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Parisotto YF, Cabric V, Park T, Akagbosu B, Zhao Z, Lo Y, Fisher L, Shibu G, Paucar Iza YA, Leslie C, Brown CC. Thetis cells induce food-specific Treg cell differentiation and oral tolerance. bioRxiv 2024:2024.05.08.592952. [PMID: 38766121 PMCID: PMC11100678 DOI: 10.1101/2024.05.08.592952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The intestinal immune system must establish tolerance to food antigens to prevent onset of allergic and inflammatory diseases. Peripherally generated regulatory T (pTreg) cells play an essential role in suppressing inflammatory responses to allergens; however, the antigen-presenting cell (APC) that instructs food-specific pTreg cells is not known. Here, we show that antigen presentation and TGF-β activation by a subset of RORγt + antigen-presenting cells (APC), Thetis cells IV (TC IV), is required for food-induced pTreg cell differentiation and oral tolerance. By contrast, antigen presentation by dendritic cells (DCs) was dispensable for pTreg induction but required for T H 1 effector responses, highlighting a division of labor between tolerogenic TCs and pro-inflammatory DCs. While antigen presentation by TCs was required for food-specific pTreg generation both in early life and adulthood, the increased abundance of TCs in the peri-weaning period was associated with a window of opportunity for enhanced pTreg differentiation. These findings establish a critical role for TCs in oral tolerance and suggest that these cells may represent a key therapeutic target for the treatment of food-associated allergic and inflammatory diseases.
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2
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Amaral EP, Namasivayam S, Queiroz ATL, Fukutani E, Hilligan KL, Aberman K, Fisher L, Bomfim CCB, Kauffman K, Buchanan J, Santuo L, Gazzinelli-Guimaraes PH, Costa DL, Teixeira MA, Barreto-Duarte B, Rocha CG, Santana MF, Cordeiro-Santos M, Barber DL, Wilkinson RJ, Kramnik I, Igarashi K, Scriba T, Mayer-Barber KD, Andrade BB, Sher A. BACH1 promotes tissue necrosis and Mycobacterium tuberculosis susceptibility. Nat Microbiol 2024; 9:120-135. [PMID: 38066332 PMCID: PMC10769877 DOI: 10.1038/s41564-023-01523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 10/11/2023] [Indexed: 01/07/2024]
Abstract
Oxidative stress triggers ferroptosis, a form of cellular necrosis characterized by iron-dependent lipid peroxidation, and has been implicated in Mycobacterium tuberculosis (Mtb) pathogenesis. We investigated whether Bach1, a transcription factor that represses multiple antioxidant genes, regulates host resistance to Mtb. We found that BACH1 expression is associated clinically with active pulmonary tuberculosis. Bach1 deletion in Mtb-infected mice increased glutathione levels and Gpx4 expression that inhibit lipid peroxidation. Bach1-/- macrophages exhibited increased resistance to Mtb-induced cell death, while Mtb-infected Bach1-deficient mice displayed reduced bacterial loads, pulmonary necrosis and lipid peroxidation concurrent with increased survival. Single-cell RNA-seq analysis of lungs from Mtb-infected Bach1-/- mice revealed an enrichment of genes associated with ferroptosis suppression. Bach1 depletion in Mtb-infected B6.Sst1S mice that display human-like necrotic lung pathology also markedly reduced necrosis and increased host resistance. These findings identify Bach1 as a key regulator of cellular and tissue necrosis and host resistance in Mtb infection.
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Affiliation(s)
- Eduardo P Amaral
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA.
| | | | - Artur T L Queiroz
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
| | - Eduardo Fukutani
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
| | - Kerry L Hilligan
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Kate Aberman
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Logan Fisher
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA
- Immunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY, USA
| | - Caio Cesar B Bomfim
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Keith Kauffman
- T lymphocyte Biology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Jay Buchanan
- T lymphocyte Biology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Leslie Santuo
- T lymphocyte Biology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Pedro Henrique Gazzinelli-Guimaraes
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Diego L Costa
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA
- Departmento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Mariane Araujo Teixeira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Clarissa Gurgel Rocha
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador, Bahia, Brazil
- Center for Biotechnology and Cell Therapy, D'Or Institute for Research and Education (IDOR), Sao Rafael Hospital, Salvador, Bahia, Brazil
| | - Monique Freire Santana
- Departmento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Estado do Amazonas-FCECON, Manaus, Amazonas, Brazil
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Faculdade de Medicina, Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | - Daniel L Barber
- T lymphocyte Biology Section, Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Igor Kramnik
- Boston University School of Medicine, Boston, MA, USA
| | - Kazuhiko Igarashi
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Thomas Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Observatory, South Africa
| | - Katrin D Mayer-Barber
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador, Bahia, Brazil
- Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Curso de Medicina, Universidade Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Bahia, Brazil
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, USA.
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McInerney CD, Kotzé A, Bacon S, Cutting JE, Fisher L, Goldacre B, Johnson OA, Kua J, McGuckin D, Mehrkar A, Moonesinghe SR. Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY. Anaesthesia 2023; 78:692-700. [PMID: 36958018 DOI: 10.1111/anae.16001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.
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Affiliation(s)
- C D McInerney
- Academic Unit of Primary Medical Care, University of Sheffield, UK
- School of Computing, University of Leeds, UK
- National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - A Kotzé
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, UK
| | - S Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - J E Cutting
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, UK
| | - L Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - B Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - O A Johnson
- School of Computing, University of Leeds, UK
- National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - J Kua
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
| | - D McGuckin
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
| | - A Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - S R Moonesinghe
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
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Fisher L, Ahmed O, Chalchal H, Deobald R, El-Gayed A, Graham P, Groot G, Haider K, Iqbal N, Johnson K, Le D, Mahmood S, Manna M, Meiers P, Pauls M, Salim M, Sami A, Wright P, Younis M, Ahmed S. P058 Outcomes of Rural Men With Breast Cancer: A Multicenter Population Based Retrospective Cohort Study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00177-7] [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: 03/15/2023] Open
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5
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Fisher L, Mack JM. Reducing the time of antibiotic administration to febrile neutropenic patients in the emergency room. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Fisher L, Polonsky WH, Perez-Nieves M, Desai U, Strycker L, Hessler D. A new perspective on diabetes distress using the type 2 diabetes distress assessment system (T2-DDAS): Prevalence and change over time. J Diabetes Complications 2022; 36:108256. [PMID: 35810147 DOI: 10.1016/j.jdiacomp.2022.108256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 04/27/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS To establish cut-points and thresholds for elevated diabetes distress; document change over time; and define minimal clinically important differences (MCID) using the new Type 2 Diabetes Distress Assessment System (T2-DDAS). METHODS A national sample of adults with type 2 diabetes completed the T2-DDAS CORE distress scale and the 7 T2-DDAS SOURCE distress scales at baseline and 6-months. Scores were computed separately for insulin- and non-insulin users. Spline regression models defined CORE cut-points and SEM formulas defined MCID. A rational "threshold" approach defined elevated SOURCE scores. RESULTS 471 participants (205 insulin, 266 non-insulin) completed both assessments. Analyses yielded ≥2.0 as the cut-point for both elevated CORE and elevated SOURCE. Prevalence of elevated CORE was 61.8 % (69.9 % over 6 months). Elevated SOURCE scores varied from 30.6 % (Stigma/Shame) to 76.4 % (Management); 87.5 % indicated at least 1 elevated SOURCE score. Most (77.1 %) reported multiple elevated SOURCES. 81.8 % with elevated CORE distress at baseline remained elevated at 6 months. MCID analyses yielded +/- 0.25 as significant change. Few differences between insulin- and non-insulin users occurred. CONCLUSIONS Elevated CORE distress is highly prevalent and persistent over time; most participants reported multiple SOURCES of distress. Findings highlight the need for comprehensive assessment of diabetes distress.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, CA, USA.
