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Paddick SM, Gamassa E, Mwaluwinga N, Lewis EG, Duinmaijer A, Urasa S, Tucker L, Mukaetova-Ladinska E, Cosker G, Dekker M, Kisoli A, Cletus J, Lissu C, Dotchin C, Gray W, Walker R. Preliminary evaluation of a smartphone application (DelApp) for identification of delirium in sub-Saharan Africa. Acta Neuropsychiatr 2023:1-28. [PMID: 37345466 DOI: 10.1017/neu.2023.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE In sub-Saharan Africa (SSA), there are no validated screening tools for delirium in older adults, despite the known vulnerability of older people to delirium and the associated adverse outcomes. This study aimed to assess the effectiveness of a brief smartphone-based assessment of arousal and attention (DelApp) in identification of delirium amongst older adults admitted to the medical department of a tertiary referral hospital in Northern Tanzania. METHOD Consecutive admissions were screened using the DelApp during a larger study of delirium prevalence and risk factors. All participants subsequently underwent detailed clinical assessment for delirium by a research doctor. Delirium and dementia were identified against DSM-5 criteria by consensus. RESULTS Complete data for 66 individuals were collected of whom 15 (22.7%) had delirium, 24.5% had dementia without delirium and 10.6% delirium superimposed on dementia. Sensitivity and specificity of the DelApp for delirium were 0.87 and 0.62 respectively (AUROC 0.77) and 0.88 and 0.73 (AUROC 0.85) for major cognitive impairment (dementia and delirium combined). Lower DelApp score was associated with age, significant visual impairment (<6/60 acuity), illness severity, reduced arousal and DSM-5 delirium on univariable analysis, but on multivariable logistic regression only arousal remained significant. CONCLUSION In this setting, the DelApp performed well in identifying delirium and major cognitive impairment but did not differentiate delirium and dementia. Performance is likely to have been affected by confounders including uncorrected visual impairment and reduced level of arousal without delirium. Negative predictive value was nevertheless high, indicating excellent "rule out" value in this setting.
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Affiliation(s)
- S M Paddick
- Institute of Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - E Gamassa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - N Mwaluwinga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - E G Lewis
- Charité - Universitätsmedizin Berlin CVK: Campus Virchow-Klinikum Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - S Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | | | - G Cosker
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Dekker
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - A Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - C Dotchin
- Institute of Population Sciences, Newcastle University, Newcstle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - W Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - R Walker
- Institute of Population Sciences, Newcastle University, Newcstle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Kasiem FR, Tucker L, Vis M, Luime J, Tchetverikov I, Wervers K, Hazes J, Coates L, Kok MR. POS1054 PAIN AND DEPRESSION ARE ASSOCIATED WITH NON-RESPONSE TO METHOTREXATE IN PATIENTS WITH PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPsoriatic arthritis (PsA) is a heterogeneous, immune-mediated inflammatory arthritis. Methotrexate (MTX) is the first-line treatment in PsA patients, despite diverse clinical phenotypes and highly varied responses(1). As yet, it is not possible to predict MTX treatment response. The identification of demographic, clinical and psychosocial factors associated with MTX non-response, would facilitate a paradigm shift from a ‘one-size-fits-all’ approach to a more personalized medicine strategy, based on individual patient characteristics.ObjectivesThe aim of this study was to identify demographic, clinical and psychosocial factors associated with MTX non-response 3 months after MTX initiation in adult patients with PsA.MethodsNewly diagnosed, adult PsA patients were recruited to the DEPAR (Dutch southwest Early Psoriatic Arthritis cohort) study. MTX non-response was defined as patients achieving <5/7 point of the Minimal Disease Activity (MDA) criteria after 3 months of MTX therapy. A logistic regression analysis was performed to identify demographic, clinical and psychosocial factors associated with MTX non-response. Demographic characteristics included age, sex, alcohol use, smoking (pack years) and body mass index (BMI). Clinical characteristics included duration of PsA symptoms, swollen and tender joint counts (66/68), Psoriasis Area and Severity Index (PASI) scores, presence of dactylitis and enthesitis scores (Leeds Enthesitis Index/Maastricht Ankylosing Spondylitis. [LEI_MASES]). Psychosocial variables included both subscales of the Hospital and Anxiety Depression Scale (HADS).ResultsComplete data of the variables of interest were available for 174/332 (52%) patients starting MTX monotherapy within the first year of diagnosis. Mean (SD) age was 53 (14) years and 88 patients (51%) were male. A total of 39 patients (22%) achieved MDA after 3 months of MTX therapy. Correlations between the variables and regression statistics are shown in Table 1. A significant correlation was seen between MTX non-response and enthesitis (OR 0.66, CI 0.47-0.94) and depression (OR 0.41, CI 0.25-0.66). Furthermore, the interaction of BMI with tender joint count (OR 0.95, CI 0.91-1.00) was found to be significantly correlated, whereas the independent variables were not.Table 1.Final model of the logistic regression analysis of methotrexate non-response 3 months after methotrexate initiation.Independent variablesOdds Ratio95% CIDemographic variables BMI1.260.61-2.60 BMI31.001.00-1.00Clinical characteristics Tender joint count (68)3.160.94-10.57 Enthesitis (LEI/MASES)0.660.47-0.94 Psoriasis (PASI)1.110.99-1.25 BMI*Tender joint count (68)0.950.91-1.00Patient reported outcomes Depression (HADS)†0.410.25-0.66FootnotesSignificant values in bold face† Root transformedConclusionOur results indicate that enthesitis, depression and the combination of a higher BMI with a tender joint count are all associated with MTX non-response 3 months after MTX initiation. Pain may be the common denominator preventing patients from achieving MDA.References[1]Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79(6):700-12.[2]den Braanker H, Wervers K, Mus AMC, Bangoer PS, Davelaar N, Luime J, et al. Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis. RMD Open. 2020;6(2).Disclosure of InterestsNone declared
