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Robinson JL, Gatford KL, Hurst CP, Clifton VL, Morrison JL, Stark MJ. Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study. J Asthma 2023:1-11. [PMID: 37021838 DOI: 10.1080/02770903.2023.2200824] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Asthma occurs in ∼17% of Australian pregnancies and is associated with adverse perinatal outcomes, which worsen with poor asthma control . Consequently, the South Australian 'Asthma in Pregnancy' perinatal guidelines were revised in 2012 to address management according to severity. This study investigated if these revised guidelines reduced the impact of maternal asthma on risks of adverse perinatal outcomes before (Epoch 1, 2006-2011) and after the revision (Epoch 2, 2013-2018). METHODS Routinely collected perinatal and neonatal datasets from the Women's and Children's Hospital (Adelaide, Australia) were linked. Maternal asthma (prevalence:7.5%) was defined as asthma medication use or symptoms described to midwives. In imputation (n = 59131) and complete case datasets (n = 49594), analyses were conducted by inverse proportional weighting and multivariate logistic regression, accounting for confounders. RESULTS Overall, maternal asthma was associated with increased risks of any antenatal corticosteroid treatment for threatened preterm birth (aOR 1.319, 95% CI 1.078-1.614), any Caesarean section (aOR 1.196, 95% CI 1.059-1.351), Caesarean section without labor (aOR 1.241, 95% CI 1.067-1.444), intrauterine growth restriction (IUGR, aOR 1.285, 95% CI 1.026-1.61), and small for gestational age (aOR 1.324, 95% CI 1.136-1.542). After guideline revision, asthma-associated risks of any Caesarean section (p < 0.001), any antenatal corticosteroids (p = 0.041), and small for gestational age (p = 0.050), but not IUGR and Caesarean section without labour, were reduced. CONCLUSIONS Clinical practice guidelines based on the latest evidence do not guarantee clinical efficacy. Since adverse perinatal outcomes did not all improve, this work highlights the need to evaluate the ongoing impact of guidelines on clinical outcomes.
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Affiliation(s)
- J L Robinson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Early Origins of Adult Health Research Group, Health, and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - K L Gatford
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - C P Hurst
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - V L Clifton
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - J L Morrison
- Early Origins of Adult Health Research Group, Health, and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - M J Stark
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Women's & Children's Hospital, Adelaide, Australia
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McKeating DR, Clifton VL, Hurst CP, Fisher JJ, Bennett WW, Perkins AV. Elemental Metabolomics for Prediction of Term Gestational Outcomes Utilising 18-Week Maternal Plasma and Urine Samples. Biol Trace Elem Res 2021; 199:26-40. [PMID: 32239374 DOI: 10.1007/s12011-020-02127-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
A normal pregnancy is essential to establishing a healthy start to life. Complications during have been associated with adverse perinatal outcomes and lifelong health problems. The ability to identify risk factors associated with pregnancy complications early in gestation is vitally important for preventing negative foetal outcomes. Maternal nutrition has been long considered vital to a healthy pregnancy, with micronutrients and trace elements heavily implicated in maternofoetal metabolism. This study proposed the use of elemental metabolomics to study multiple elements at 18 weeks gestation from blood plasma and urine to construct models that could predict outcomes such as small for gestational age (SGA) (n = 10), low placental weight (n = 18), and preterm birth (n = 13) from control samples (n = 87). Samples collected from the Lyell McEwin Hospital in Adelaide, South Australia, were measured for 27 plasma elements and 37 urine elements by inductively coupled plasma mass spectrometry. Exploratory analysis indicated an average selenium concentration 20 μg/L lower than established reference ranges across all groups, low zinc in preterm (0.64 μg/L, reference range 0.66-1.10 μg/L), and higher iodine in preterm and SGA gestations (preterm 102 μg/L, SGA 111 μg/L, reference range 40-92 μg/L). Using random forest algorithms with receiver operating characteristic curves, low placental weight was predicted with 86.7% accuracy using plasma, 78.6% prediction for SGA with urine, and 73.5% determination of preterm pregnancies. This study indicates that elemental metabolomic modelling could provide a means of early detection of at-risk pregnancies allowing for more targeted monitoring of mothers, with potential for early intervention strategies to be developed.