| | - W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | | | - U Desai
- Analysis Group, Boston, MA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - D Hessler
- University of California, San Francisco, CA, USA
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Obando D, Hill J, Sharp H, Pickles A, Fisher L, Wright N. Synergy between callous-unemotional traits and aggression in preschool children: Cross-informant and cross-cultural replication in the UK Wirral Child Health and Development Study, and the Colombian La Sabana Parent-Child Study. Dev Psychopathol 2022; 34:1079-1087. [PMID: 33752771 DOI: 10.1017/s0954579420002114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Incremental prediction of aggression from callous-unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.
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Affiliation(s)
- D Obando
- Department of Psychology, Universidad de La Sabana, Chia, Colombia
| | - J Hill
- Department of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - H Sharp
- School of Psychology, Institute of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - A Pickles
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - L Fisher
- School of Psychology, Institute of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - N Wright
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
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Bomfim CCB, Fisher L, Amaral EP, Mittereder L, McCann K, Correa AAS, Namasivayam S, Swamydas M, Moayeri M, Weiss JM, Chari R, McVicar DW, Costa DL, D’Império Lima MR, Sher A. Mycobacterium tuberculosis Induces Irg1 in Murine Macrophages by a Pathway Involving Both TLR-2 and STING/IFNAR Signaling and Requiring Bacterial Phagocytosis. Front Cell Infect Microbiol 2022; 12:862582. [PMID: 35586249 PMCID: PMC9109611 DOI: 10.3389/fcimb.2022.862582] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Irg1 is an enzyme that generates itaconate, a metabolite that plays a key role in the regulation of inflammatory responses. Previous studies have implicated Irg1 as an important mediator in preventing excessive inflammation and tissue damage in Mycobacterium tuberculosis (Mtb) infection. Here, we investigated the pattern recognition receptors and signaling pathways by which Mtb triggers Irg1 gene expression by comparing the responses of control and genetically deficient BMDMs. Using this approach, we demonstrated partial roles for TLR-2 (but not TLR-4 or -9), MyD88 and NFκB signaling in Irg1 induction by Mtb bacilli. In addition, drug inhibition studies revealed major requirements for phagocytosis and endosomal acidification in Irg1 expression triggered by Mtb but not LPS or PAM3CSK4. Importantly, the Mtb-induced Irg1 response was highly dependent on the presence of the bacterial ESX-1 secretion system, as well as host STING and Type I IFN receptor (IFNAR) signaling with Type II IFN (IFN-γ) signaling playing only a minimal role. Based on these findings we hypothesize that Mtb induces Irg1 expression in macrophages via the combination of two independent triggers both dependent on bacterial phagocytosis: 1) a major signal stimulated by phagocytized Mtb products released by an ESX-1-dependent mechanism into the cytosol where they activate the STING pathway leading to Type I-IFN production, and 2) a secondary TLR-2, MyD88 and NFκB dependent signal that enhances Irg1 production independently of Type I IFN induction.
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Affiliation(s)
- Caio C. B. Bomfim
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Laboratory of Parasitic Diseases - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Logan Fisher
- Laboratory of Parasitic Diseases - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Eduardo P. Amaral
- Laboratory of Parasitic Diseases - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Lara Mittereder
- Laboratory of Parasitic Diseases - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Katelyn McCann
- Laboratory of Clinical Immunology and Microbiology - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - André A. S. Correa
- Department of Biochemistry and Immunology - Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Graduate Program in Basic and Applied Immunology - Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Sivaranjani Namasivayam
- Laboratory of Parasitic Diseases - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Muthulekha Swamydas
- Laboratory of Clinical Immunology and Microbiology - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Mahtab Moayeri
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jonathan M. Weiss
- Laboratory of Cancer Immunometabolism, Center for Cancer Research, National Cancer Institute, Frederick, MD, United States
| | - Raj Chari
- Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Daniel W. McVicar
- Laboratory of Cancer Immunometabolism, Center for Cancer Research, National Cancer Institute, Frederick, MD, United States
| | - Diego L. Costa
- Department of Biochemistry and Immunology - Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Graduate Program in Basic and Applied Immunology - Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Maria R. D’Império Lima
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Alan Sher
- Laboratory of Parasitic Diseases - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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9
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Akagbosu B, Tayyebi Z, Shibu G, Paucar Iza YA, Deep D, Parisotto YF, Fisher L, Pasolli HA, Thevin V, Elmentaite R, Knott M, Hemmers S, Jahn L, Friedrich C, Verter J, Wang ZM, van den Brink M, Gasteiger G, Grünewald TGP, Marie JC, Leslie C, Rudensky AY, Brown CC. Novel antigen-presenting cell imparts T reg-dependent tolerance to gut microbiota. Nature 2022; 610:752-760. [PMID: 36070798 PMCID: PMC9605865 DOI: 10.1038/s41586-022-05309-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [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: 05/09/2021] [Accepted: 09/01/2022] [Indexed: 01/21/2023]
Abstract
Establishing and maintaining tolerance to self-antigens or innocuous foreign antigens is vital for the preservation of organismal health. Within the thymus, medullary thymic epithelial cells (mTECs) expressing autoimmune regulator (AIRE) have a critical role in self-tolerance through deletion of autoreactive T cells and promotion of thymic regulatory T (Treg) cell development1-4. Within weeks of birth, a separate wave of Treg cell differentiation occurs in the periphery upon exposure to antigens derived from the diet and commensal microbiota5-8, yet the cell types responsible for the generation of peripheral Treg (pTreg) cells have not been identified. Here we describe the identification of a class of RORγt+ antigen-presenting cells called Thetis cells, with transcriptional features of both mTECs and dendritic cells, comprising four major sub-groups (TC I-TC IV). We uncover a developmental wave of Thetis cells within intestinal lymph nodes during a critical window in early life, coinciding with the wave of pTreg cell differentiation. Whereas TC I and TC III expressed the signature mTEC nuclear factor AIRE, TC IV lacked AIRE expression and was enriched for molecules required for pTreg generation, including the TGF-β-activating integrin αvβ8. Loss of either major histocompatibility complex class II (MHCII) or ITGB8 by Thetis cells led to a profound impairment in intestinal pTreg differentiation, with ensuing colitis. By contrast, MHCII expression by RORγt+ group 3 innate lymphoid cells (ILC3) and classical dendritic cells was neither sufficient nor required for pTreg generation, further implicating TC IV as the tolerogenic RORγt+ antigen-presenting cell with an essential function in early life. Our studies reveal parallel pathways for the establishment of tolerance to self and foreign antigens in the thymus and periphery, respectively, marked by the involvement of shared cellular and transcriptional programmes.