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Guedes A, Tucker L, Trumble T, Groschen D, Dobbs E, Baldo C, Wendt-Hornickle E. Inhibiting soluble epoxide hydrolase and cyclooxygenases enhance joint pain control, stimulate collagen synthesis and protect chondrocytes from cytokine-induced apoptosis. Vet Anaesth Analg 2021. [DOI: 10.1016/j.vaa.2021.08.015] [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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Chapa J, DiPerna C, Lueck P, Tucker L, Hage C, Guglin M, Jones M, Ballut K, Rao R. Immediate Post-Discharge Comprehensive Rehabilitation Program Expedites Heart Transplant Recovery and Reduces Readmission. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.742] [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: 11/26/2022] Open
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Asukile M, Viljoen C, Pan EL, Eastman R, Tucker L. Online EEG teaching – Identifying the most effective and preferred learning methods on a web-based EEG training course. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.727] [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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Tucker L. Challenges and opportunities in the prevention and treatment of epilepsy in Africa: Perspectives from across the continent. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.213] [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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Lloyd‐Fox S, Blasi A, Pasco G, Gliga T, Jones EJH, Murphy DGM, Elwell CE, Charman T, Johnson MH, Baron‐Cohen S, Bedford R, Bolton P, Cheung HMC, Davies K, Elsabbagh M, Fernandes J, Gammer I, Guiraud J, Liew M, Maris H, O'Hara L, Pickles A, Ribeiro H, Salomone E, Tucker L, Yemane F. Cortical responses before 6 months of life associate with later autism. Eur J Neurosci 2018; 47:736-749. [PMID: 29057543 PMCID: PMC5900943 DOI: 10.1111/ejn.13757] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [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: 12/21/2016] [Revised: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 01/12/2023]
Abstract
Autism spectrum disorder (ASD) is a common, highly heritable, developmental disorder and later-born siblings of diagnosed children are at higher risk of developing ASD than the general population. Although the emergence of behavioural symptoms of ASD in toddlerhood is well characterized, far less is known about development during the first months of life of infants at familial risk. In a prospective longitudinal study of infants at familial risk followed to 36 months, we measured functional near-infrared spectroscopy (fNIRS) brain responses to social videos of people (i.e. peek-a-boo) compared to non-social images (vehicles) and human vocalizations compared to non-vocal sounds. At 4-6 months, infants who went on to develop ASD at 3 years (N = 5) evidenced-reduced activation to visual social stimuli relative to low-risk infants (N = 16) across inferior frontal (IFG) and posterior temporal (pSTS-TPJ) regions of the cortex. Furthermore, these infants also showed reduced activation to vocal sounds and enhanced activation to non-vocal sounds within left lateralized temporal (aMTG-STG/pSTS-TPJ) regions compared with low-risk infants and high-risk infants who did not develop ASD (N = 15). The degree of activation to both the visual and auditory stimuli correlated with parent-reported ASD symptomology in toddlerhood. These preliminary findings are consistent with later atypical social brain responses seen in children and adults with ASD, and highlight the need for further work interrogating atypical processing in early infancy and how it may relate to later social interaction and communication difficulties characteristic of ASD.
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Affiliation(s)
- S. Lloyd‐Fox
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonMalet St.WC1E 7HXLondonUK
| | - A. Blasi
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonMalet St.WC1E 7HXLondonUK
| | - G. Pasco
- Department of PsychologyInstitute of Psychiatry, Psychology, & NeuroscienceKing's College LondonLondonUK
| | - T. Gliga
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonMalet St.WC1E 7HXLondonUK
| | - E. J. H. Jones
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonMalet St.WC1E 7HXLondonUK
| | - D. G. M. Murphy
- Department of Forensic and Neurodevelopmental ScienceThe Sackler Institute for Translational NeurodevelopmentInstitute of Psychiatry, Psychology, & NeuroscienceKing's College LondonLondonUK
| | - C. E. Elwell
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - T. Charman
- Department of PsychologyInstitute of Psychiatry, Psychology, & NeuroscienceKing's College LondonLondonUK
| | - M. H. Johnson
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonMalet St.WC1E 7HXLondonUK
- Department of PsychologyUniversity of CambridgeCambridgeUK
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Cutler C, Peng T, Stinson J, Tucker L, Boneparth A, Klein Gitelman M, Moorthy LN. A North American perspective of content and quality of websites in the English language on childhood-onset lupus erythematosus. Lupus 2017; 27:762-770. [PMID: 29256340 DOI: 10.1177/0961203317746246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The objective of this article is to examine the quality, content, and readability of information and resources in the English language and accessible on the internet by pediatric patients with systemic lupus erythematosus (SLE) and their families in North America. Methods Keywords relevant to SLE were generated by an undergraduate student, a first-year medical student, and a third-year pediatric resident, and a search was conducted across five commonly used search engines. Quality of information found was evaluated independently by an undergraduate student, a graduate student, a first-year medical student, and a third-year pediatric resident using the DISCERN tool. Two pediatric rheumatologists assessed website accuracy and completeness. Readability of websites was determined using the Flesch-Kincaid grade level and Reading Ease score. Results Out of 2000 websites generated in the search, only 34 unique websites met inclusion criteria. Only 16 of these websites had DISCERN scores above 50% (fair quality). Overall quality of website information was fair with mean ±standard deviation (SD) DISCERN quality score of 44 ± 7 (range: 30-56). Only nine websites of 34 had DISCERN scores above 50 (>66%, indicating greater quality) and were further assessed for completeness. Flesch-Kincaid grade level was 11 ± 1 (mean±SD) and reading ease score was 39 ± 10 (mean±SD, range of 11-61). Conclusion Our study highlights the need for more complete, readable information regarding the unique needs of pediatric patients with childhood-onset SLE and their families.
