AIMS To provide mental health and well-being data relating to UK RPAS operators. METHODS UK RPAS operators completed mental health questionnaires to assess levels of post-traumatic stress disorder (PTSD), anxiety and depression symptoms, alcohol use and occupational functioning. Respondents were also asked about work patterns. RESULTS Forty-one per cent of the sample reported potentially hazardous alcohol use. Ten per cent met psychiatric symptom criteria for moderate or severe anxiety, and 20% for moderate depressive symptoms. While there were no cases of probable PTSD, 30% of the sample reported sub-clinical PTSD symptoms likely to impair occupational functioning. Overall, 70% of the sample reported that psychological symptoms significantly impaired their functioning. CONCLUSIONS Compared to UK military sub-groups, RPAS operators were not at increased risk of mental health problems. However, a high proportion of the sample reported significant functional impairment, which has not been explored in other comparable studies. The most frequently highlighted work-related stressors were timing of RPAS work and operator shift patterns.
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Affiliation(s)
- A Phillips
- Academic Department of Military Mental Health, Kings College London, London, UK
| | - D Sherwood
- Academic Department of Military Mental Health, Kings College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Kings College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Kings College London, London, UK
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Phillips A, Jannati A, Hinchamn C, Stern A, Fried P. Neuromodulation by iTBS and 10Hz rTMS Compared in Healthy and Depressed Adults. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ellis K, Cuthberson C, Rimmler S, Carthron D, Phillips A, Callahan L, Rini C. MULTIMORBIDITY INFLUENCES SUPPORT FOR PHYSICAL ACTIVITY AMONG ADULTS WITH OSTEOARTHRITIS AND THEIR PARTNERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Ellis
- University of Michigan, School of Social Work
| | | | - S Rimmler
- UNC Gillings School of Global Public Health
| | - D Carthron
- Michigan State University, College of Nursing
| | | | - L Callahan
- University of North Carolina, Chapel Hill, NC
| | - C Rini
- Hackensack University Medical Center
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Sheehan O, Blinka M, Phillips A, Roth D. THE EXPERIENCE OF MEDICAL VISIT COMPANIONS ACCOMPANYING OLDER ADULTS TO PHYSICIAN VISITS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- O Sheehan
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD USA
| | - M Blinka
- Johns Hopkins University School of Medicine, Division of Geriatrics
| | | | - D Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD USA
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Phillips A, Sundar S, Singh K, Pounds R, Nevin J, Kehoe S, Balega J, Elattar A. The NICE classification for 'Ultra-radical (extensive) surgery for advanced ovarian cancer' guidance does not meaningfully predict postoperative complications: a cohort study. BJOG 2018; 126:96-104. [PMID: 30092615 DOI: 10.1111/1471-0528.15423] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine which descriptors of cytoreductive surgical extent in advanced ovarian cancer (AOC) best predict postoperative morbidity. DESIGN Retrospective notes review. SETTING A gynaecological cancer centre in the UK. POPULATION Six hundred and eight women operated on for AOC over a period of 114 months at a tertiary cancer centre, between 16 August 2007 and 16 February 2017. METHODS Outcome data were analysed by six approaches to classify the extent of surgery: standard/ultra-radical surgery; standard/radical/supra-radical surgery; presence/absence of gastrointestinal resections; low/intermediate/high surgical complexity score (SCS); presence of bowel anastomoses and/or diaphragmatic surgery; and the presence/absence of multiple bowel resections. MAIN OUTCOME MEASURES Major (grades 3-5) postoperative morbidity and mortality. RESULTS Forty-three (7.1%) patients experienced major complications. Grade-5 complications occurred in six patients (1.0%). Patients who underwent multiple bowel resections had a relative risk (RR) of 7.73 (95% confidence interval, 95% CI 3.92-15.26), patients with a high SCS had an RR of 6.12 (95% CI 3.25-11.52), patients with diaphragmatic surgery and gastrointestinal anastomosis had an RR of 5.57 (95% CI 2.65-11.72), patients with 'any gastrointestinal resection' had an RR of 4.69 (95% CI 2.66-8.24), patients with ultra-radical surgery had an RR of 4.65 (95% CI 2.26-8.79), and patients with supra-radical surgery had an RR of 4.20 (95% CI 2.35-7.51) of grades 3-5 morbidity, compared with patients undergoing standard surgery as defined by the National Institute for Health and Care Excellence (NICE) in the UK. No significant difference was seen in the rate of major morbidity between standard (6/59, 10.2%) and ultra-radical (9/81, 11.1%) surgery within the cohort who had intermediate complex surgery (P > 0.05). CONCLUSIONS The numbers of procedures performed significantly correlate with major morbidity. The number of procedures performed better predicted major postoperative morbidity than the performance of certain 'high risk' procedures. We recommend using SCS to define a higher risk operation. NICE should re-evaluate the use of the term 'ultra-radical' surgery. TWEETABLE ABSTRACT Multiple bowel resection is the best predictor of morbidity and is more predictive than 'ultra-radical surgery'.