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Affiliation(s)
- Blossom Akagbosu
- grid.51462.340000 0001 2171 9952Immuno-Oncology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Zakieh Tayyebi
- grid.51462.340000 0001 2171 9952Computational and Systems Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.5386.8000000041936877XTri-Institutional Program in Computational Biology and Medicine, Weill Cornell Graduate School, New York, NY USA
| | - Gayathri Shibu
- grid.51462.340000 0001 2171 9952Immuno-Oncology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA ,grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA
| | - Yoselin A. Paucar Iza
- grid.51462.340000 0001 2171 9952Immuno-Oncology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA ,grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA
| | - Deeksha Deep
- grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA ,grid.51462.340000 0001 2171 9952Howard Hughes Medical Institute and Immunology Program, Sloan Kettering Institute and Ludwig Center at Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.5386.8000000041936877XTri-Institutional MD-PhD Program, Weill Cornell Medicine, The Rockefeller University and Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Yollanda Franco Parisotto
- grid.51462.340000 0001 2171 9952Immuno-Oncology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Logan Fisher
- grid.51462.340000 0001 2171 9952Immuno-Oncology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA ,grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA
| | - H. Amalia Pasolli
- grid.134907.80000 0001 2166 1519Electron Microscopy Resource Center, The Rockefeller University, New York, NY USA
| | - Valentin Thevin
- grid.462282.80000 0004 0384 0005Tumor Escape Resistance Immunity Department, CRCL, INSERM U1052, CNRS 5286, Centre Léon Bérard, Université de Lyon, Lyon, France ,Equipe Labellisée Ligue Nationale contre le Cancer, Lyon, France
| | - Rasa Elmentaite
- grid.10306.340000 0004 0606 5382Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton UK
| | - Maximilian Knott
- grid.5252.00000 0004 1936 973XInstitute of PathologyFaculty of Medicine, LMU Munich, Munich, Germany
| | - Saskia Hemmers
- grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA ,grid.51462.340000 0001 2171 9952Howard Hughes Medical Institute and Immunology Program, Sloan Kettering Institute and Ludwig Center at Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.26009.3d0000 0004 1936 7961Present Address: Department of Immunology, Duke University, Durham, NC USA
| | - Lorenz Jahn
- grid.51462.340000 0001 2171 9952Department of Immunology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Christin Friedrich
- grid.8379.50000 0001 1958 8658Würzburg Institute of Systems Immunology, Max Planck Research Group, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Jacob Verter
- grid.51462.340000 0001 2171 9952Howard Hughes Medical Institute and Immunology Program, Sloan Kettering Institute and Ludwig Center at Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Zhong-Min Wang
- grid.51462.340000 0001 2171 9952Howard Hughes Medical Institute and Immunology Program, Sloan Kettering Institute and Ludwig Center at Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Marcel van den Brink
- grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA ,grid.51462.340000 0001 2171 9952Department of Immunology, Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.51462.340000 0001 2171 9952Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Georg Gasteiger
- grid.8379.50000 0001 1958 8658Würzburg Institute of Systems Immunology, Max Planck Research Group, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Thomas G. P. Grünewald
- grid.510964.fHopp—Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Julien C. Marie
- grid.462282.80000 0004 0384 0005Tumor Escape Resistance Immunity Department, CRCL, INSERM U1052, CNRS 5286, Centre Léon Bérard, Université de Lyon, Lyon, France ,Equipe Labellisée Ligue Nationale contre le Cancer, Lyon, France
| | - Christina Leslie
- grid.51462.340000 0001 2171 9952Computational and Systems Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Alexander Y. Rudensky
- grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA ,grid.51462.340000 0001 2171 9952Howard Hughes Medical Institute and Immunology Program, Sloan Kettering Institute and Ludwig Center at Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Chrysothemis C. Brown
- grid.51462.340000 0001 2171 9952Immuno-Oncology, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, USA ,grid.5386.8000000041936877XImmunology and Microbial Pathogenesis Program, Weill Cornell Medicine Graduate School of Medical Sciences, New York, NY USA ,grid.51462.340000 0001 2171 9952Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.51462.340000 0001 2171 9952Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY USA
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10
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Polonsky WH, Fortmann AL, Price D, Fisher L. "Hyperglycemia aversiveness": Investigating an overlooked problem among adults with type 1 diabetes. J Diabetes Complications 2021; 35:107925. [PMID: 33836966 DOI: 10.1016/j.jdiacomp.2021.107925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. METHODS We developed three self-report items as a means to identify individuals who endorse a consistent preference for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), validated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. RESULTS Hyperglycemia Aversives comprised 16.4% of the sample. This unique group demonstrated significantly higher mean %TIR (71.6% vs. 63.6%) and %TBR (5.1% vs. 2.2%), lower mean %TAR > 250 mg/dL (6.0% vs. 10.1%), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remaining study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. CONCLUSIONS We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyperglycemia. These individuals achieve significantly greater %TIR and less %TAR, but at the cost of greater %TBR and more frequent severe hypoglycemia episodes.