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Affiliation(s)
- C Cutler
- 1 Department of Pediatrics, 43982 Rutgers Robert Wood Johnson Medical School, New Brunswick , NJ, USA
| | - T Peng
- 2 Department of Pediatrics, Division of Allergy and Immunology, 12222 UCLA David Geffen School of Medicine , Los Angeles, CA, USA
| | - J Stinson
- 3 Child Health Evaluative Science, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, ON, Canada
| | - L Tucker
- 4 Division of Rheumatology, BC Children's Hospital, Vancouver, BC, Canada
| | - A Boneparth
- 1 Department of Pediatrics, 43982 Rutgers Robert Wood Johnson Medical School, New Brunswick , NJ, USA
| | - M Klein Gitelman
- 5 Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Nandini Moorthy
- 1 Department of Pediatrics, 43982 Rutgers Robert Wood Johnson Medical School, New Brunswick , NJ, USA
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Paddick SM, Lewis EG, Duinmaijer A, Banks J, Urasa S, Tucker L, Kisoli A, Cletus J, Lissu C, Kissima J, Dotchin C, Gray WK, Muaketova-Ladinska E, Cosker G, Walker RW. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017; 385:156-163. [PMID: 29406898 DOI: 10.1016/j.jns.2017.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/14/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania. METHOD The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria. RESULTS Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients. CONCLUSION Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
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Affiliation(s)
- S M Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | - E G Lewis
- Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - J Banks
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | - A Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - J Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - E Muaketova-Ladinska
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - G Cosker
- Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - R W Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Paddick S, Lewis E, Duinmaijer A, Banks J, Tucker L, Kisoli A, Cletus J, Urasa S, Lissu C, Kissima J, Dotchin C, Gray W, Mukaetova-Ladinska E, Cosker G, Walker R. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2395] [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: 10/18/2022]
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Weisshaar D, Lin D, Tucker L, Trammell J. Risk Factors Associated with Mortality in Broad HF Population. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.552] [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: 11/16/2022] Open
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Abstract
Associations between sexual risk and alcohol consumption may be self-evident but have eluded detailed examination in the UK. A cohort of 520 genitourinary (GU) medicine clinic attenders in the south of England were given a detailed questionnaire and compared with a matched cohort from the General Household Survey (GHS). Clinic attenders binged heavily –a median of 13 units on a usual night and 26 on a 'heavy' night, compared with six units in the GHS cohort. In all, 86% of clinic attenders exceeded the UK government 'binge drinking' level of six units, and 32% of subjects thought that alcohol played a role in their clinic attendance. A total of 77% had been drinking before sex with a new partner; of these, 65% were usually or occasionally very drunk. Binge drinking was increased in the 29% diagnosed with a bacterial sexually transmitted infection ( P < 0.003). Of the women, 19% reported an unwanted pregnancy, with 28% drinking beforehand.
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Affiliation(s)
- K Standerwick
- School of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - C Davies
- School of Medicine, University of Southampton, UK
| | - L Tucker
- Department of Genitourinary Medicine, St Mary's Hospital, Milton Road, Portsmouth PO3 6AD, UK; Liver Research Group, Mailpoint 811, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Nick Sheron
- Liver Research Group, Mailpoint 811, Southampton General Hospital, Southampton SO16 6YD, UK
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Tucker L. SP0179 Transition Care Programmes: A North American Perspective. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6386] [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]
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Bethel MA, Harrison P, Sourij H, Sun Y, Tucker L, Kennedy I, White S, Hill L, Oulhaj A, Coleman RL, Holman RR. Randomized controlled trial comparing impact on platelet reactivity of twice-daily with once-daily aspirin in people with Type 2 diabetes. Diabet Med 2016; 33:224-30. [PMID: 26043186 DOI: 10.1111/dme.12828] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 01/19/2023]
Abstract
AIMS Reduced aspirin efficacy has been demonstrated in people with Type 2 diabetes. Because increased platelet reactivity and/or turnover are postulated mechanisms, we examined whether higher and/or more frequent aspirin dosing might reduce platelet reactivity more effectively. METHODS Participants with Type 2 diabetes (n = 24) but without known cardiovascular disease were randomized in a three-way crossover design to 2-week treatment periods with aspirin 100 mg once daily, 200 mg once daily or 100 mg twice daily. The primary outcome was platelet reactivity, assessed using the VerifyNow(™) ASA method. Relationships between platelet reactivity and aspirin dosing were examined using generalized linear mixed models with random subject effects. RESULTS Platelet reactivity decreased from baseline with all doses of aspirin. Modelled platelet reactivity was more effectively reduced with aspirin 100 mg twice daily vs. 100 mg once daily, but not vs. 200 mg once daily. Aspirin 200 mg once daily did not differ from 100 mg once daily. Aspirin 100 mg twice daily was also more effective than once daily as measured by collagen/epinephrine-stimulated platelet aggregation and urinary thromboxane levels, with a similar trend measured by serum thromboxane levels. No episodes of bleeding occurred. CONCLUSIONS In Type 2 diabetes, aspirin 100 mg twice daily reduced platelet reactivity more effectively than 100 mg once daily, and numerically more than 200 mg once daily. Clinical outcome trials evaluating primary cardiovascular disease prevention with aspirin in Type 2 diabetes may need to consider using a more frequent dosing schedule.
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Affiliation(s)
- M A Bethel
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - P Harrison
- School of Immunity and Infection, University of Birmingham Medical School, Birmingham, UK
| | - H Sourij
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Y Sun
- Peking University People's Hospital, Beijing, People's Republic of China
| | - L Tucker
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - I Kennedy
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - S White
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - L Hill
- Department of Haematology, John Radcliffe Hospital, Oxford, UK
| | - A Oulhaj
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - R L Coleman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
| | - R R Holman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, UK
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Lazo I, White K, Zaritsky E, Han L, Ciaravino G, Tucker L. Characterizing bevacizumab use in endometrial cancer in a community medical setting. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.085] [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: 11/25/2022]
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Guzman J, Kerr T, Ward L, Ma J, Oen K, Boire G, Feldman B, Scuccimarri R, Houghton K, Bruns A, Dancey P, Rosenberg A, Tucker L. SAT0507 Growth and Weight Gain in Children with Juvenile Idiopathic Arthritis: Results from the Reacch-Out Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Guzman J, Loughin T, Henrey A, Berard R, Shiff N, Jurencak R, Benseler S, Tucker L. FRI0499 Using Patient-Relevant Variables to Describe the Disease Course in Children with Juvenile Idiopathic Arthritis: Results from the Reacch-Out Cohort: Table1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2396] [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]
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Mina R, Klein-Gitelman MS, Nelson S, Eberhard BA, Higgins G, Singer NG, Onel K, Tucker L, O'Neil KM, Punaro M, Levy DM, Haines K, Ying J, Brunner HI. Effects of obesity on health-related quality of life in juvenile-onset systemic lupus erythematosus. Lupus 2014; 24:191-7. [PMID: 25335488 DOI: 10.1177/0961203314555537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluated the effects of obesity on health-related quality of life (HRQOL) measures in juvenile-onset systemic lupus erythematosus (jSLE). METHODS Obesity was defined as a body mass index (BMI) ≥ 95 th percentile according to the Sex-specific Center for Disease Control BMI-For-Age Charts and determined in a multicenter cohort of jSLE patients. In this secondary analysis, the domain and summary scores of the Pediatric Quality of Life (PedsQL) Inventory and the Child Health Questionnaire (CHQ) of obese jSLE patients were compared to those of non-obese jSLE patients as well as historical obese and non-obese healthy controls. Mixed-effects modeling was performed to evaluate the relationship between obesity and HRQOL measures. RESULTS Among the 202 jSLE patients, 25% (n = 51) were obese. Obesity had a significant negative impact on HRQOL in jSLE, even after adjusting for differences in current corticosteroid use, disease activity, disease damage, gender and race between groups. Obese jSLE patients had lower physical functioning compared to non-obese jSLE patients, and to non-obese and obese healthy controls. Compared to their non-obese counterparts, obese jSLE patients also had worse school functioning, more pain, worse social functioning and emotional functioning. Parents of obese jSLE patients worry more. The CHQ scores for obese jSLE patients were also worse compared to non-obese jSLE patients in several other domains. CONCLUSION Our study demonstrates the detrimental effects of obesity on patient-reported outcomes in jSLE. This supports the importance of weight management for the therapeutic plan of jSLE.