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Affiliation(s)
- A Phillips
- Department of Obstetrics and Gynaecology, Royal Derby Hospital, Derby, UK
| | - S Sundar
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - K Singh
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - R Pounds
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - J Nevin
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - S Kehoe
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Balega
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - A Elattar
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
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Hanlon I, Hewitt C, Bell K, Phillips A, Mikocka-Walus A. Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:244-259. [PMID: 29901820 DOI: 10.1111/apt.14840] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/08/2018] [Accepted: 05/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. AIMS To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. METHODS We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis. RESULTS We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. CONCLUSION There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases.
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Affiliation(s)
- I Hanlon
- Department of Health Sciences, University of York, York, UK
| | - C Hewitt
- Department of Health Sciences, University of York, York, UK
| | - K Bell
- Department of Health Sciences, University of York, York, UK
| | - A Phillips
- Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Mikocka-Walus
- Department of Health Sciences, University of York, York, UK.,School of Psychology, Deakin University Geelong, Melbourne, Vic., Australia
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Dickson SJ, Clay KA, Adam M, Ardley C, Bailey MS, Burns DS, Cox AT, Craig DG, Espina M, Ewington I, Fitchett G, Grindrod J, Hinsley DE, Horne S, Hutley E, Johnston AM, Kao RLC, Lamb LE, Lewis S, Marion D, Moore AJ, Nicholson-Roberts TC, Phillips A, Praught J, Rees PS, Schoonbaert I, Trinick T, Wilson DR, Simpson AJ, Wang D, O'Shea MK, Fletcher TE. Enhanced case management can be delivered for patients with EVD in Africa: Experience from a UK military Ebola treatment centre in Sierra Leone. J Infect 2018; 76:383-392. [PMID: 29248587 PMCID: PMC5903873 DOI: 10.1016/j.jinf.2017.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 06/26/2017] [Revised: 11/28/2017] [Accepted: 12/10/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Limited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with Ebola virus disease (EVD) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting. METHODS Demographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015. RESULTS A total of 44 EVD patients were admitted (median age 37 years (range 17-63), 32/44 healthcare workers), and excluding those evacuated, the case fatality rate was 49% (95% CI 33%-65%). No pregnant women were admitted. At admission 9/44 had stage 1 disease (fever and constitutional symptoms only), 12/44 had stage 2 disease (presence of diarrhoea and/or vomiting) and 23/44 had stage 3 disease (presence of diarrhoea and/or vomiting with organ failure), with case fatality rates of 11% (95% CI 1%-58%), 27% (95% CI 6%-61%), and 70% (95% CI 47%-87%) respectively (p = 0.009). Haemorrhage occurred in 17/41 (41%) patients. The majority (21/40) of patients had hypokalaemia with hyperkalaemia occurring in 12/40 patients. Acute kidney injury (AKI) occurred in 20/40 patients, with 14/20 (70%, 95% CI 46%-88%) dying, compared to 5/20 (25%, 95% CI 9%-49%) dying who did not have AKI (p = 0.01). Ebola virus (EBOV) PCR cycle threshold value at baseline was mean 20.3 (SD 4.3) in fatal cases and 24.8 (SD 5.5) in survivors (p = 0.007). Mean national early warning score (NEWS) at admission was 5.5 (SD 4.4) in fatal cases and 3.0 (SD 1.9) in survivors (p = 0.02). Central venous catheters were placed in 37/41 patients and intravenous fluid administered to 40/41 patients (median duration of 5 days). Faecal management systems were inserted in 21/41 patients, urinary catheters placed in 27/41 and blood component therapy administered to 20/41 patients. CONCLUSIONS EVD is commonly associated life-threatening electrolyte imbalance and organ dysfunction. We believe that the enhanced levels of protocolized care, scale and range of medical interventions we report, offer a blueprint for the future management of EVD in resource-limited settings.