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Affiliation(s)
- W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, United States of America; Department of Medicine, University of California, San Diego, CA, United States of America.
| | - A L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, United States of America
| | - D Price
- Dexcom, Inc., San Diego, CA, United States of America
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
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11
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Aberman K, Fisher L, Oland S, Sher A, Amaral EP. The transcription factor Bach1 plays an important role in regulating macrophage ferroptosis upon iron supplementation. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.111.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Ferroptosis is a novel iron-mediated necrotic cell death pathway associated with accumulation of lipid peroxidation, reduced levels of glutathione (GSH) and glutathione peroxidase-4 (Gpx4). This form of cell death has been implicated in different diseases, including tuberculosis. Our group previously described that Mtb-induced macrophage necrosis is associated with hallmarks of ferroptosis, facilitating bacterial spread extracellularly. Nevertheless, the mechanisms underlying the effect of iron in modulating cell death remain poorly delineated. In this study, we used an iron overload model of ferroptosis on bone-marrow derived macrophages (BMDMs) to investigate molecular mediators of antioxidant generation and lipid peroxidation, and their role in modulating ferroptotic cell death. Our findings showed that BMDMs deficient in Nrf2, a transcription factor that regulates many antioxidant genes, were highly susceptible to iron-mediated ferroptosis. In the opposite direction, BMDMs deficient in lipoxygenase-5 (5-LO) as well as in Bach1, a Nrf2 suppressor, displayed enhanced resistance to the cytotoxic effects of iron overload. Interestingly, ~50% of the ferroptotic death triggered by iron supplementation was blocked by 5-LO deficiency while in Bach1-/- macrophage cultures this suppression reached ~94%. Together, these findings indicate that 5-LO plays a partial role in lipid peroxidation driven by iron overload and reveal Bach1 as a master regulator of ferroptosis in macrophages. This study additionally provides a conceptual basis for further investigation of the role of ferroptosis-induced cellular and tissue damage in Mtb infection.
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Affiliation(s)
| | | | | | - Alan Sher
- 1Laboratory of Parasitic Diseases, NIAID, NIH
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12
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Costa DL, Amaral EP, Namasivayam S, Mittereder LR, Fisher L, Bonfim CC, Sardinha-Silva A, Thompson RW, Hieny SE, Andrade BB, Sher A. Heme oxygenase-1 inhibition promotes IFNγ- and NOS2-mediated control of Mycobacterium tuberculosis infection. Mucosal Immunol 2021; 14:253-266. [PMID: 32862202 PMCID: PMC7796944 DOI: 10.1038/s41385-020-00342-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/17/2020] [Accepted: 08/12/2020] [Indexed: 02/04/2023]
Abstract
Mycobacterium tuberculosis (Mtb) infection induces pulmonary expression of the heme-degrading enzyme heme oxygenase-1 (HO-1). We have previously shown that pharmacological inhibition of HO-1 activity in experimental tuberculosis results in decreased bacterial loads and unexpectedly that this outcome depends on the presence of T lymphocytes. Here, we extend these findings by demonstrating that IFNγ production by T lymphocytes and NOS2 expression underlie this T-cell requirement and that HO-1 inhibition potentiates IFNγ-induced NOS2-dependent control of Mtb by macrophages in vitro. Among the products of heme degradation by HO-1 (biliverdin, carbon monoxide, and iron), only iron supplementation reverted the HO-1 inhibition-induced enhancement of bacterial control and this reversal was associated with decreased NOS2 expression and NO production. In addition, we found that HO-1 inhibition results in decreased labile iron levels in Mtb-infected macrophages in vitro and diminished iron accumulation in Mtb-infected lungs in vivo. Together these results suggest that the T-lymphocyte dependence of the therapeutic outcome of HO-1 inhibition on Mtb infection reflects the role of the enzyme in generating iron that suppresses T-cell-mediated IFNγ/NOS2-dependent bacterial control. In broader terms, our findings highlight the importance of the crosstalk between iron metabolism and adaptive immunity in determining the outcome of infection.
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Affiliation(s)
- Diego L Costa
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA,* Diego L Costa current affiliation: Departmento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Eduardo P Amaral
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sivaranjani Namasivayam
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lara R Mittereder
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Logan Fisher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Caio C Bonfim
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Aline Sardinha-Silva
- Molecular Parasitology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert W Thompson
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sara E Hieny
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Bruno B Andrade
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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13
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Adeleke OA, Fisher L, Moore IN, Nardone GA, Sher A. A Long-Acting Thermoresponsive Injectable Formulation of Tin Protoporphyrin Sustains Antitubercular Efficacy in a Murine Infection Model. ACS Pharmacol Transl Sci 2020; 4:276-287. [PMID: 33615179 PMCID: PMC7887855 DOI: 10.1021/acsptsci.0c00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 11/29/2022]
Abstract
![]()
Tuberculosis is the leading cause of death from a single infectious agent, ranking
above the human immunodeficiency virus (HIV). Effective treatment using antibiotics is
achievable, but poor patient compliance constitutes a major challenge impeding
successful pharmacotherapeutic outcomes. This is often due to the prolonged treatment
periods required and contributes significantly to the rising incidence of drug
resistance, which is a major cause of tuberculosis mortality. Thus, innovative
interventions capable of encouraging compliance and decreasing lengthy and frequent
dosing are needed. Previously, aqueous tin protoporphyrin IX (SnPPIX), a heme
oxygenase-1 inhibitor, administered as multiple daily intraperitoneal (IP) injections,
showed considerable antitubercular efficacy and treatment shortening capabilities as a
host-directed therapy in infected mice. Since daily IP injection is a clinically
impractical administration approach, this proof-of-concept study aims to develop a
novel, sustained action injectable formulation of SnPPIX for safe intramuscular (IM)
administration. Herein, a SnPPIX-loaded poloxamer-poly(acrylic acid)-based
thermoresponsive injectable formulation (SnPPIX-TIF) is designed for effective IM
delivery. Results show SnPPIX-TIF is microparticulate, syringeable, injectable, and
exhibits complete in vitro/in vivo gelation.
Administered once weekly, SnPPIX-TIF significantly prolonged absorption and
antimicrobial efficacy in infected mice. In addition, SnPPIX-TIF is well-tolerated
in vivo; results from treated animals show no significant
histopathologic alterations and were indistinguishable from the untreated control group,
thus supporting its biocompatibility and preclinical safety. Overall, the IM delivery of
the thermoresponsive injectable formulation safely sustains antitubercular effect in an
infected murine model and decreases the number of injections required, signifying a
potentially practical approach for future clinical translation.