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Affiliation(s)
- R Mina
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati, Cincinnati, OH, USA
| | - M S Klein-Gitelman
- Division of Pediatric Rheumatology, Children's Memorial Hospital, Chicago, IL, USA
| | - S Nelson
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B A Eberhard
- Division of Pediatric Rheumatology, Steven and Alexandra Cohen Children's Medical Center of NY, New York, USA
| | - G Higgins
- Division of Pediatric Rheumatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA
| | - N G Singer
- Division of Rheumatology, MetroHealth Medical Center & Case Western Reserve University, Cleveland, OH, USA
| | - K Onel
- Division of Pediatric Rheumatology, University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - L Tucker
- Division of Pediatric Rheumatology, BC Children's Hospital, Vancouver, BC, Canada
| | - K M O'Neil
- Section of Rheumatology, Riley Hospital for Children, Indianapolis, IN, USA
| | - M Punaro
- Division of Pediatric Rheumatology, Texas Scottish Rite Hospital, Dallas, TX, USA
| | - D M Levy
- Division of Rheumatology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - K Haines
- Section of Pediatric Rheumatology & Immunology, Joseph M. Sanzari Children's Hospital, Hackensack UMC, Hackensack, NJ, USA
| | - J Ying
- University of Cincinnati, Cincinnati, OH, USA
| | - H I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Tromans C, Highnam R, Morrish O, Black R, Tucker L, Gilbert F, Brady M. TU-F-18C-06: Which Women Based On Clinical Benefits and Dose Should Be Considered For Breast Screening with Tomosynthesis? Med Phys 2014. [DOI: 10.1118/1.4889351] [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: 11/07/2022] Open
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Blomfield J, Tucker L, McLeay L, Morris L. Evaluation of antioxidant dietary supplementation on semen quality parameters in New Zealand Standardbred stallions. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2013.10.061] [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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Dimitrov BD, Sundaram S, Roderick P, Frater A, Leydon G, Sheron N, Dewhirst S, Tucker L, Maskell J, Chatwin J, Harindra V. PP43 Feasibility and Acceptability of a Brief Intervention to Reduce Alcohol Consumption in Sexual Health Clinic Attendees. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.140] [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: 11/03/2022]
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Stinson J, Spiegel L, Watanabe Duffy K, Tucker L, Stringer E, Hazel B, Hochman J, Gill N, Spadafora K, Kaufman M. THU0320 Development and testing of the readiness for adult care in rheumatology (RACER) questionnaire for adolescents with rheumatic conditions. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ghoreishi M, Tucker L, Dutz JP. Skin-antigen specific antibodies are detected in UV irradiation and TLR7 agonist induced lupus-like disease in autoimmune prone NOD mice and in pediatric SLE. Arthritis Res Ther 2012. [PMCID: PMC3467520 DOI: 10.1186/ar3977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Blume A, Standerwick K, Tucker L, Harris S, Sheron N. Sexual assault and coincident alcohol use in attendees at a genitourinary medicine clinic in the south of England. Int J STD AIDS 2012; 23:115-9. [PMID: 22422686 DOI: 10.1258/ijsa.2011.011149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To investigate the relationship between alcohol consumption and the experience of sexual assault, either as victim or perpetrator, among genitourinary (GU) medicine department attendees in Portsmouth, UK, we carried out a cross-sectional survey of consecutive patients attending the walk-in service when a researcher was available. Self-completed questionnaires were used and anonymized data were collected from 1186 participants (response rate 34%). Responses showed that 15.6% of female and 3.7% of male participants had ever being sexually assaulted. Women who reported sexual assault drank more on a heavy night out than those who did not report sexual assault (mean 21.3 versus 17.0 units, P = 0.041). Over half of the victims had been drinking prior to the relevant assault. Twenty-seven participants (2.3%) admitted to having sex with a person who was not fully willing. Of these, 59% had been drinking prior to the assault, and the majority believed alcohol had contributed to the assault. Any strategies aiming to reduce the incidence of sexual assault must address hazardous drinking as a high priority.
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Affiliation(s)
- A Blume
- Department of Genitourinary Medicine, St Mary's Hospital, Portsmouth, UK.
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Peterson BD, Pirritano M, Tucker L, Lampic C. Fertility awareness and parenting attitudes among American male and female undergraduate university students. Hum Reprod 2012; 27:1375-82. [DOI: 10.1093/humrep/des011] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tabár L, Tucker L, Davenport RR, Mullet JG, Hsiu-Hsi Chen AT, Ming-Fang Yen A, Yueh-Hsia Chiu S, Gladwell J, Olinger K, Dean PB. The use of mammographic tumour feature significantly improves outcome prediction of breast cancers smaller than 15 mm: a reproducibility study from two comprehensive breast centres. memo 2011. [DOI: 10.1007/s12254-011-0287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Forbes LJL, Linsell L, Atkins L, Burgess C, Tucker L, Omar L, Ramirez AJ. A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial. Br J Cancer 2011; 105:18-21. [PMID: 21654683 PMCID: PMC3137419 DOI: 10.1038/bjc.2011.205] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 12/15/2022] Open
Abstract
Background: We have developed the Promoting Early Presentation (PEP) Intervention to equip older women with the knowledge, skills, confidence and motivation to present promptly with breast symptoms, and thereby improve survival from breast cancer. The PEP Intervention consists of a 10-min interaction between a radiographer and an older woman, supported by a booklet. Our previous report showed that at 1 year, the PEP intervention increased the proportion who were breast cancer aware compared with usual care. Methods: We randomised 867 women aged 67–70 years attending for their final routine appointment on the National Health Service Breast Screening Programme to receive the PEP Intervention, a booklet alone or usual care. The primary outcome was breast cancer awareness measured using a validated questionnaire asking about knowledge of breast cancer symptoms, knowledge that the risk of breast cancer increases with age and breast checking behaviour. Results: At 2 years, the PEP Intervention increased the proportion who were breast cancer aware compared with usual care (21 vs 6% odds ratio 8.1, 95% confidence interval 2.7–25.0). Conclusions: The uniquely large and sustained effect of the PEP Intervention on breast cancer awareness increases the likelihood that a woman will present promptly should she develop breast cancer symptoms up to many years later.