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Affiliation(s)
- S J Dickson
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - K A Clay
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M Adam
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - C Ardley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M S Bailey
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D S Burns
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A T Cox
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D G Craig
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M Espina
- Royal Canadian Medical Services, Ottawa, Canada
| | - I Ewington
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - G Fitchett
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J Grindrod
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D E Hinsley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - S Horne
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - E Hutley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A M Johnston
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - R L C Kao
- Royal Canadian Medical Services, Ottawa, Canada
| | - L E Lamb
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - S Lewis
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D Marion
- Royal Canadian Medical Services, Ottawa, Canada
| | - A J Moore
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - T C Nicholson-Roberts
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A Phillips
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J Praught
- Royal Canadian Medical Services, Ottawa, Canada
| | - P S Rees
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | | | - T Trinick
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D R Wilson
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A J Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, United Kingdom
| | - D Wang
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - M K O'Shea
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - T E Fletcher
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
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Kalokairinou L, Howard HC, Slokenberga S, Fisher E, Flatscher-Thöni M, Hartlev M, van Hellemondt R, Juškevičius J, Kapelenska-Pregowska J, Kováč P, Lovrečić L, Nys H, de Paor A, Phillips A, Prudil L, Rial-Sebbag E, Romeo Casabona CM, Sándor J, Schuster A, Soini S, Søvig KH, Stoffel D, Titma T, Trokanas T, Borry P. Legislation of direct-to-consumer genetic testing in Europe: a fragmented regulatory landscape. J Community Genet 2018; 9:117-132. [PMID: 29150824 PMCID: PMC5849704 DOI: 10.1007/s12687-017-0344-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 02/15/2017] [Accepted: 11/06/2017] [Indexed: 01/07/2023] Open
Abstract
Despite the increasing availability of direct-to-consumer (DTC) genetic testing, it is currently unclear how such services are regulated in Europe, due to the lack of EU or national legislation specifically addressing this issue. In this article, we provide an overview of laws that could potentially impact the regulation of DTC genetic testing in 26 European countries, namely Austria, Belgium, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, the Netherlands and the United Kingdom. Emphasis is placed on provisions relating to medical supervision, genetic counselling and informed consent. Our results indicate that currently there is a wide spectrum of laws regarding genetic testing in Europe. There are countries (e.g. France and Germany) which essentially ban DTC genetic testing, while in others (e.g. Luxembourg and Poland) DTC genetic testing may only be restricted by general laws, usually regarding health care services and patients' rights.
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Affiliation(s)
- L Kalokairinou
- Department of Public Health and Primary Care, Centre for Biomedical Law and Ethics, University of Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium.
| | - H C Howard
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - S Slokenberga
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
- Faculty of Law, Uppsala University, Uppsala, Sweden
| | - E Fisher
- Robert Koch-Institute, Berlin, Germany
| | - M Flatscher-Thöni
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - M Hartlev
- Faculty of Law, University of Copenhagen, Copenhagen, Denmark
| | | | - J Juškevičius
- Faculty of Law, Mykolas Romeris University, Vilnius, Lithuania
| | | | - P Kováč
- Forensic.sk Inštitút forenzných medicínskych expertíz s.r.o, Bratislava, Slovakia
- Department of Criminal Law and Criminology, Faculty of Law, Trnava University, Trnava, Slovakia
| | - L Lovrečić
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - H Nys
- Department of Public Health and Primary Care, Centre for Biomedical Law and Ethics, University of Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium
| | - A de Paor
- School of Law and Government, Dublin City University, Dublin, Ireland
| | - A Phillips
- School of Law, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - L Prudil
- AK PRUDIL a spol, Brno, Czech Republic
| | - E Rial-Sebbag
- Institut national de la santé et de la recherche médicale, Paris, France
| | | | - J Sándor
- Faculty of Political Science, Legal Studies and Gender Studies of the Central European University, Budapest, Hungary
| | - A Schuster
- Department of Legal Sciences, University of Trento, Trento, Italy
| | - S Soini
- Helsinki University Central Hospital, Helsinki, Finland
| | - K H Søvig
- Faculty of law, University of Bergen, Bergen, Norway
| | - D Stoffel
- University Paris-Est Créteil, Créteil, France
| | - T Titma
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
- School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - T Trokanas
- School of Law, European University of Cyprus, Egkomi, Cyprus
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Law and Ethics, University of Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium
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Phillips A, Kulendra ER, Lam R, Kulendra NJ, Brockman DJ. Surgical management of a cat with hepatic arterioportal fistula. J Small Anim Pract 2018. [PMID: 29536551 DOI: 10.1111/jsap.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 9-month-old domestic short-haired cat presented with stunted growth and chronic gastrointestinal signs. Tachypnoea, a heart murmur and cranial abdominal bruit were detected on physical examination. Echocardiography revealed volume overload in all heart chambers. CT angiography identified an abnormal communication between the hepatic arterial circulation and the portal vein, along with multiple acquired shunts. The abnormal vascular communication was surgically ligated. Echocardiography documented improvement in cardiac parameters following surgery and the cat continues to have no clinical signs 39 months after surgery. This report describes successful surgical management of feline hepatic arterioportal fistula for the first time.