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Affiliation(s)
- Oluwatoyin A Adeleke
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland 20892, United States.,Division of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Science University, Pretoria 0208, South Africa
| | - Logan Fisher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland 20892, United States
| | - Ian N Moore
- Infectious Disease Pathogenesis Section (IDPS), Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Rockville, Maryland 20852, United States
| | - Glenn A Nardone
- Protein Chemistry Section, Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Rockville, Maryland 20852, United States
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland 20892, United States
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14
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Polonsky WH, Fisher L, Hessler D, Liu J, Fan L, McAuliffe-Fogarty AH. Worries and concerns about hypoglycemia in adults with type 1 diabetes: An examination of the reliability and validity of the Hypoglycemic Attitudes and Behavior Scale (HABS). J Diabetes Complications 2020; 34:107606. [PMID: 32354623 DOI: 10.1016/j.jdiacomp.2020.107606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/20/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
Abstract
AIMS To examine the factor structure, validity and reliability of the Hypoglycemic Attitudes and Behavior Scale (HABS) in T1D adults (previously examined only in T2D adults), and to determine if it has unique value, after controlling for hypoglycemic fear. METHODS The original 14 HABS items were submitted to a confirmatory factor analysis (CFA) with T1D participants. Construct validity criteria included diabetes distress, generalized anxiety, well-being, hypoglycemic fear, hypoglycemia history and self-reported glycemic control. RESULTS A CFA yielded a similar 3-factor solution, with all items loading on the same factors as in the analyses with T2D adults: Hypoglycemia Anxiety, Avoidance and Confidence. Higher levels of Anxiety and Avoidance were significantly associated with poorer well-being and higher levels of generalized anxiety, diabetes distress and hypoglycemic fear, with correlations in the reverse direction for Confidence. After controls (including hypoglycemic fear), the HABS subscales were significantly linked to several criterion variables. CONCLUSIONS Though originally developed and validated with T2D adults, the HABS demonstrates sufficient validity and reliability for use with a T1D population; and it captures unique critical elements of hypoglycemic concerns. Thus, it may contribute to a greater understanding of hypoglycemia management and more targeted clinical interventions in a T1D population.
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Affiliation(s)
- W H Polonsky
- Department of Medicine, University of California, San Diego, United States of America; Behavioral Diabetes Institute, San Diego, CA, United States of America.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| | - J Liu
- T1D Exchange, Boston, MA, United States of America
| | - L Fan
- Eli Lilly and Company, Lilly Diabetes, Indianapolis, IN, United States of America
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15
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Honaker Y, Hubbard N, Xiang Y, Fisher L, Hagin D, Sommer K, Song Y, Yang SJ, Lopez C, Tappen T, Dam EM, Khan I, Hale M, Buckner JH, Scharenberg AM, Torgerson TR, Rawlings DJ. Gene editing to induce FOXP3 expression in human CD4+ T cells leads to a stable regulatory phenotype and function. Sci Transl Med 2020; 12:12/546/eaay6422. [DOI: 10.1126/scitranslmed.aay6422] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/09/2019] [Accepted: 04/13/2020] [Indexed: 12/21/2022]
Abstract
Thymic regulatory T cells (tTregs) are potent inhibitors of autoreactive immune responses, and loss of tTreg function results in fatal autoimmune disease. Defects in tTreg number or function are also implicated in multiple autoimmune diseases, leading to growing interest in use of Treg as cell therapies to establish immune tolerance. Because tTregs are present at low numbers in circulating blood and may be challenging to purify and expand and also inherently defective in some subjects, we designed an alternative strategy to create autologous Treg-like cells from bulk CD4+ T cells. We used homology-directed repair (HDR)–based gene editing to enforce expression of FOXP3, the master transcription factor for tTreg. Targeted insertion of a robust enhancer/promoter proximal to the first coding exon bypassed epigenetic silencing, permitting stable and robust expression of endogenous FOXP3. HDR-edited T cells, edTregs, manifested a transcriptional program leading to sustained expression of canonical markers and suppressive activity of tTreg. Both human and murine edTregs mediated immunosuppression in vivo in models of inflammatory disease. Further, this engineering strategy permitted generation of antigen-specific edTreg with robust in vitro and in vivo functional activity. Last, edTreg could be enriched and expanded at scale using clinically relevant methods. Together, these findings suggest that edTreg production may permit broad future clinical application.
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Affiliation(s)
- Yuchi Honaker
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Nicholas Hubbard
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Yufei Xiang
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Logan Fisher
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - David Hagin
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Karen Sommer
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Yumei Song
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | | | - Christina Lopez
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Tori Tappen
- Benaroya Research Institute, Seattle, WA 98101, USA
| | | | - Iram Khan
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Malika Hale
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Jane H. Buckner
- Benaroya Research Institute, Seattle, WA 98101, USA
- Department of Medicine, University of Washington, Seattle, WA 98101, USA
- Department of Immunology, University of Washington, Seattle, WA 98101, USA
| | - Andrew M. Scharenberg
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
- Department of Immunology, University of Washington, Seattle, WA 98101, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98101, USA
| | - Troy R. Torgerson
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
- Department of Immunology, University of Washington, Seattle, WA 98101, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98101, USA
| | - David J. Rawlings
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, WA 98101, USA
- Department of Immunology, University of Washington, Seattle, WA 98101, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98101, USA
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16
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Amaral EP, Namasivayam S, Costa DL, Fisher L, Bomfim CCB, Andrade BB, Sher A. The transcription factor BACH1 promotes tissue damage and host susceptibility in Mycobacterium tuberculosis infection by reducing expression of Gpx4, a major negative regulator of ferroptosis. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.227.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Ferroptosis is a type of regulated necrotic cell death induced by the acumulation of free iron and lipid peroxides. We have previously described a role for ferroptosis in Mtb-induced macrophage necrosis based on its biochemical requirements and its blockade both in vitro and in vivo by a lipid peroxidation inhibitor (fer-1). To help validate these findings and further delineate the mechanism involved we have analyzed Mtb-induced cellular necrosis and host resistance in mice deficient in or overexpressing glutathione peroxidase (Gpx4), an essential regulator of ferroptosis. To do so we generated conditional-knockout mice for Gpx4 by using creERT2, CD45cre and LysMcre systems targeting different cell compartments. After aerosol low dose Mtb infection these conditional-knockout mice showed both increased lung necrosis and elevated pulmonary and splenic bacterial burdens. In the opposite direction, Gpx4-overexpressing mice infected at high dose with Mtb were found to display decreased bacterial burdens as well as reduced pulmonary necrosis. Genetic deletion of BACH1, a transcription factor known to repress antioxidant genes including Gpx4, increased the levels of intracellular glutathione as well as enhanced expression of Gpx4 during Mtb infection in vitro and in vivo. Moreover, Bach1−/− mice infected at high dose with Mtb displayed a significant reduction in bacterial loads and lung necrosis along with lowered levels of lipid peroxides as well as enhanced survival. Together, these findings provide genetic evidence further delineating the role of ferroptosis as a mechanism of host cell death and tissue necrosis in Mtb infection and implicate both Gpx4 and Bach1 as potential targets for host-direct therapy of tuberculosis.