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Affiliation(s)
- Daniel R McKeating
- School of Medical Science, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4215, Australia
| | - Vicki L Clifton
- Pregnancy and Development, Mater Research Institute-University of Queensland, Translational Research Institute, South Brisbane, Australia
| | - Cameron P Hurst
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Joshua J Fisher
- School of Medical Science, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4215, Australia
| | - William W Bennett
- School of Environment and Science, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Anthony V Perkins
- School of Medical Science, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4215, Australia.
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Hurst CP, Rakkapao N, Hay K. Impact of diabetes self-management, diabetes management self-efficacy and diabetes knowledge on glycemic control in people with Type 2 Diabetes (T2D): A multi-center study in Thailand. PLoS One 2021; 15:e0244692. [PMID: 33382799 PMCID: PMC7774854 DOI: 10.1371/journal.pone.0244692] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
We investigate the relationship of diabetes knowledge, diabetes management self-efficacy and diabetes self-management with blood glucose control among people with Thai type 2 diabetes mellitus (T2D). Seven hundred outpatients from diabetes clinics from large university and small community hospitals in two provinces of Thailand (Khon Kaen and Bangkok) were interviewed to evaluate their diabetes knowledge (DK), diabetes management self-efficacy (DMSE) and diabetes self-management (DSM). In addition, patient medical records were accessed to obtain other patient characteristics including patients’ HbA1c levels. Bivariate and multivariable logistic regression modelling was conducted and unadjusted and adjusted odds ratios obtained, respectively. Over half (52.4%) of the patients in our sample failed to control their blood glucose (HbA1c > 7%). All three psychometric measures (DK, DMSE and DSM) were identified as associated with blood glucose control in the bivariate analysis (ORDK(unadj) = 0.89, 95%CI: 0.82, 0.96; ORDSM(unadj) = 1.64, 95%CI: 1.46, 1.82; ORDMSE(unadj) = 2.84; 95%CI: 2.43, 3.32). However, after mutual adjustment and adjustment for other patient characteristics, of the three psychometric measures, only diabetes management self-efficacy remained associated with blood glucose control (ORDMSE(adj) = 2.67; 95%CI: 2.20, 3.25). Diabetes management self-efficacy is shown to be strongly associated with blood glucose control in the Thai Type 2 diabetes population. Current early diabetes interventions in Thailand tend to focus on disease knowledge. A stronger emphasis on enhancing patients’ disease management self-efficacy in these interventions is likely to lead to substantial improvement in both diabetes self-management and blood glucose control, thereafter reducing the risk, or prolonging the development, of chronic diabetes complications.
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Affiliation(s)
- Cameron P. Hurst
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Public Health, Thammasat University, Muang, Lampang, Thailand
| | - Nitchamon Rakkapao
- Faculty of Public Health, Thammasat University, Muang, Lampang, Thailand
- * E-mail:
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Affiliation(s)
- Helen M Stallman
- School of Psychology, Social Work and Social Policy, University of South Australia,
| | - Cameron P Hurst
- School of Public Health, Queensland University of Technology,
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Piralam B, Prosperi C, Thamthitiwat S, Bunthi C, Sawatwong P, Sangwichian O, Higdon MM, Watson NL, Deloria Knoll M, Paveenkittiporn W, Chara C, Hurst CP, Akarasewi P, Rhodes J, Maloney SA, O’Brien KL, Baggett HC. Pneumococcal colonization prevalence and density among Thai children with severe pneumonia and community controls. PLoS One 2020; 15:e0232151. [PMID: 32348330 PMCID: PMC7190126 DOI: 10.1371/journal.pone.0232151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/06/2020] [Indexed: 02/03/2023] Open
Abstract
Background Pneumococcal colonization prevalence and colonization density, which has been associated with invasive disease, can offer insight into local pneumococcal ecology and help inform vaccine policy discussions. Methods The Pneumonia Etiology Research for Child Health Project (PERCH), a multi-country case-control study, evaluated the etiology of hospitalized cases of severe and very severe pneumonia among children aged 1–59 months. The PERCH Thailand site enrolled children during January 2012–February 2014. We determined pneumococcal colonization prevalence and density, and serotype distribution of colonizing isolates. Results We enrolled 224 severe/very severe pneumonia cases and 659 community controls in Thailand. Compared to controls, cases had lower colonization prevalence (54.5% vs. 62.5%, p = 0.12) and lower median colonization density (42.1 vs. 210.2 x 103 copies/mL, p <0.0001); 42% of cases had documented antibiotic pretreatment vs. 0.8% of controls. In no sub-group of assessed cases did pneumococcal colonization density exceed the median for controls, including cases with no prior antibiotics (63.9x103 copies/mL), with consolidation on chest x-ray (76.5x103 copies/mL) or with pneumococcus detected in whole blood by PCR (9.3x103 copies/mL). Serotype distribution was similar among cases and controls, and a high percentage of colonizing isolates from cases and controls were serotypes included in PCV10 (70.0% and 61.8%, respectively) and PCV13 (76.7% and 67.9%, respectively). Conclusions Pneumococcal colonization is common among children aged <5 years in Thailand. However, colonization density was not higher among children with severe pneumonia compared to controls. These results can inform discussions about PCV introduction and provide baseline data to monitor PCV impact after introduction in Thailand.