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Affiliation(s)
- L J L Forbes
- Promoting Early Presentation Group, Kings College London, Adamson Centre for Mental Health, South Wing, St Thomas' Hospital, London SE1 7EH, UK.
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Forster AS, Forbes LJL, Atkins L, Patnick J, Sellars S, Tucker L, Baxter R, Ramirez AJ. Evaluation and implementation of an intervention to promote early presentation. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.19] [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]
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Linsell L, Forbes LJL, Kapari M, Burgess C, Omar L, Tucker L, Ramirez AJ. A randomised controlled trial of an intervention to promote early presentation of breast cancer in older women: effect on breast cancer awareness. Br J Cancer 2009; 101 Suppl 2:S40-8. [PMID: 19956161 PMCID: PMC2790707 DOI: 10.1038/sj.bjc.6605389] [Citation(s) in RCA: 41] [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] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is virtually no evidence for the effectiveness of interventions to promote early presentation in breast cancer. We aimed to test the efficacy of an intervention to equip older women with the knowledge, skills, confidence and motivation to detect symptoms and seek help promptly, with the aim of promoting early presentation with breast cancer symptoms. METHODS We randomised 867 women aged 67-70 years attending for their final routine appointment on the UK NHS Breast Screening Programme to receive: a scripted 10-min interaction with a radiographer plus a booklet, a booklet alone or usual care. The primary outcome was whether or not a woman was breast cancer aware based on knowledge of breast cancer symptoms and age-related risk, and reported breast checking. RESULTS At 1 month, the intervention increased the proportion who were breast cancer aware compared with usual care (interaction arm: 32.8% vs 4.1%; odds ratio (OR): 24.0, 95% confidence interval (CI): 7.7-73.7; booklet arm: 12.7% vs 4.1%; OR: 4.4, 95% CI: 1.6-12.0). At 1 year, the effects of the interaction plus booklet, and the booklet, on breast cancer awareness were largely sustained, although the interaction plus booklet remained much more effective. CONCLUSIONS An intervention to equip older women with the knowledge, skills, confidence and motivation to detect breast cancer symptoms and seek help promptly increases breast cancer awareness at 1 year. Future research will evaluate whether the intervention promotes early presentation and reduces breast cancer mortality.
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Affiliation(s)
- L Linsell
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
| | - L J L Forbes
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
| | - M Kapari
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
| | - C Burgess
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
| | - L Omar
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
| | - L Tucker
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
| | - A J Ramirez
- King's College London, Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, St Thomas' Hospital, London SE1 7EH, UK
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Holman RR, Paul S, Farmer A, Tucker L, Stratton IM, Neil HAW. Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial. Diabetologia 2009; 52:50-9. [PMID: 19002433 DOI: 10.1007/s00125-008-1179-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [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: 04/09/2008] [Accepted: 08/22/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to examine the impact of statin or omega-3-acid ethyl esters 90 (omega-3 EE90; omega-3-acid ethyl esters 90 refers to a mixture of ethyl esters of n-3 fatty acids) on estimated cardiovascular disease (CVD) risk in community-based people with type 2 diabetes but without known CVD and not taking lipid-lowering therapy. METHODS A central computer randomised 800 patients in 59 UK general practices to atorvastatin (n = 401, 20 mg/day) or placebo (n = 399) and omega-3 EE90 (n = 397, 2 g/day) or placebo (n = 403) in a concealed factorial manner. Participants with LDL-cholesterol <2.6 mmol/l, triacylglycerol <1.5 mmol/l and estimated 10-year CVD risk <20% were compared at 4 months. RESULTS Mean (SD) age was 63.5 (11.7) years, HbA(1c) 6.9 (1.1) % and known diabetes duration (median [interquartile range]) was 4 (2-8) years. Fifty-seven per cent were men, 90% white and 74% had an estimated 10-year CVD risk >or=20%. Of 732 patients with 4-month data, more allocated atorvastatin (n = 371) compared with placebo (n = 361) achieved LDL-cholesterol <2.6 mmol/l (91% vs 24%, p < 0.001) and had estimated 10-year CVD risks <20% (38% vs 26%, p < 0.001). No differences were seen between those allocated omega-3 EE90 (n = 371) compared with placebo (n = 361) for participants achieving triacylglycerol <1.5 mmol/l (65% vs 60%, p = 0.18) or estimated 10-year CVD risks <20% (34% vs 30%, p = 0.18). There were no side effects of note. CONCLUSIONS/INTERPRETATION Many community-based diabetic patients without known CVD remain at high CVD risk despite statin treatment and require additional risk-reduction strategies. The impact of omega-3 EE90 on CVD risk will remain uncertain until clinical endpoint trial results are available. TRIAL REGISTRATION ISRCT no. 76737502.
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Affiliation(s)
- R R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, Headington, Oxford, UK.