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17
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Hessler D, Fisher L, Polonsky W, Strycker L, Parra J, Bowyer V, Dedhia M, Masharani U. There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. Diabet Med 2020; 37:71-74. [PMID: 31314907 DOI: 10.1111/dme.14082] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of targeted interventions to reduce high diabetes distress among adults with Type 1 diabetes with a comparison sample of similar but untreated individuals, and to document the stability of untreated diabetes distress over time. METHODS A total of 51 adults with Type 1 diabetes with elevated baseline diabetes distress (distress score ≥ 2.0) and HbA1c levels (≥ 58 mmol/mol) were identified from a longitudinal, non-intervention study, and compared with a similar sample of 51 participants in an intervention study. Both groups completed the T1-DDS diabetes distress questionnaire at baseline and 9 months. RESULTS Large and significant reductions in diabetes distress scores were recorded in the intervention group (mean ± sd change = -0.6 ± 0.6), while minimal change was found in the non-intervention group (-0.2 ± 0.6, group effect P = 0.002; effect size d = 0.67). Additional analyses using the established minimal clinically important difference for the T1-DDS showed that diabetes distress increased significantly (minimal clinically important difference ≥ 1) or persisted at high levels for 51% of participants in the non-intervention group, compared with 23.5% in the intervention group. CONCLUSION Our results showed that targeted interventions led to dramatic reductions in diabetes distress compared with a lack of treatment. We also conclude that elevated diabetes distress, when left unaddressed, does not resolve over time and often remains chronic. (Clinical Trials Registry no.: NCT02175732).
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Affiliation(s)
- D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - W Polonsky
- Behavioural Diabetes Institute, Department of Psychiatry, University of California, San Diego, CA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - J Parra
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - V Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Dedhia
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - U Masharani
- Department of Medicine, University of California, San Francisco, CA, USA
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Skinner T, Byrne M, Dickinson JK, Fisher L, Funnell M, Guzman S, Hendrieckx C, Hermanns N, Kanc K, Lloyd C, Mocan A, Nouwen A, Pouwer F, Saleh-Stattin N, Snoek F, Speight J, Sturt J, Vallis M, Wagner J, Willaing I, Young-Hyman D, Zoffmann V. Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes. Diabet Med 2019; 36:911-912. [PMID: 30785642 DOI: 10.1111/dme.13934] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Skinner
- University of Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Denmark
| | - M Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - J K Dickinson
- Diabetes Education and Management, Teachers College Columbia University, New York, NY, USA
| | - L Fisher
- Family and Community Medicine, University of California San Francisco, San Francisco, LA, USA
| | - M Funnell
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Guzman
- Behavioural Diabetes Institute, San Diego, CA, USA
| | - C Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - N Hermanns
- Jazindiabetes, (Diabetes & Me), Slovenia
| | - K Kanc
- Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, Germany
| | - C Lloyd
- Open University, Milton Keynes, UK
| | - A Mocan
- Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - A Nouwen
- Middlesex University, London, UK
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
| | | | - F Snoek
- Amsterdam UMC, Amsterdam, Netherlands
| | - J Speight
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - J Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK
| | - M Vallis
- Dalhousie University, Halifax, Canada
| | - J Wagner
- Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Denmark
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Abstract
Addressing the emotional side of diabetes and its management has received considerable attention in recent years. At the centre of most of these efforts is the concept of 'diabetes distress', a generic term that captures the primary sources and intensity of emotional distress associated with diabetes and its management over time. As interest in diabetes distress has grown, however, it has been difficult to integrate and translate the various strands of clinical research in a manner that can guide diabetes distress intervention efforts in the real world of clinical care. The aim of this paper is to fill this gap by outlining practical strategies for intervention in clinical settings and to assist diabetes healthcare professionals in thinking through how diabetes distress might be addressed practically in their clinics. To address these goals, this review is divided into five sections: a definition of diabetes distress, ways diabetes distress can be assessed and monitored, information about diabetes distress for use in intervention planning, topics to be considered for inclusion in diabetes distress interventions, and alternatives for where in the care process a diabetes distress intervention might be considered. We focus on diabetes distress experienced by adults with both Type 1 and Type 2 diabetes.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
| | - W H Polonsky
- University of California, San Diego, Behavioral Diabetes Institute, San Diego, Ca, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
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20
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Joensen L, Fisher L, Skinner T, Doherty Y, Willaing I. Integrating psychosocial support into routine diabetes care: perspectives from participants at the Self-Management Alliance meeting 2016. Diabet Med 2019; 36:847-853. [PMID: 30315608 DOI: 10.1111/dme.13836] [Citation(s) in RCA: 22] [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] [Accepted: 10/11/2018] [Indexed: 01/09/2023]
Abstract
AIMS To identify challenges and solutions to integrating psychosocial support into routine diabetes care from the perspective of stakeholders with expertise in diabetes self-management education and support. METHODS Ninety-four people attended the annual international Diabetes Self-Management Alliance meeting in 2016, which included plenary sessions and workshops on self-management education, support and prevention. One workshop focused on how to integrate psychosocial support into routine diabetes care; this was run four times consecutively, allowing all conference participants to attend the workshops in groups of 20-25 people. RESULTS Challenges and solutions associated with integrating psychosocial support into routine diabetes care concern the patient-provider relationship, the healthcare system and the community. Challenges identified were: lack of time, skills and resources to deal with psychological well-being; a culture of patient blame and care expectations; the complexity of person-centred assessment of psychological issues; and the substantial healthcare system focus on productivity and biomedical indicators. Lack of involvement of local communities and of inclusion of social determinants of health were also highlighted as challenging. Solutions identified were more patient-provider dialogue; more training and better skills among care providers; system incentives for psychosocial outcomes; and targeting social determinants of health and involvement of family and peers. CONCLUSIONS From the perspective of international stakeholders with an expertise in diabetes self-management and support attending the conference in Denmark, substantial new incentives and systematic cultural changes are needed in healthcare systems to integrate psychosocial support into routine diabetes care, as recommended in international guidelines.
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Affiliation(s)
- L Joensen
- Department of Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - T Skinner
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Denmark
| | - Y Doherty
- Department of Psychological Medicine, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - I Willaing
- Department of Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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21
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Trief PM, Fisher L, Sandberg J, Hessler DM, Cibula DA, Weinstock RS. Two for one? Effects of a couples intervention on partners of persons with Type 2 diabetes: a randomized controlled trial. Diabet Med 2019; 36:473-481. [PMID: 30485516 PMCID: PMC6408270 DOI: 10.1111/dme.13871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/26/2018] [Indexed: 11/30/2022]
Abstract
AIMS To compare the outcomes of partners who participated in a telephone couples behavioural intervention to improve glycaemic control in persons with Type 2 diabetes with those of untreated partners of participants in an individual intervention or education; to explore 'ripple effects', i.e. positive behaviour changes seen in untreated partners. METHODS The Diabetes Support Project was a three-arm randomized telephone intervention trial comparing outcomes of couples calls (CC), individual calls (IC) and diabetes education calls (DE). Couples included one partner with Type 2 diabetes and HbA1c ≥ 58 mmol/mol (7.5%). All arms received self-management education (two calls). CC and IC arms participated in 10 additional behaviour change calls. CC included partners, emphasizing partner communication, collaboration and support. Blinded assessments were performed at 4, 8 and 12 months. Partner outcomes were psychosocial (diabetes distress, relationship satisfaction, depressive symptoms), medical (BMI, blood pressure) and behavioural (fat intake, activity). RESULTS Partners' (N = 268) mean age was 55.8 years, 64.6% were female and 29.9% were from minority ethnic groups. CC (vs. IC and DE) partners had greater reductions in diabetes distress, greater increases in marital satisfaction (4 and 8 months), and some improvements in diastolic BP. There were no consistent differences among arms in other outcomes. There was no evidence of a dietary or activity behaviour ripple effect on untreated partners, i.e. comparing partners in the IC and DE arms. CONCLUSIONS A collaborative couples intervention resulted in significant improvements in partner diabetes distress and relationship satisfaction. There were no consistent effects on behavioural or medical partner outcomes, and no evidence of diet or activity behaviour ripple effects, suggesting that partners should be targeted directly to achieve these changes. (Clinical Trial Registry No: NCT01017523).