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Affiliation(s)
- Barameht Piralam
- Department of Epidemiology and Biostatistics, Khon Kaen University, Khon Kaen, Thailand
- * E-mail: ,
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Charatdao Bunthi
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nora L. Watson
- The Emmes Company, Rockville, Maryland, United States of America
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Cameron P. Hurst
- Department of Epidemiology and Biostatistics, Khon Kaen University, Khon Kaen, Thailand
| | - Pasakorn Akarasewi
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Julia Rhodes
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Susan A. Maloney
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Henry C. Baggett
- Division of Global Health Protection, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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Jutivorakool K, Sittiwattanawong P, Kantikosum K, Hurst CP, Kumtornrut C, Asawanonda P, Klaewsongkram J, Rerknimitr P. Skin Manifestations in Patients with Adult-onset Immunodeficiency due to Anti-interferon-gamma Autoantibody: A Relationship with Systemic Infections. Acta Derm Venereol 2018; 98:742-747. [PMID: 29701234 DOI: 10.2340/00015555-2959] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adult-onset immunodeficiency due to anti-interferon-γ autoantibody is an emerging acquired immunodeficiency with frequent skin manifestations. A retrospective chart review was conducted and identified 41 patients with the syndrome. Skin involvement was detected in 33 (80%) patients, 15 (45%) with infective skin diseases and 27 (82%) with reactive skin disorders. Reactive lesions were mostly neutrophilic dermatoses, e.g. Sweet syndrome. Of note, the presence of neutrophilic dermatoses was highly associated with infections of other sites. An adjusted odds ratio for the existence of infections in patients with neutrophilic dermatoses was 14.79 (95% CI: 5.13, 42.70; p < 0.001). Moreover, neutrophilic dermatoses were significantly correlated with opportunistic infections observed in those with defects in cell-mediated immunity including non-tuberculous mycobacterium and disseminated fungal infection. The odds ratio for opportunistic infections in the presence of neutrophilic dermatoses was 12.35 (95% CI: 5.00, 30.55; p <0.001). Thus, the presence of neutrophilic dermatoses in patients with the syndrome can signal opportunistic infections that warrant physician attention.
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Affiliation(s)
- Kamonwan Jutivorakool
- Division of Infectious Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Boonyagars L, Hirunwiwatkul P, Hurst CP. CD4 count and risk of anti-tuberculosis drug-associated cutaneous reactions in HIV-infected Thai patients. Int J Tuberc Lung Dis 2018; 21:338-344. [PMID: 28225346 DOI: 10.5588/ijtld.16.0425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) is a major cause of morbidity and mortality in human immunodeficiency virus (HIV) infected patients. However, anti-tuberculosis drugs can cause cutaneous adverse drug reactions (CADRs). This study was conducted to evaluate differences in CADR incidence between low and high CD4 cell count in patients with low and high CD4 cell count and to identify other risk factors for CADR in HIV-TB co-infected patients. DESIGN In a retrospective cohort of adult HIV-TB co-infected patients receiving standard anti-tuberculosis treatment between January 2008 and December 2015 at Vajira Hospital, Bangkok, Thailand, baseline demographic, clinical characteristics and factors associated with CADRs, including CD4 cell count status, were collected. RESULTS Of 307 patients enrolled, CADRs occurred in 48 during the 6-month period of anti-tuberculosis treatment (incidence rate 0.41 events/person-year). Maculopapular rash was the most prevalent CADR. Low CD4 cell count was not associated with CADRs. Cox regression analysis revealed that moderate decrease in the glomerular filtration rate, history of drug hypersensitivity and concomitant cotrimoxazole use were all associated with CADRs. Concomitant antiretroviral therapy use was associated with lower risk of CADRs. No difference in the time to CADRs between patients with lower and higher CD4 cell count could be demonstrated. CONCLUSION CADRs are common in HIV-TB co-infected patients. Early recognition and prompt withdrawal of the offending agent can prevent complications and improve TB care.