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Affiliation(s)
- A Phillips
- Department of Clinical Science and Service, The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - E R Kulendra
- Department of Clinical Science and Service, The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - R Lam
- Department of Clinical Science and Service, The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - N J Kulendra
- Department of Clinical Science and Service, The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - D J Brockman
- Department of Clinical Science and Service, The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
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40
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Donovan K, Pacholok S, Phillips A, Humes J, Coles G, Williams J. Effect of Dialyser Composition and Reuse on Neutrophil Count and Elastase α-1 Proteinase Inhibitor Complex Formation. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the inter-relationship of leucopenia and PMN elastase release we undertook a prospective crossover study of 6 patients dialysed with new and reused cuprophane, cellulose acetate and polysulfone membranes. Serial blood samples were analysed for PMN count, and elastase-α 1-proteinase inhibitor complex (Eα1PI) concentrations. After 15 min dialysis with new membranes median PMN counts fell by 72.2%, 25.3% and 22.1% with cuprophane, cellulose and polysulfone, respectively. With reuse the decreases were reduced to 6.4%, 8% and 13.6%. All membranes produced a gradual increase of Eα1PI. Median Eα1PI accumulation rates (ng ml−1min−1) with new membranes were 175, 169 and 187 for cuprophane, cellulose acetate and polysulfone, respectively. With reuse of cuphro-phane and cellulose acetate these rates fell to 99 and 109 (p<0.05 and p<0.05, respectively), however, with polysulfone it remained unchanged at 180 ng ml−1 min−1. This study highlights differences between two aspects of the neutrophil response to haemodialysis, and demonstrates that extrapolation from individual parameters to conclusions concerning biocompatibility may be inappropriate.
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Affiliation(s)
- K.L. Donovan
- Institute of Nephrology, Royal Infirmary, Cardiff, Wales - UK
| | - S. Pacholok
- Merck Sharp and Dohme Research Laboratories, Rahway, New Jersey - USA
| | - A. Phillips
- Institute of Nephrology, Royal Infirmary, Cardiff, Wales - UK
| | - J.L. Humes
- Institute of Nephrology, Royal Infirmary, Cardiff, Wales - UK
| | - G.A. Coles
- Institute of Nephrology, Royal Infirmary, Cardiff, Wales - UK
| | - J.D. Williams
- Institute of Nephrology, Royal Infirmary, Cardiff, Wales - UK
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41
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Harrison AS, Doherty P, Phillips A. An analysis of barriers to entry of cardiac rehabilitation in patients with diabetes: Using data from the National Audit of Cardiac Rehabilitation. Diab Vasc Dis Res 2018; 15:145-149. [PMID: 29205066 DOI: 10.1177/1479164117744490] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND UK cardiac rehabilitation has reached for the first time 50% uptake in 2016; however, this still leaves 50% of the eligible group not starting cardiac rehabilitation. The characteristics of patients missing cardiac rehabilitation are relatively unknown with some studies in America suggesting that patients with diabetes have a reduced likelihood of joining cardiac rehabilitation. METHODS This study used routinely collected data from the National Audit of Cardiac Rehabilitation to investigate proportional differences in patients with cardiovascular disease with, and without, diabetes taking up the offer of cardiac rehabilitation. RESULTS The proportion of patients with diabetes entering cardiac rehabilitation dropped by between 7% and 15% depending on the age group (<40 years, 7% reduction; 61-80 years, 15%). The study's results showed that in all demographic and diagnostic groups, the proportion of patients with diabetes was significantly less than that of the eligible group ( p < 0.001). There was no difference in the proportion of loss, from eligible to starting cardiac rehabilitation, between males and females, which was 13% for both groups. CONCLUSION This study confirms, in a new UK population with over 121,002 eligible patients, that there is a statistically significant drop in patients with diabetes taking up cardiac rehabilitation. This study is unique in looking at all four key diagnosis and treatment groups and comparing them to those taking up cardiac rehabilitation. To achieve the target of 65% uptake set by NHS England, improvements in identifying and targeting complex patients, such as those with diabetes, need to be adopted.