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Affiliation(s)
- P M Trief
- Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - L Fisher
- Department of Family Medicine, University of California, San Francisco, CA, USA
| | - J Sandberg
- School of Family Life, Brigham Young University, Provo, UT, USA
| | - D M Hessler
- Department of Family Medicine, University of California, San Francisco, CA, USA
| | - D A Cibula
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - R S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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22
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Khan AJ, Pedrelli P, Shapero BG, Fisher L, Nyer M, Farabaugh AI, MacPherson L. The Association between Distress Tolerance and Alcohol Related Problems: The Pathway of Drinking to Cope. Subst Use Misuse 2018; 53:2199-2209. [PMID: 29708456 DOI: 10.1080/10826084.2018.1464027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Binge drinking (BD) and alcohol related problems (ARP) are highly prevalent among college students. However, current models examining ARP suggest drinking quantity only accounts for a portion of the variance, suggesting other variables contribute to ARP. Distress tolerance (DT), or the ability to withstand negative affect, is associated with alcohol misuse and may be an important mechanism related to ARP. However, studies have reported inconsistent findings on this association, which may be due to the use of only global scores to measure DT rather than specific DT components. Furthermore, the mechanisms underlying this association remain unknown. Drinking to cope with negative affect has been associated with both DT and ARP, suggesting it may be a mechanism explaining the relationship between DT and ARP. The current study examined the association between specific proposed DT components (i.e., tolerance, absorption, appraisal, and regulation) and drinking to cope and ARP in 147 college students who BD. A hierarchical linear regression was performed in order to examine which DT component best predicted ARP. Four follow-up mediation models were then tested to examine whether drinking to cope mediated the relationship between each DT component and ARP. Appraisal of DT was the only DT component that significantly predicted ARP, in the model controlling for drinking quantity and sex differences. Drinking to cope mediated the relationship between ARP and tolerance, absorption, and regulation, but not appraisal of DT. Implications for furthering our understanding of DT and treatment of BD as it relates to DT are explored.
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Affiliation(s)
- A J Khan
- a Emotion and Learning Lab, Department of Psychology , Suffolk University , Boston , Massachusetts , USA
| | - P Pedrelli
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - B G Shapero
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - L Fisher
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - M Nyer
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - A I Farabaugh
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - L MacPherson
- d Greenebaum Comprehensive Cancer Center, University of Maryland , Baltimore , Maryland , USA
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23
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Hessler DM, Fisher L, Polonsky WH, Bowyer V, Potter M. Motivation and attitudes toward changing health (MATCH): A new patient-reported measure to inform clinical conversations. J Diabetes Complications 2018; 32:665-669. [PMID: 29887299 PMCID: PMC6867057 DOI: 10.1016/j.jdiacomp.2018.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify and assess patient motivation to initiate or maintain behavior changes. METHODS Attitudinal statements were developed from structured patient interviews and translated into 18 survey items. Items were analyzed with exploratory factor analysis (EFA). RESULTS An EFA with 340 type 2 diabetes patients identified three areas of patient attitudes toward changing health behaviors: (1) willingness to make changes (3 items; α = 0.69), (2) perceived ability to make or maintain changes (3 items; α = 0.74), and (3) and feeling changes are worthwhile (3 items; α = 0.61). Greater perceived ability and feelings of worthwhileness were associated with positive psychosocial and behavioral management indicators. All three areas were associated with confidence and attitudes toward making a specific behavioral change (e.g., improve diet). CONCLUSIONS MATCH is an internally consistent and valid 9-item scale that provides a profile of factors influencing motivation that can be used in clinical and research settings.
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Affiliation(s)
- Danielle M Hessler
- Department of Family & Community Medicine, University of California-, San Francisco, United States.
| | - L Fisher
- Department of Family & Community Medicine, University of California-, San Francisco, United States
| | | | - V Bowyer
- Department of Family & Community Medicine, University of California-, San Francisco, United States
| | - M Potter
- Department of Family & Community Medicine, University of California-, San Francisco, United States
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24
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Polonsky WH, Fisher L, Hessler D. The impact of non-severe hypoglycemia on quality of life in patients with type 2 diabetes. J Diabetes Complications 2018; 32:373-378. [PMID: 29496364 DOI: 10.1016/j.jdiacomp.2018.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 01/08/2023]
Abstract
AIMS To determine the impact of frequency of non-severe hypoglycemic events (NSHE) and the perceived burden of NSHE on quality of life (QOL) over time. METHODS T2D adults (n = 424) were re-contacted two years after initial QOL assessment. Responding subjects (n = 290) reported the frequency and burden of NSHE over time and completed six generic and diabetes-specific QOL measures. RESULTS Most subjects (86%) reported ≥ one NSHE over time. Higher frequency of NSHE was significantly associated with decrements in QOL. Greater perceived burden of NSHE was significantly linked to decreases in QOL over time for all six QOL measures. Interaction terms indicated that participants with a higher frequency of NSHE and higher perceived burden reported the greatest decrease in QOL; participants who experienced frequent NSHE but did not perceive these events as burdensome evidenced little worsening in QOL over time. CONCLUSIONS NSHE have a negative impact on QOL over time in T2D adults. However, it is not just the occurrence of NSHE that affects QOL; it is the individual's felt burden of these events that is critical. The greatest reductions in QOL are seen among those subjects reporting a higher frequency of NSHE and indicating that such events are burdensome.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, USA; Behavioral Diabetes Institute, San Diego, USA.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco
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25
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Dennis S, Fisher L, Ware C, Giraldo C. Preliminary study of the effect of gamma irradiation on the vase life of Iridaceae Hollandica. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.12.003] [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: 11/24/2022]
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26
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Abstract
A wide range of diabetes-directed interventions - including novel medications, devices and comprehensive education programmes - have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco
| | - W H Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco
| | - M B Potter
- Department of Family & Community Medicine, University of California, San Francisco
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27
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Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, Blumer I, Bowyer V. Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes. Diabet Med 2017; 34:1228-1234. [PMID: 28498610 PMCID: PMC5561505 DOI: 10.1111/dme.13381] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [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: 05/08/2017] [Indexed: 12/20/2022]
Abstract
AIM To determine the cross-sectional and longitudinal associations between diabetes distress and diabetes management. METHODS In a non-interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. RESULTS At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross-sectional or longitudinal analyses. CONCLUSIONS Significant cross-sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care.