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Affiliation(s)
- L Boonyagars
- Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok
| | - P Hirunwiwatkul
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok
| | - C P Hurst
- Biostatistics Center of Excellence, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Chansangpetch S, Panpruk R, Manassakorn A, Tantisevi V, Rojanapongpun P, Hurst CP, Lin SC. Impact of Myopia on Corneal Biomechanics in Glaucoma and Nonglaucoma Patients. Invest Ophthalmol Vis Sci 2017; 58:4990-4996. [PMID: 28979996 PMCID: PMC5627793 DOI: 10.1167/iovs.17-22219] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose We evaluated the impact of myopia on corneal biomechanical properties in primary open-angle glaucoma (POAG) and nonglaucoma patients, and the effect of modification of glaucoma on myopic eyes. Methods This cross-sectional study included 66 POAG eyes (33 myopia, 33 nonmyopia) and 66 normal eyes (33 myopia, 33 nonmyopia). Seven corneal biomechanical parameters were measured by ultra-high-speed Scheimpflug imaging, including corneal deformation amplitude (CDA), inward/outward corneal applanation length (ICA, OCA), inward/outward corneal velocity (ICV, OCV), radius, and peak distance (PD). Results Mean age (SD) of the 65 male (49%) and 67 female (51%) patients was 59 (9.82) years. Myopia was associated with significantly higher CDA (adjusted effect = 0.104, P = 0.001) and lower OCV (adjusted effect = -0.105, P < 0.001) in the POAG group. Within the nonglaucoma group, myopic eyes had a significantly lower OCV (adjusted effect = -0.086, P < 0.001) and higher CDA (adjusted effect = 0.079, P = 0.001). All parameters except PD suggested that glaucoma modified the effect of myopia on corneal biomechanics. Percentage differences in the adjusted myopic effect between POAG and nonglaucoma patients was 31.65, 27.27, 31.65, 50.00, 22.09, and 60.49 for CDA, ICA, OCA, ICV, OCV, and radius, respectively. Conclusions Myopia had a significant impact on corneal biomechanical properties in the POAG and nonglaucoma groups. The differences in corneal biomechanical parameters suggest that myopia is correlated with significantly lower ocular rigidity. POAG may enhance the effects of myopia on most of these parameters.
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Affiliation(s)
- Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California, United States
| | - Rawiphan Panpruk
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anita Manassakorn
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Visanee Tantisevi
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Prin Rojanapongpun
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Cameron P Hurst
- Biostatistics Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California, United States
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Sonthon P, Promthet S, Changsirikulchai S, Rangsin R, Thinkhamrop B, Rattanamongkolgul S, Hurst CP. The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study. PLoS One 2017; 12:e0180977. [PMID: 28753611 PMCID: PMC5533425 DOI: 10.1371/journal.pone.0180977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/24/2017] [Indexed: 01/29/2023] Open
Abstract
Objective The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients. Methods This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011–2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression. Results After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59–0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression. Conclusions This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression.
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Affiliation(s)
- Paithoon Sonthon
- Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
- Phetchabun Provincial Public Health Office, Ministry of Public Health, Phetchabun, Thailand
| | | | | | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | | | - Cameron P. Hurst
- Center of Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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Abstract
Background: Raising breast cancer awareness is a key strategy to reduce associated mortality. While a paucity
of adequately validated instruments for breast cancer awareness is applicable across cultures, even outside the health
care setting such instruments have been developed. Objective: This study investigated the validity and psychometric
properties of a breast cancer awareness scale in Indonesia (BCAS-I). Methods: This cross-sectional study was carried
out among Indonesian women conveniently selected within three provinces (Yogyakarta, South of Sumatera and East
Nusa Tenggara) located in rural-urban areas using stratified random sampling. First, we translated all questionnaires
from English to the local language and then back-translated. The third step was to perform psychometric testing of
the adapted instrument by establishing internal consistency (Cronbach’s alpha score 0.79) and construct validity by
confirmatory factor analysis (CFA). Results: In the 856 participants who responded (responded rate = 98.28%), the
age ranged from 18 to 80 years old (mean = 30, SD = 11). The BCAS-I was shown to have good internal consistency,
and CFA demonstrated the model fit data adequately (χ2 = 922.267, df = 515, p <0.001, comparative fit index = 0.965,
Tucker-Lewis Index = 0.96, goodness-of-fit index = 0.97, adjusted goodness-of-fit index = 0.97, root-mean-square
error of approximation = 0.03 95% confidence interval: 0.027, 0.034). The final version of BCAS-I consists of 33
items across 5 domains that cover most key aspects of breast cancer awareness for this population. Conclusion: The
BCAS-I demonstrated good psychometric properties and was found to be valid to provide a measurement of breast
cancer awareness in Asian women in general and Indonesian women in particular.