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Affiliation(s)
| | | | - Anne Phillips
- Department of Health Sciences, University of York, York, UK
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42
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Xu J, Hartley BJ, Kurup P, Phillips A, Topol A, Xu M, Ononenyi C, Foscue E, Ho SM, Baguley TD, Carty N, Barros CS, Müller U, Gupta S, Gochman P, Rapoport J, Ellman JA, Pittenger C, Aronow B, Nairn AC, Nestor MW, Lombroso PJ, Brennand KJ. Inhibition of STEP 61 ameliorates deficits in mouse and hiPSC-based schizophrenia models. Mol Psychiatry 2018; 23:271-281. [PMID: 27752082 PMCID: PMC5395367 DOI: 10.1038/mp.2016.163] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/13/2016] [Accepted: 08/11/2016] [Indexed: 02/03/2023]
Abstract
The brain-specific tyrosine phosphatase, STEP (STriatal-Enriched protein tyrosine Phosphatase) is an important regulator of synaptic function. STEP normally opposes synaptic strengthening by increasing N-methyl D-aspartate glutamate receptor (NMDAR) internalization through dephosphorylation of GluN2B and inactivation of the kinases extracellular signal-regulated kinase 1/2 and Fyn. Here we show that STEP61 is elevated in the cortex in the Nrg1+/- knockout mouse model of schizophrenia (SZ). Genetic reduction or pharmacological inhibition of STEP prevents the loss of NMDARs from synaptic membranes and reverses behavioral deficits in Nrg1+/- mice. STEP61 protein is also increased in cortical lysates from the central nervous system-specific ErbB2/4 mouse model of SZ, as well as in human induced pluripotent stem cell (hiPSC)-derived forebrain neurons and Ngn2-induced excitatory neurons, from two independent SZ patient cohorts. In these selected SZ models, increased STEP61 protein levels likely reflect reduced ubiquitination and degradation. These convergent findings from mouse and hiPSC SZ models provide evidence for STEP61 dysfunction in SZ.
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Affiliation(s)
- J Xu
- Child Study Center, Yale University, New Haven, CT, USA
| | - B J Hartley
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P Kurup
- Child Study Center, Yale University, New Haven, CT, USA
| | - A Phillips
- Hussman Institute for Autism, Baltimore, MD, USA
| | - A Topol
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Xu
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - C Ononenyi
- Child Study Center, Yale University, New Haven, CT, USA
| | - E Foscue
- Child Study Center, Yale University, New Haven, CT, USA
| | - S-M Ho
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Developmental and Stem Cell Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Baguley
- Department of Chemistry, Yale University, New Haven, CT, USA
| | - N Carty
- Child Study Center, Yale University, New Haven, CT, USA
| | - C S Barros
- Dorris Neuroscience Center, Department of Cell Biology, The Scripps Research Institute, La Jolla, CA, USA,Plymouth University School of Medicine, Plymouth UK
| | - U Müller
- Dorris Neuroscience Center, Department of Cell Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - S Gupta
- UC Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - P Gochman
- Childhood Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - J Rapoport
- Childhood Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - J A Ellman
- Department of Chemistry, Yale University, New Haven, CT, USA
| | - C Pittenger
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - B Aronow
- UC Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - A C Nairn
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - M W Nestor
- Hussman Institute for Autism, Baltimore, MD, USA
| | - P J Lombroso
- Child Study Center, Yale University, New Haven, CT, USA,Department of Psychiatry, Yale University, New Haven, CT, USA,Department of Neurobiology, Yale University, New Haven, CT, USA,Department of Psychiatry, Yale University, New Haven, CT, USA E-mail:
| | - K J Brennand
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA. E-mail:
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Santos JR, Cozzi-Lepri A, Phillips A, De Wit S, Pedersen C, Reiss P, Blaxhult A, Lazzarin A, Sluzhynska M, Orkin C, Duvivier C, Bogner J, Gargalianos-Kakolyris P, Schmid P, Hassoun G, Khromova I, Beniowski M, Hadziosmanovic V, Sedlacek D, Paredes R, Lundgren JD. Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe. HIV Med 2018; 19:324-338. [PMID: 29388732 DOI: 10.1111/hiv.12581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens. METHODS Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches. RESULTS The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART. CONCLUSIONS Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.