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Gloyn AL, van de Bunt M, Stratton IM, Lonie L, Tucker L, Ellard S, Holman RR. Prevalence of GCK mutations in individuals screened for fasting hyperglycaemia. Diabetologia 2009; 52:172-4. [PMID: 19002431 DOI: 10.1007/s00125-008-1188-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
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Tucker L, Omar L, Burgess C, Kedge L, Whelehan P, Ramirez A. Promoting early presentation of breast cancer amongst older women: radiographers' experiences of taking on a new role. Breast Cancer Res 2008. [PMCID: PMC3332646 DOI: 10.1186/bcr2079] [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: 11/17/2022] Open
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Burgess C, Whelehan P, Omar L, Tucker L, Kedge L, Ramirez A. Is it feasible to train diagnostic radiographers to deliver a psycho-educational intervention to promote early presentation of breast cancer amongst older women? A pilot study. Breast Cancer Res 2008. [PMCID: PMC3332589 DOI: 10.1186/bcr2017] [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: 11/20/2022] Open
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Owens B, Tucker L, Collins MA, McCracken KJ. Effects of different feed additives alone or in combination on broiler performance, gut microflora and ileal histology. Br Poult Sci 2008; 49:202-12. [PMID: 18409095 DOI: 10.1080/00071660802004890] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
1. The objectives of this experiment were to investigate the effects of different xylanases, alone or in combination with different organic acid and oligosaccharide sources, on bird performance, gut microflora and ileal histology. 2. Birds were given a diet based on a commercial formulation, which was split into 8 batches. Batch 1 contained the antibiotic growth promoter Avilamycin and acted as the positive control. To batch 2 the enzyme Allzyme PT was added and to batch 3 Allzyme PT was added with the organic acid and oligosaccharide mixture Avimos. To batch 4, Allzyme PT was added with the oligosaccharide mixture Biomos. To batch 5, yeast extract 2012 was added with the organic acid mixture Gustor and the enzyme xylanase XP20. To batch 6, yeast extract 2012 and feed acidifier Gustor were added as before, with the enzyme Avizyme 1300. Batches 7 and 8 both acted as negative experimental controls, with no added growth promoters. 3. A total of 64 birds were housed in individual wire cages in each of three consecutive experimental replicates (24 birds/treatment). Birds were fed ad libitum from 7 to 28 d and a 7-d excreta collection was carried out to determine apparent metabolisable energy (AME) content. 4. At 28 d, the birds were killed and viscosity of jejunal digesta supernatant and gizzard weight were determined. Samples were taken from the crop, ileum and caecum and analysed for viable presumptive lactic acid bacteria and coliforms. The overall microbial flora was determined using denaturing gradient gel electrophoresis of 16S ribosomal DNA followed by DNA sequence analysis in order to assign amplicons to a bacterial species. Ileal sections were also collected for histological analysis. 5. Total live weight gain (12%) and gain:feed (9%) were significantly improved for all diets containing additives, compared to the negative control diets. All diets containing xylanases gave significantly lower in vivo viscosity values than the positive and negative controls. Diet treatment significantly affected viable coliform numbers in the ileum and also viable lactobacilli in the ileum and caecum. A substantial proportion of the bacteria present in the GI tract (40%) belong to unknown species. No effects of diet treatment on histological measurements were observed in this study. 6. All the additive combinations studied were at least as effective as the antibiotic growth promoter and the results for Allzyme PT suggest that xylanase alone is as effective as any of the combinations studied.
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Affiliation(s)
- B Owens
- Agriculture, Food and Environmental Science Division, Queen's University, Belfast, Northern Ireland.
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Blasi A, Fox S, Everdell N, Volein A, Tucker L, Csibra G, Gibson AP, Hebden JC, Johnson MH, Elwell CE. Investigation of depth dependent changes in cerebral haemodynamics during face perception in infants. Phys Med Biol 2007; 52:6849-64. [DOI: 10.1088/0031-9155/52/23/005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Using a sample of college-aged men, we evaluated the validity of a staging algorithm for dairy calcium intake that had been previously validated in a sample of college women. College-aged men enrolled at a private university in the United States were randomly selected to participate. The sample consisted of 180 male participants. Self-reported calcium intake was measured using a 26-item food frequency questionnaire. Stages of change classifications were based on a four-question algorithm for dairy calcium intake and a three-item self-efficacy questionnaire. Significant differences were found between dairy/calcium intake levels between pre-contemplation, contemplation/preparation, and action/maintenance groups. Results also showed that 46% of participants were in the action/maintenance stage. There was a significant difference in self-efficacy between members of the pre-action and action stages. The study suggests that this stage of change algorithm for dairy calcium intake is valid for use in a male college student population.
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Affiliation(s)
- Anastasia M Snelling
- School of Education, Teaching, and Health, American University, Washington, DC 20016, USA.
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Affiliation(s)
- N A Dayal
- Centre for Rheumatology, Department of Medicine, The Middlesex Hospital University College London, UK.
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Politch J, Xu C, Tucker L, Anderson D. Separation of HIV-1 from the motile sperm fraction: comparison of gradient/swim-up and double tube techniques. Fertil Steril 2001. [DOI: 10.1016/s0015-0282(01)02162-8] [Citation(s) in RCA: 5] [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: 11/28/2022]
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Isenberg D, Katz D, Maddison P, Watts R, Tucker L, Cooke A. Induction of anti-DNA antibodies: commentary on article by Satake et al. Lupus 2001; 10:63-5. [PMID: 11243512 DOI: 10.1191/096120301667736481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Falcone M, Yeung B, Tucker L, Rodriguez E, Krahl T, Sarvetnick N. IL-4 triggers autoimmune diabetes by increasing self-antigen presentation within the pancreatic Islets. Clin Immunol 2001; 98:190-9. [PMID: 11161975 DOI: 10.1006/clim.2000.4979] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 11/22/2022]
Abstract
Several findings have recently questioned the long held hypothesis that cytokines belonging to the Th2 pathway are protective in T-cell-mediated autoimmunity. Among them, there is our previous report that pancreatic expression of IL-4 activated islet antigen-specific BDC2.5 T cells and rendered them able to trigger insulin-dependent diabetes mellitus in ins-IL-4/BDC2.5 mice (Mueller et al., Immunity, 7, 1997). Here we analyze the mechanisms underlying IL-4-mediated activation of the self-reactive BDC2.5 T cells. IL-4 is mainly known as the Th2-driving cytokine. However, IL-4 is also critical for DC maturation and upregulation of antigen uptake and presentation by macrophages. In our model, we found that pancreatic expression of IL-4 activated self-reactive BDC2.5 T cells by increasing islet antigen presentation by macrophages and dendritic cells. IL-4 could have triggered self-antigen presentation within the pancreatic islets both by driving maturation of DC from a tolerizing to a priming state and by increasing self-antigen uptake by macrophages.
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Affiliation(s)
- M Falcone
- Department of Immunology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California, 92037, USA
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Judkowski V, Pinilla C, Schroder K, Tucker L, Sarvetnick N, Wilson DB. Identification of MHC class II-restricted peptide ligands, including a glutamic acid decarboxylase 65 sequence, that stimulate diabetogenic T cells from transgenic BDC2.5 nonobese diabetic mice. J Immunol 2001; 166:908-17. [PMID: 11145667 DOI: 10.4049/jimmunol.166.2.908] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nonobese diabetic (NOD) mice spontaneously develop insulitis and destruction of pancreatic islet beta cells similar to type 1 diabetes mellitis in humans. Insulitis also occurs in the BDC2.5 TCR transgenic line of NOD mice that express the rearranged TCR alpha- and beta-chain genes of a diabetogenic NOD CD4 T cell clone. When activated with syngeneic islet cells in culture, BDC2.5 T cells adoptively transfer disease to NOD recipients, but the identity of the islet cell Ag responsible for pathogenicity is not known. To characterize the autoantigen(s) involved, BDC2.5 T cells were used to screen a combinatorial peptide library arranged in a positional scanning format. We identified more than 100 decapeptides that stimulate these T cells at nanomolar concentrations; they are then capable of transferring disease to NOD-scid mice. Surprisingly, some of the peptides include sequences similar (8 of 10 residues) to those found within the 528-539 fragment of glutamic acid decarboxylase 65. Although this 12-mer glutamic acid decarboxylase 65 fragment is only slightly stimulatory for BDC2.5 T cells (EC(50) > 100 microM), a larger 16-mer fragment, 526-541, shows activity in the low micromolar range (EC(50) = 2.3 microM). Finally, T cells from prediabetic NOD mice respond spontaneously to these peptide analogs in culture; this finding validates them as being related to a critical autoantigen involved in the etiology of spontaneous diabetes and indicates that their further characterization is important for a better understanding of underlying disease mechanisms.