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Affiliation(s)
- Solikhah Solikhah
- Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand,Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta 55166, Indonesia.
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Rakkapao N, Promthet S, Moore MA, Hurst CP. Development of a Breast Cancer Awareness Scale for Thai Women: Moving towards a Validated Measure. Asian Pac J Cancer Prev 2017; 17:851-6. [PMID: 26925691 DOI: 10.7314/apjcp.2016.17.2.851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Breast cancer is a major health problem among women around the world. Recent developments in screening and treatment have greatly improved the prognosis of patients with breast cancer in developed countries. However, in developing countries breast cancer mortality remains high.Breast cancer awareness is a first and important step in reducing breast cancer mortality. The development of a validated instrument to measure breast cancer awareness is crucial for the understanding and implementation of suitable health education programs to facilitate early deletion and minimize mortality. OBJECTIVE The objective of this study was to develop an instrument for the assessment of breast cancer awareness in Thai women. MATERIALS AND METHODS This methodological study was conducted in two stages: (1) literature searches and semi-structured interviews were conducted to generate items of the breast cancer awareness scale (B-CAS) which were subsequently examined for content and face validity, and (2) an exploration of the factor structure of the resulting instrument and an examination of its reliability. Data were collected using a self-administered questionnaire in Thai women aged 20-64 in August, 2015. RESULTS A total of 219 women (response rate 97.4 %) participated in this validation study. The B-CAS contains five domains with 53 items on breast cancer awareness: 1) knowledge of risk factors, 2) knowledge of signs and symptoms, 3) attitude to breast cancer prevention, 4) barriers of breast screening, and 5) health behavior related to breast cancer awareness. Items with a content validity index <0.80 were excluded, and factor structure for the remaining items reflected the hypothesized five factor model. The scales based on all retained items was shown to have strongly internal consistency reliability (Cronbach's α=0.86). CONCLUSIONS The B-CAS provides good psychometric properties to assess breast cancer awareness in women. It can be used to examine breast cancer awareness in Thai women and it could lead to the development and evaluation of suitable educational interventions for raising breast cancer awareness. Future research should focus on further validating the B-CAS including an assessment of construct and criterion-based validity.
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Affiliation(s)
- Nitchamon Rakkapao
- Doctor of Public Health Program, Khon Kaen University, Thailand E-mail :
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Rerknimitr P, Pongpairoj K, Kumtornrat C, Panchaprateep R, Hurst CP, Chutinet A, Asawanonda P, Suwanwela NC. Anterior Tragal Crease Is Associated With Atherosclerosis: A Study Evaluating Carotid Artery Intima-Media Thickness. Angiology 2017; 68:683-687. [PMID: 28056529 DOI: 10.1177/0003319716685481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The utility of the ear crease sign, anterior tragal crease (ATC), as a marker of atherosclerosis is yet to be established. The intima-media thickness of the common carotid artery (IMT-CCA) has been used as a noninvasive surrogate marker for atherosclerosis. History of traditional risk factors for atherosclerosis was obtained from 147 volunteers; ear examination was also performed and venous blood was drawn for laboratory analysis. The volunteers then underwent an ultrasonography measurement of the IMT-CCA. In univariate analysis, presence of ATC, age, underlying hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular disease, cigarette smoking, low-density lipoprotein, and high-sensitivity C-reactive protein were significantly associated with the IMT-CCA. Further multivariate analysis confirmed a significant association between the presence of ATC and IMT-CCA, when adjusted for other factors (adjusted βATC = .010, 95% confidence interval: 0.0021-0.019). Anterior tragal crease is a potential clinical sign that can predict atherosclerosis. The sign is easily recognizable and may help health-care professionals to identify those at risk of atherosclerosis, especially in people with no clinical signs of the disease.