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Affiliation(s)
- J R Santos
- Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - A Phillips
- Royal Free and University College, London, UK
| | - S De Wit
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - C Pedersen
- Odense University Hospital, Odense, Denmark
| | - P Reiss
- Academic Medical Center, Amsterdam, the Netherlands
| | - A Blaxhult
- Karolinska Institute, Venhälsan, Stockholm, Sweden
| | - A Lazzarin
- San Raffaele Scientific Institute, Milan, Italy
| | - M Sluzhynska
- Lviv Regional HIV/AIDS Prevention and Control Centre, Kiev, Ukraine
| | - C Orkin
- Royal London Hospital, London, UK
| | - C Duvivier
- Hôpital Necker-Enfants Malades, Paris, France
| | - J Bogner
- Medizinische Poliklinik, Munchen, Germany
| | | | - P Schmid
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - G Hassoun
- Rambam Health Care Campus, Haifa, Israel
| | - I Khromova
- Centre for HIV/AIDS and Infectious Diseases, Moscow, Russia
| | | | - V Hadziosmanovic
- Klinicki Centar Univerziteta Sarajevo (KCUS), Sarajevo, Bosnia & Herzegovina
| | - D Sedlacek
- Charles University Hospital, Plzen, Czech Republic
| | - R Paredes
- Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Barcelona, Spain.,Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - J D Lundgren
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Decatris M, Hayes M, Reed N, Bhalla V, Thomas J, Gaikwad K, Birchall K, Phillips A, Ryan P, Du Rand I, Taniere P. Programmed death-ligand 1 (PD-L1) expression and testing experience in a cohort of advanced non-small cell lung cancer (NSCLC) patients. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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45
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Phillips A, Heier M, Strobl R, Linkohr B, Holle R, Peters A, Grill E. Anticholinergic and sedative medication as risk factor for vertigo and dizziness in the general population: Results from the KORA-FF4 survey. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Phillips
- Ludwig-Maximilians-Universität, German Center for Vertigo and Balance Disorders, Munich
- Ludwig-Maximilians-Universität, Institute for Medical Information Processing, Biometrics and Epidemiology, Munich
| | - M Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - R Strobl
- Ludwig-Maximilians-Universität, German Center for Vertigo and Balance Disorders, Munich
- Ludwig-Maximilians-Universität, Institute for Medical Information Processing, Biometrics and Epidemiology, Munich
| | - B Linkohr
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - R Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - A Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - E Grill
- Ludwig-Maximilians-Universität, German Center for Vertigo and Balance Disorders, Munich
- Ludwig-Maximilians-Universität, Institute for Medical Information Processing, Biometrics and Epidemiology, Munich
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Turvill J, Rook L, Rawle M, Robins G, Smale S, Kant P, Phillips A. Validation of a care pathway for the use of faecal calprotectin in monitoring patients with Crohn's disease. Frontline Gastroenterol 2017; 8:183-188. [PMID: 28839907 PMCID: PMC5558279 DOI: 10.1136/flgastro-2016-100780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION We have previously published an evidence-based care pathway for the use of faecal calprotectin (FC) to monitor patients with Crohn's disease established on therapy. Patients are treated as low, intermediate or high risk of continuing Crohn's disease activity based on their FC, whatever their phenotype and surgical status are. Low-risk patients (FC <100 µg/g) are offered 12 monthly follow-ups or step down of therapy if asymptomatic or initial expectant symptomatic treatment. Intermediate-risk patients (FC 100-250 µg/g) are reviewed at 6 months with a repeat FC. High-risk patients (two consecutive FCs >250 µg/g) are flagged up to the responsible clinician as likely having an active Crohn's disease. METHODS To validate this care pathway over a 2-year period, by determining its negative predictive value (NPV) and positive predictive value (PPV). RESULTS 123 patients were managed by means of the care pathway for a mean of 24.4 months. The NPV and PPV were 0.97 (CI 0.93 to 0.98) and 0.85 (CI 0.80 to 0.94), respectively (sensitivity: 0.92 (0.83 to 0.96) and specificity: 0.95 (0.92 to 0.98)). Importantly 69% of patients with FC >250 µg/g were in clinical remission, the care pathway identifying patients who would benefit from presymptomatic disease modification. CONCLUSIONS This validation of a pragmatic clinical care pathway demonstrates a safe and effective mechanism by which to use FC to monitor risk of disease activity in patients with Crohn's disease established on therapy. It provides a framework for prioritising follow-up and for identifying patients at risk of continuing disease activity or those in whom therapy could be stepped down.