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Affiliation(s)
- V Judkowski
- Torrey Pines Institute for Molecular Studies, San Diego, CA 92121, USA
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Balasa B, La Cava A, Van Gunst K, Mocnik L, Balakrishna D, Nguyen N, Tucker L, Sarvetnick N. A mechanism for IL-10-mediated diabetes in the nonobese diabetic (NOD) mouse: ICAM-1 deficiency blocks accelerated diabetes. J Immunol 2000; 165:7330-7. [PMID: 11120869 DOI: 10.4049/jimmunol.165.12.7330] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neonatal islet-specific expression of IL-10 in nonobese diabetic (NOD) mice accelerates the onset of diabetes, whereas systemic treatment of young NOD mice with IL-10 prevents diabetes. The mechanism for acceleration of diabetes in IL-10-NOD mice is not known. Here we show, by adoptive transfers, that prediabetic or diabetic NOD splenocytes upon encountering IL-10 in the pancreatic islets readily promoted diabetes. This outcome suggests that the compartment of exposure, not the timing, confers proinflammatory effects on this molecule. Moreover, injection of IL-10-deficient NOD splenocytes into transgenic IL-10-NOD.scid/scid mice elicited accelerated disease, demonstrating that pancreatic IL-10 but not endogenous IL-10 is sufficient for the acceleration of diabetes. Immunohistochemical analysis revealed hyperexpression of ICAM-1 on the vascular endothelium of IL-10-NOD mice. The finding suggests that IL-10 may promote diabetes via an ICAM-1-dependent pathway. We found that introduction of ICAM-1 deficiency into IL-10-NOD mice as well as into NOD mice prevented accelerated insulitis and diabetes. Failure to develop insulitis and diabetes was preceded by the absence of GAD65-specific T cell responses. The data suggest that ICAM-1 plays a role in the formation of the "immunological synapse", thereby affecting the generation and/or expansion of islet-specific T cells. In addition, ICAM-1 also played a role in the effector phase of autoimmune diabetes because adoptive transfer of diabetogenic BDC2.5 T cells failed to elicit clinical disease in ICAM-1-deficient IL-10-NOD and NOD mice. These findings provide evidence that pancreatic IL-10 is sufficient to drive pathogenic autoimmune responses and accelerates diabetes via an ICAM-1-dependent pathway.
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MESH Headings
- Adoptive Transfer
- Animals
- Autoantigens/immunology
- Diabetes Mellitus, Type 1/etiology
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/prevention & control
- Female
- Glutamate Decarboxylase/immunology
- Immunity, Innate/genetics
- Intercellular Adhesion Molecule-1/biosynthesis
- Intercellular Adhesion Molecule-1/genetics
- Interleukin-10/biosynthesis
- Interleukin-10/deficiency
- Interleukin-10/genetics
- Interleukin-10/physiology
- Islets of Langerhans/pathology
- Isoenzymes/immunology
- Lymphocyte Activation
- Lymphocyte Transfusion
- Mice
- Mice, Inbred BALB C
- Mice, Inbred NOD
- Mice, Knockout
- Mice, SCID
- Mice, Transgenic
- Pancreas/immunology
- Pancreas/metabolism
- Spleen/cytology
- Spleen/immunology
- Spleen/metabolism
- Spleen/transplantation
- T-Lymphocytes/enzymology
- T-Lymphocytes/immunology
- Transgenes/immunology
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Affiliation(s)
- B Balasa
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
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43
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Zwerdling T, Davies S, Lazar L, Crawford B, Tucker L, Boughner A, Richter-Beck L. Unique aspects of caring for dying children and their families. Am J Hosp Palliat Care 2000; 17:305-11. [PMID: 11886054 DOI: 10.1177/104990910001700507] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
Pediatric hospice has become an important service for children and their families in the past decade. In this article we present unique aspects of StarShine, the hospice of Children's Hospital Medical Center in Cincinnati, Ohio. Length-of-service data demonstrate the need to find innovative ways of encouraging earlier referral to hospice. Several specialized aspects of care, such as long-term bereavement, pet visitation and social services for the family are presented. The initiation of a novel in-home pain management program is described. StarShine has not followed an adult hospice model, and as such, we discuss those unique aspects of dying pediatric patients and suggest specific solutions and interventions designed for children.
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Affiliation(s)
- T Zwerdling
- Division of Hematology/Oncology/Stem Cell Transplant, Children's Hospital Medical Center Cincinnati, Ohio, USA
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44
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Duffy CM, Tucker L, Burgos-Vargas R. Update on functional assessment tools. J Rheumatol Suppl 2000; 58:11-4. [PMID: 10782850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In recent years, there has been a tremendous growth in the development of measurement instruments that evaluate health status, functional status, disability, and quality of life in adults with rheumatic diseases. In the past decade, similar measures have been developed for application in children with rheumatic diseases. These include the Childhood Arthritis Impact Measurement Scales (CHAIMS), the Childhood Health Assessment Questionnaire (CHAQ), the Juvenile Arthritis Functional Assessment Report (JAFAR), the Juvenile Arthritis Self-report Index (JASI), the Juvenile Arthritis Quality of Life Questionnaire (JAQQ), and the Childhood Arthritis Health Profile (CAHP). The latter 2 instruments assess health related quality of life (HRQOL) and they are discussed here. The need to adapt this kind of instrument for use in an international climate creates an interesting dilemma and this is discussed.
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Affiliation(s)
- C M Duffy
- Division of Rheumatology, Montreal Children's Hospital, Quebec, Canada.