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Affiliation(s)
- Pawinee Rerknimitr
- 1 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Korbkarn Pongpairoj
- 1 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Chanat Kumtornrat
- 1 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand.,2 Dermatology Unit, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ratchathorn Panchaprateep
- 1 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Cameron P Hurst
- 3 Faculty of Medicine, Center for Excellence in Biostatistics, Chulalongkorn University, Bangkok, Thailand
| | - Aurauma Chutinet
- 4 Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pravit Asawanonda
- 1 Division of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Nijasri C Suwanwela
- 4 Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Duong C, Hurst CP. Reliability and validity of the Khmer version of the 10-item Connor-Davidson Resilience Scale (Kh-CD-RISC10) in Cambodian adolescents. BMC Res Notes 2016; 9:297. [PMID: 27278796 PMCID: PMC4898380 DOI: 10.1186/s13104-016-2099-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 05/23/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Resilience has been characterized as a defensive factor against the refinement of mental health problems. This study adapted the Connor-Davidson Resilience Scale (Kh-CD-RISC10) for use in Khmer adolescents and subsequently investigates its psychometric properties. METHODS Using stratified random sampling, this cross-sectional study sampled Cambodian adolescents from high schools selected randomly within three provinces (Phnom Penh, Battambang and Mondulkiri)-location (rural, urban) combinations. Parallel analysis was used to identify the number of component(s), and the structure of the single factor was subsequently explored using principal axis factoring. A confirmatory factor analysis was then performed to establish the fit of the Kh-CD-RISC10 to another sample. To assess convergent validity, the factor scores of the Khmer version of Connor-Davidson Resilience Scale were categorized into three levels, and then the general negative affectivity (GNA) and physiological hyperarousal (PH) scales (derived from the DASS 21) were compared among the three resilience groups. RESULTS Of the 798 participants who responded (responded rate = 82.26 %), 440 (41.23 %) were female and the age ranged from 14 to 24 years old (mean = 17.36, SD = 1.325). The internal consistency of the Khmer 10-item CD-RISC was also shown to be high in Cambodian adolescents (Cronbach's alpha = 0. 82). Confirmatory factor analysis revealed the single factor model fit data adequately (χ(2) = 100.103, df = 35, p < 0.001, CFI = 0.9484, RMSEA = 0.0384). We found that there were significant differences in both General Negative affectivity and Physiological Hyperarousal among the three resilience groups (FGNA = 12. 84, df = 2, p < 0.001; FPH = 13. 01, df = 2, p < 0.001). CONCLUSION The results from the present study indicate that the Khmer version of CD-RISC shows good psychometric properties in Cambodian adolescents. Our result confirms that a single dimension underlay the 10 items on the CD-RISC scale of this population, and can be used to assess the resilience comparing to the level of PTSD symptoms in general Khmer adolescent.
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Affiliation(s)
- Chanmettachampavieng Duong
- Department of Community Development, Faculty of Development Studies, Royal University of Phnom Penh, Phnom Penh, Cambodia.,Doctor of Public Health program, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Cameron P Hurst
- Center of Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
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14
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Thorberg FA, Young RM, Sullivan KA, Lyvers M, Hurst CP, Connor JP, Tyssen R, London ED, Noble EP, Feeney GFX. A longitudinal mediational study on the stability of alexithymia among alcohol-dependent outpatients in cognitive–behavioral therapy. Psychology of Addictive Behaviors 2016; 30:64-72. [DOI: 10.1037/adb0000135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Piralam B, Tomczyk SM, Rhodes JC, Thamthitiwat S, Gregory CJ, Olsen SJ, Praphasiri P, Sawatwong P, Naorat S, Chantra S, Areerat P, Hurst CP, Moore MR, Muangchana C, Baggett HC. Incidence of Pneumococcal Pneumonia Among Adults in Rural Thailand, 2006-2011: Implications for Pneumococcal Vaccine Considerations. Am J Trop Med Hyg 2015; 93:1140-1147. [PMID: 26503277 PMCID: PMC4674225 DOI: 10.4269/ajtmh.15-0429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022] Open
Abstract
The incidence of pneumococcal pneumonia among adults is a key driver for the cost-effectiveness of pneumococcal conjugate vaccine used among children. We sought to obtain more accurate incidence estimates among adults by including results of pneumococcal urine antigen testing (UAT) from population-based pneumonia surveillance in two Thai provinces. Active surveillance from 2006 to 2011 identified acute lower respiratory infection (ALRI)-related hospital admissions. Adult cases of pneumococcal pneumonia were defined as hospitalized ALRI patients aged ≥ 18 years with isolation of Streptococcus pneumoniae from blood or with positive UAT. Among 39,525 adult ALRI patients, we identified 481 pneumococcal pneumonia cases (105 by blood culture, 376 by UAT only). Estimated incidence of pneumococcal pneumonia hospitalizations was 30.5 cases per 100,000 persons per year (2.2 and 28.3 cases per 100,000 persons per year by blood culture and UAT, respectively). Incidence varied between 22.7 in 2007 and 43.5 in 2010, and increased with age to over 150 per 100,000 persons per year among persons aged ≥ 70 years. Viral coinfections including influenza A/B, respiratory syncytial virus (RSV), and adenovirus occurred in 11% (44/409) of pneumococcal pneumonia cases tested. Use of UAT to identify cases of pneumococcal pneumonia among adults in rural Thailand substantially increases estimates of pneumococcal pneumonia burden, thereby informing cost-effectiveness analyses and vaccine policy decisions.