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Affiliation(s)
- James Turvill
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Lisa Rook
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Maxine Rawle
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Gerry Robins
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Simon Smale
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Prashant Kant
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Anne Phillips
- Department of Gastroenterology, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
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Phillips A, Strobl R, Vogt S, Ladwig KH, Thorand B, Grill E. Sarcopenia is associated with disability status-results from the KORA-Age study. Osteoporos Int 2017; 28:2069-2079. [PMID: 28386704 DOI: 10.1007/s00198-017-4027-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/29/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED We estimated the prevalence of sarcopenia and its impact on disability in older people. Sarcopenia was found to contribute to higher disability scores. However, our study was not able to show any influence of sarcopenia on the rate of functional decline. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not. INTRODUCTION The objectives of this study using data from a population-based cohort were to estimate the prevalence of sarcopenia in older people in Germany and to test the hypothesis that sarcopenia is associated with disability in older adults. METHODS Cross-sectional (n = 927) and longitudinal analyses (n = 859) of participants aged ≥65 years at baseline from southern Germany enrolled in the Cooperative Health Research in the Region Augsburg (KORA)-Age study (2009-2012). Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm which includes the presence of both low muscle mass and low muscle function (strength or performance). Disability status was measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). The presence of disability was defined as HAQ-DI >0. Directed acyclic graphs (DAGs) were constructed to identify potential confounders. The effect of sarcopenia on disability was analyzed using linear mixed effect models with disability values as a continuous outcome. RESULTS The overall prevalence of sarcopenia was 5.7% (men 4.0%, women 7.5%) and increased with age. The 3-year incidence of disability was 32.7%. After adjustment for potential confounders, presence of sarcopenia was significantly associated with higher disability scores (0.142 [confidence interval 0.029-0.254]). CONCLUSION The prevalence of sarcopenia is consistent with estimates from other European studies using this algorithm. Our results suggest that sarcopenia can contribute to higher disability scores in older adults. However, our study was not able to show any influence of sarcopenia on the rate of functional decline using the EWGSOP diagnostic algorithm for sarcopenia. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not.
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Affiliation(s)
- A Phillips
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - R Strobl
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S Vogt
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - K-H Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - E Grill
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
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Judd A, Lodwick R, Noguera‐Julian A, Gibb DM, Butler K, Costagliola D, Sabin C, van Sighem A, Ledergerber B, Torti C, Mocroft A, Podzamczer D, Dorrucci M, De Wit S, Obel N, Dabis F, Cozzi‐Lepri A, García F, Brockmeyer NH, Warszawski J, Gonzalez‐Tome MI, Mussini C, Touloumi G, Zangerle R, Ghosn J, Castagna A, Fätkenheuer G, Stephan C, Meyer L, Campbell MA, Chene G, Phillips A. Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe. HIV Med 2017; 18:171-180. [PMID: 27625109 PMCID: PMC5298034 DOI: 10.1111/hiv.12411] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. METHODS We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. RESULTS The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4. CONCLUSIONS The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.