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45
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Tucker L, Lodhavia N, Terreault D. Physicians in Rhode Island. Med Health R I 2000; 83:108-11. [PMID: 10821010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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46
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Panther LA, Tucker L, Xu C, Tuomala RE, Mullins JI, Anderson DJ. Genital tract human immunodeficiency virus type 1 (HIV-1) shedding and inflammation and HIV-1 env diversity in perinatal HIV-1 transmission. J Infect Dis 2000; 181:555-63. [PMID: 10669339 DOI: 10.1086/315230] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study sought to identify genital tract characteristics associated with vertical transmission of human immunodeficiency virus type 1 (HIV-1). HIV-1 DNA and RNA, HIV-1 env diversity, and inflammatory cells were quantified in cervicovaginal lavages (CVLs) of 24 women enrolled in the Women and Infants Transmission Study; 7 women transmitted HIV-1 perinatally. Vaginal candidiasis, HIV-1 culture positivity, levels of HIV-1 DNA and cell-free RNA, and HIV-1 env diversity were significantly higher in the CVLs of transmitters. CVL HIV-1 DNA levels correlated with higher levels of inflammatory cells and cell-free HIV-1 RNA. Of subjects with paired blood and CVL specimens, there was more HIV-1 env heterogeneity between blood and CVLs in transmitters than in nontransmitters. In summary, increased HIV-1 shedding is correlated with a more complex population of HIV-1 quasispecies in the genital tracts of parturient women, which may increase the probability that a fetotropic strain is transmitted.
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Affiliation(s)
- L A Panther
- Department of Obstetrics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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47
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Vassiliadou N, Tucker L, Anderson DJ. Progesterone-induced inhibition of chemokine receptor expression on peripheral blood mononuclear cells correlates with reduced HIV-1 infectability in vitro. J Immunol 1999; 162:7510-8. [PMID: 10358206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Recent studies have shown that progesterone, a sex steroid hormone, enhances the sexual transmission of various pathogens, including SIV. The goal of this study was to determine whether progesterone affects mechanisms underlying the sexual transmission of HIV-1. We first studied the effects of various physiologic concentrations of progesterone on the expression of chemokines and chemokine receptors by T cells and macrophages. Chemokines are involved in leukocyte recruitment to peripheral sites; in addition, the chemokine receptors CCR5 and CXCR4 are HIV-1 coreceptors, and their ligands can block HIV-1 infection. Progesterone treatment had no effect on constitutive expression of CCR5 and CXCR4 by nonactivated T cells and macrophages, but significantly inhibited IL-2-induced up-regulation of CCR5 and CXCR4 on activated T cells (p < 0.05). Progesterone also inhibited both mitogen-induced proliferation and chemokine secretion (macrophage inflammatory protein-1alpha, macrophage inflammatory protein-1beta, RANTES) by CD8+ T lymphocytes. Control and progesterone-treated PBMC cultures were also tested for susceptibility to infection by T cell-tropic (HIV-1MN) and macrophage-tropic (HIV-1JR-CSF) viral strains in vitro. Infection with low titers of HIV-1MN was consistently inhibited in progesterone-treated cultures; progesterone effects on infection with the HIV-1JR-CSF strain were more variable, but correlated with progesterone-induced reductions in CCR5 levels. These results indicate that progesterone treatment can inhibit mechanisms underlying HIV-1 transmission, including infection of CD4+ target cells via CXCR4/CCR5 coreceptors and effects on chemokine-mediated recruitment of lymphocytes and monocytes to mucosal epithelia.
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Affiliation(s)
- N Vassiliadou
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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48
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Mayer KH, Boswell S, Goldstein R, Lo W, Xu C, Tucker L, DePasquale MP, D'Aquila R, Anderson DJ. Persistence of human immunodeficiency virus in semen after adding indinavir to combination antiretroviral therapy. Clin Infect Dis 1999; 28:1252-9. [PMID: 10451162 DOI: 10.1086/514775] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Changes in human immunodeficiency virus (HIV) type 1 concentration and protease genotype were evaluated in semen specimens from 22 HIV-positive men before and 6 months after the addition of indinavir to dual nucleoside therapy. Seminal HIV was detected by polymerase chain reaction analysis for DNA or RNA for 59% of men before combination treatment and persisted at 6 months for 31% of the men who initially had seminal HIV detected (P = .026). The maximum levels of cell-free RNA, cell-associated RNA, and proviral DNA in semen before treatment and at 6 months were 400,000 and 10,000 copies/mL, 70,000 and 27,000 copies/mL, and 80,000 and 3,000 copies/mL, respectively. Three of the four men with persistent seminal DNA had plasma viral loads of > 10,000 copies/mL before treatment. One patient who became intolerant to indinavir had seminal HIV RNA detected by PCR analysis after 6 months. Although none of the cultures of semen specimens from the four men with PCR analysis-detectable seminal DNA after 6 months yielded HIV, indinavir resistance mutations were identified in a seminal leukocyte DNA specimen from one patient, and a second patient whose therapy was switched to saquinavir had different protease inhibitor resistance mutations in seminal and blood leukocyte DNA specimens. HIV-1 protease inhibitor resistance mutants may emerge in the semen of patients receiving combination therapy.
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Affiliation(s)
- K H Mayer
- Fenway Community Health Center, Brigham and Women's Hospital, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.
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49
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O'Donnell A, Tucker L. Pre-dialysis education. A change in clinical practice. How effective is it? EDTNA ERCA J 1999; 25:29-32. [PMID: 10531879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The last decade has seen a great expansion in the provision of pre-dialysis education within the UK, with our programme in operation since 1996. In order to evaluate its impact on patient care, two methodologies were employed: the first used a satisfaction survey with which to examine patient perception of the programme; the second approach examined resource utilisation, in particular length of stay, as an outcome measure. Difficulties have arisen in discerning the impact of the programme amongst the other education interventions to which the patient is exposed. Comparative length of stay data was used as an alternative means of assessment. The results of the audit led us to question the effectiveness of the methodology that we employed and has led us to propose the development of a standard. It is hoped that the adoption of a more structured approach will not only aid the effectiveness of the programme itself but also facilitate the evaluation process.
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50
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Abstract
In this article we present data from our laboratory, and review the literature available, on the potential association between HIV-1 and sperm. We focus on the use of PCR technology to answer this very important question, and emphasise the importance of using highly purified sperm preparations. We conclude that the likelihood of HIV infection/association with viable mature sperm is low.
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Affiliation(s)
- A J Quayle
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Womens Hospital, Harvard Medical School, Boston, MA 02115, USA
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