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Affiliation(s)
- Barameht Piralam
- *Address correspondence to Barameht Piralam, Nakhon Phanom Provincial Health Office, 356 Abhibanbancha Road, Muang, Nakhon Phanom 48000, Thailand. E-mail:
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16
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Janyacharoen T, Phusririt C, Angkapattamakul S, Hurst CP, Sawanyawisuth K. Cardiopulmonary effects of traditional Thai dance on menopausal women: a randomized controlled trial. J Phys Ther Sci 2015; 27:2569-72. [PMID: 26357441 PMCID: PMC4563316 DOI: 10.1589/jpts.27.2569] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/15/2015] [Indexed: 12/04/2022] Open
Abstract
[Purpose] This study evaluated the effects of Thai dance on cardiopulmonary factors in
menopausal women. [Subjects] Sixty-six menopausal women aged 40 years or more. [Methods]
Subjects were randomly assigned to either the Thai dance or control group. The Thai dance
group performed a traditional Thai dancing exercise program for 60 minutes, 3 times per
week for 6 weeks. The control group received general health guidance. The 6-minutewalk
test, peak expiratory flow, forced vital capacity, forced expiratory volume in one second,
maximal voluntary ventilation, and chest expansion were assessed at baseline and at the
end of the study. [Results] Sixty-six menopausal women were eligible. At the end of the
study, all variables were significantly better in the Thai dance group than the control
group. Moreover, all variables improved significantly compared to baseline in the Thai
dance group but not in the control group. For example, the mean 6-minutewalk test result
in Thai dance group at the end of the study was 285.4 m, which was significantly higher
than that at baseline (254.8 m) and the control group at baseline (247.0 m). [Conclusion]
A 6-week Thai dance program improves cardiorespiratory endurance in menopausal women.
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Affiliation(s)
- Taweesak Janyacharoen
- Research Center in Back, Neck Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Thailand ; Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Chonticha Phusririt
- Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Sariya Angkapattamakul
- Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Cameron P Hurst
- Clinical Epidemiology Unit (CEU), Faculty of Medicine, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand ; The Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen University, Thailand
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17
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Sampson DL, Chng YL, Upton Z, Hurst CP, Parker AW, Parker TJ. The highly abundant urinary metabolite urobilin interferes with the bicinchoninic acid assay. Anal Biochem 2013; 442:110-7. [PMID: 23911526 DOI: 10.1016/j.ab.2013.07.027] [Citation(s) in RCA: 5] [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: 05/24/2013] [Revised: 07/15/2013] [Accepted: 07/19/2013] [Indexed: 11/26/2022]
Abstract
Estimation of total protein concentration is an essential step in any protein- or peptide-centric analysis pipeline. This study demonstrates that urobilin, a breakdown product of heme and a major constituent of urine, interferes considerably with the bicinchoninic acid (BCA) assay. This interference is probably due to the propensity of urobilin to reduce cupric ions (Cu(2+)) to cuprous ions (Cu(1+)), thus mimicking the reduction of copper by proteins, which the assay was designed to do. In addition, it is demonstrated that the Bradford assay is more resistant to the influence of urobilin and other small molecules. As such, urobilin has a strong confounding effect on the estimate of total protein concentrations obtained by BCA assay and thus this assay should not be used for urinary protein quantification. It is recommended that the Bradford assay be used instead.
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Affiliation(s)
- D L Sampson
- Tissue Repair and Regeneration Program, Brisbane, QLD 4059, Australia.