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Affiliation(s)
- A Judd
- MRC Clinical Trials UnitUniversity College LondonLondonUK
| | - R Lodwick
- Department of Infection and Population HealthUniversity College LondonLondonUK
| | - A Noguera‐Julian
- Institut de Recerca Pediàtrica Hospital Sant Joan de DéuBarcelonaSpain
- Departament de PediatriaUniversitat de BarcelonaBarcelonaSpain
- CIBER de Epidemiología y Salud Pública CiberespBarcelonaSpain
| | - DM Gibb
- MRC Clinical Trials UnitUniversity College LondonLondonUK
| | - K Butler
- Department of Infectious Diseases and ImmunologyOur Lady's Children's HospitalCrumlin, DublinIreland
| | - D Costagliola
- INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136)Sorbonne UniversitésParisFrance
| | - C Sabin
- Department of Infection and Population HealthUniversity College LondonLondonUK
| | - A van Sighem
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - B Ledergerber
- Division of Infectious Diseases and Hospital EpidemiologyUniversity of ZurichZurichSwitzerland
| | - C Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical SciencesUniversity “Magna Graecia”CatanzaroItaly
| | - A Mocroft
- Department of Infection and Population HealthUniversity College LondonLondonUK
| | - D Podzamczer
- HIV and STD Unit, Infectious Disease ServiceHospital Universitari de Bellvitge. L'HospitaletBarcelonaSpain
| | | | - S De Wit
- Département of Infectious Diseases, Centre Hospitalier Saint‐PierreUniversité Libre de BruxellesBrusselsBelgium
| | - N Obel
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - F Dabis
- INSERM U1219 – Centre Inserm Bordeaux Population HealthUniversité de BordeauxBordeauxFrance
- ISPED, Centre INSERM U1219‐Bordeaux Population HealthUniversité de BordeauxBordeauxFrance
| | - A Cozzi‐Lepri
- Department of Infection and Population HealthUniversity College LondonLondonUK
| | - F García
- Clinical Microbiology Department, Complejo Hospitalario Universitario GranadaInstituto de Investigación Biosanitaria ibs.GranadaGranadaSpain
| | - NH Brockmeyer
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, St. Josef HospitalRuhr‐Universität BochumBochumGermany
| | - J Warszawski
- INSERM CESP U1018, AP‐HP Public Health DepartmentUniversité Paris‐Sud, Université Paris‐SaclayLe Kremlin‐Bicêtre ParisFrance
| | - MI Gonzalez‐Tome
- HIV and Paeds Infectious Diseases DepartmentHospital 12 de OctubreMadridSpain
| | - C Mussini
- Infectious Diseases ClinicsUniversity HospitalModenaItaly
| | - G Touloumi
- Department Hygiene, Epidemiology & Medical Statistics, Medical SchoolNational & Kapodistrian University of AthensAthensGreece
| | - R Zangerle
- Medical University InnsbruckInnsbruckAustria
| | - J Ghosn
- EA 7327, Faculté de Médecine site NeckerUniversité Paris Descartes, Sorbonne Paris CitéParisFrance
- APHP, Unité Fonctionnelle de Thérapeutique en Immuno‐InfectiologieHôpitaux Universitaires Paris Centre site Hôtel DieuParisFrance
| | - A Castagna
- San Raffaele Scientific InstituteVita‐SaLute UniversityMilanItaly
| | - G Fätkenheuer
- Department I of Internal MedicineUniversity Hospital of CologneCologneGermany
| | - C Stephan
- Second Medical Department, Infectious Diseases UnitGoethe‐University HospitalFrankfurtGermany
| | - L Meyer
- INSERM CESP U1018Université Paris‐Sud, Université Paris‐SaclayParisFrance
- AP‐HP Public Health DepartmentLe Kremlin‐BicêtreParisFrance
| | - MA Campbell
- Centre for Health and Infectious Disease ResearchUniversity of CopenhagenCopenhagenDenmark
| | - G Chene
- INSERM U1219 – Centre Inserm Bordeaux Population HealthUniversité de BordeauxBordeauxFrance
- ISPED, Centre INSERM U1219‐Bordeaux Population HealthUniversité de BordeauxBordeauxFrance
- CHU de Bordeaux, Pole de sante publique, Service d'information medicaleBordeauxFrance
| | - A Phillips
- Department of Infection and Population HealthUniversity College LondonLondonUK
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Decatris M, Reed N, Bhalla V, Birchall K, Phillips A, Ryan P, Hedges A, Hayes M, Thomas J, Du Rand I. 85: Single MDT 30-day mortality after systemic anticancer therapy (SACT) for lung cancer in an NHS trust serving an English and Welsh population. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anyanwu GI, Davies DH, Molyneux DH, Phillips A. Variation in cuticular hydrocarbons among strains ofAnopheles(Cellia)stephensiListon possibly related to prior insecticide exposure. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1997.11813184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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