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Thorberg FA, Young RM, Sullivan KA, Lyvers M, Hurst CP, Tyssen R, Connor JP, Feeney GFX. A confirmatory factor analysis of the Observer Alexithymia Scale in treatment seeking alcohol-dependent patients. Journal of Substance Use 2013. [DOI: 10.3109/14659891.2012.707281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Sampson DL, Parker TJ, Upton Z, Hurst CP. A comparison of methods for classifying clinical samples based on proteomics data: a case study for statistical and machine learning approaches. PLoS One 2011; 6:e24973. [PMID: 21969867 PMCID: PMC3182169 DOI: 10.1371/journal.pone.0024973] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/19/2011] [Indexed: 11/18/2022] Open
Abstract
The discovery of protein variation is an important strategy in disease diagnosis within the biological sciences. The current benchmark for elucidating information from multiple biological variables is the so called “omics” disciplines of the biological sciences. Such variability is uncovered by implementation of multivariable data mining techniques which come under two primary categories, machine learning strategies and statistical based approaches. Typically proteomic studies can produce hundreds or thousands of variables, p, per observation, n, depending on the analytical platform or method employed to generate the data. Many classification methods are limited by an n≪p constraint, and as such, require pre-treatment to reduce the dimensionality prior to classification. Recently machine learning techniques have gained popularity in the field for their ability to successfully classify unknown samples. One limitation of such methods is the lack of a functional model allowing meaningful interpretation of results in terms of the features used for classification. This is a problem that might be solved using a statistical model-based approach where not only is the importance of the individual protein explicit, they are combined into a readily interpretable classification rule without relying on a black box approach. Here we incorporate statistical dimension reduction techniques Partial Least Squares (PLS) and Principal Components Analysis (PCA) followed by both statistical and machine learning classification methods, and compared them to a popular machine learning technique, Support Vector Machines (SVM). Both PLS and SVM demonstrate strong utility for proteomic classification problems.
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Affiliation(s)
- Dayle L Sampson
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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20
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Thorberg FA, Young RM, Sullivan KA, Lyvers M, Hurst CP, Connor JP, Feeney GFX. Alexithymia in alcohol dependent patients is partially mediated by alcohol expectancy. Drug Alcohol Depend 2011; 116:238-41. [PMID: 21185660 DOI: 10.1016/j.drugalcdep.2010.11.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/09/2010] [Accepted: 11/14/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Up to fifty percent of alcohol dependent individuals have alexithymia, a personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externalised cognitive style. Although studies have examined alexithymia in relation to alcohol dependence, no research exists on mechanisms underlying this relationship. The present study examined the mediational effect of alcohol expectancies on alexithymia and alcohol dependence. METHODS 230 outpatients completed the Toronto Alexithymia Scale (TAS-20), the Drinking Expectancy Questionnaire (DEQ) and the Alcohol Use Disorder Identification Test (AUDIT). RESULTS Regression analysis showed that alexithymia and alcohol dependence was, in two of three cases, partially mediated through alcohol expectancy. CONCLUSIONS Alcohol expectancies of assertion and affective change show promise as mediators of alcohol dependence in individuals with alexithymia.
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Affiliation(s)
- Fred Arne Thorberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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22
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Abstract
OBJECTIVE To quantify the level of unmet dental access need which had been reported locally and to provide information about the perceived need for dental treatment with particular reference to those not registered for continuing NHS care. DESIGN A postal survey of adults resident in Aylesbury Vale, Buckinghamshire was carried out toward the end of 1994. SUBJECTS AND METHODS 2000 adults aged between 35 and 54 years were randomly selected: RESULTS A response rate of 68% matched well with the population under study. 16% of people were unable to access any regular dental care and this group had the highest treatment need, with more experience of broken fillings and toothache within the previous year. 15% thought they were registered with an NHS dentist, but were not. Only 28% of all respondents were confirmed registered with an NHS dentist. 27% said they received private care, and one-third of these said it was because they had been unable to find an NHS dentist. In total, 74% of the population under study thought they were receiving regular dental care and only 6% did not want regular care. More than one-third of respondents volunteered comments about dental services. The majority were supportive of dentists but critical of the lack of NHS provision. CONCLUSIONS This survey indicates a substantial unmet perceived need in Aylesbury Vale, with more than one-third of this population unable to access continuing NHS dental services which they prefer. There is also a need for emergency and occasional dental treatment for a small proportion of this population. It is likely that a similar situation exists elsewhere in England.
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Affiliation(s)
- H C Falcon
- Dental Service, Aylesbury Vale Healthcare, Brookside Dental Clinic, Buckinghamshire
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