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Affiliation(s)
- D M Hessler
- Department of Family & Community Medicine, San Francisco, USA
| | - L Fisher
- Department of Family & Community Medicine, San Francisco, USA
| | - W H Polonsky
- Behavioral Diabetes Institute, San Francisco, USA
| | - U Masharani
- Department of Medicine, University of California-San Francisco, San Francisco, USA
| | | | - A L Peters
- University of Southern California, Los Angeles, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
| | - V Bowyer
- Department of Family & Community Medicine, San Francisco, USA
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28
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Khan S, Evans P, Fisher L. Gastrointestinal: Biliary tubulovillous adenoma. J Gastroenterol Hepatol 2017; 32:1423. [PMID: 28752689 DOI: 10.1111/jgh.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/23/2016] [Accepted: 11/17/2016] [Indexed: 12/09/2022]
Affiliation(s)
- S Khan
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
| | - P Evans
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - L Fisher
- Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
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29
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Dempster N, Gajarski R, Fisher L, Missler H, Cole T, Nandi D. Psychosocial Determinants of Health in Young Heart Transplant Recipients: Thinking Outside the Box. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.272] [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: 10/19/2022] Open
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30
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Silveira MSVM, Bovi TG, Oliveira PF, Pavin EJ, Fisher L. Translation and cultural adaptation into Brazilian culture of type 1 diabetes distress scale. Diabetol Metab Syndr 2017; 9:61. [PMID: 28794803 PMCID: PMC5545833 DOI: 10.1186/s13098-017-0260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes related distress is common in type 1 diabetes patients (T1D). High levels of diabetes distress are related to poor metabolic control. An instrument to evaluate diabetes distress in T1D patients is "type 1 diabetes scale-T1DDS". The aim of this study was to translate and culturally adapt the T1DDS into Brazilian culture. METHODS T1DDS scale was translated into Portuguese. Back translation was performed and evaluated by a specialists committee. Pre-test was performed with 40 T1D outpatients at State University of Campinas hospital. Internal consistency, external consistency and re-test were performed. RESULTS 72% women, mean age: 32, 1 ± 9, 7 years, mean diabetes duration: 15, 8 ± 9, 1 years, mean scholarity: 11, 5 ± 3, 6, glycosylated hemoglobin mean: 9 ± 2%. Internal consistency: Cronbach alpha of T1DDS Brazilian version was 0.93. External consistency: Spearman's coefficient between T1DDS and PAID, Brazilian version, was 0.7781; (p < 0.0001). CONCLUSIONS The T1DDS Brazilian version is a reliable tool to evaluate diabetes distress in T1D patients in the Brazilian Population. This tool can be useful in clinical care and to identify patiens at risk and in need for psychosocial intervention.
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Affiliation(s)
- M. S. V. M. Silveira
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Rua Vital Brasil, 251, Barão Geraldo, Campinas, São Paulo CEP: 13083970 Brazil
| | - T. G. Bovi
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - P. F. Oliveira
- Statistical Research Center, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - E. J. Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Rua Vital Brasil, 251, Barão Geraldo, Campinas, São Paulo CEP: 13083970 Brazil
| | - L. Fisher
- Department of Family and Community Medicine, University of California San Francisco-UCSF, San Francisco, USA
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Affiliation(s)
- G W Judge
- Senior Scientific Officer, Department of Health and Social Security, 14 Russell Square, London WC1
| | - L Fisher
- Design Engineer, Biomechanical Research and Development Unit, Roehampton, London SW15
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32
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Fisher L, Hessler DM, Polonsky WH, Masharani U, Peters AL, Blumer I, Strycker LA. Prevalence of depression in Type 1 diabetes and the problem of over-diagnosis. Diabet Med 2016; 33:1590-1597. [PMID: 26433004 DOI: 10.1111/dme.12973] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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] [Accepted: 09/28/2015] [Indexed: 12/19/2022]
Abstract
AIMS To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. METHODS The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. RESULTS The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. CONCLUSIONS We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.
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Affiliation(s)
- L Fisher
- Department of Family and Community Medicine, UCSF, San Francisco, USA.
| | - D M Hessler
- Department of Family and Community Medicine, UCSF, San Francisco, USA
| | | | - U Masharani
- Department of Medicine, UCSF, San Francisco, USA
| | - A L Peters
- University of Southern California, Los Angeles, CA, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
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May PW, Clegg M, Silva TA, Zanin H, Fatibello-Filho O, Celorrio V, Fermin DJ, Welch CC, Hazell G, Fisher L, Nobbs A, Su B. Diamond-coated 'black silicon' as a promising material for high-surface-area electrochemical electrodes and antibacterial surfaces. J Mater Chem B 2016; 4:5737-5746. [PMID: 32263865 DOI: 10.1039/c6tb01774f] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This report describes a method to fabricate high-surface-area boron-doped diamond (BDD) electrodes using so-called 'black silicon' (bSi) as a substrate. This is a synthetic nanostructured material that contains high-aspect-ratio nano-protrusions, such as spikes or needles, on the Si surface produced via plasma etching. We now show that coating a bSi surface composed of 15 μm-high needles conformably with BDD produces a robust electrochemical electrode with high sensitivity and high electroactive area. A clinically relevant demonstration of the efficacy of these electrodes is shown by measuring their sensitivity for detection of dopamine (DA) in the presence of an excess of uric acid (UA). Finally, the nanostructured surface of bSi has recently been found to generate a mechanical bactericidal effect, killing both Gram-negative and Gram-positive bacteria at high rates. We will show that BDD-coated bSi also acts as an effective antibacterial surface, with the added advantage that being diamond-coated it is far more robust and less likely to become damaged than Si.
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Affiliation(s)
- P W May
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK.
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Khan S, Fisher L. Gastrointestinal: A rare case of polysplenia syndrome presenting with biliary obstruction in adulthood. J Gastroenterol Hepatol 2016; 31:1071. [PMID: 26699089 DOI: 10.1111/jgh.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 12/09/2022]
Affiliation(s)
- S Khan
- Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia
| | - L Fisher
- Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia
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Fisher L, Lapointe AK, Gilliet M, Di Lucca-Chrisment J. Efficacité du lenalidomide (Revlimid®) dans un cas d’infiltrat lymphocytaire cutané de Jessner-Kanof réfractaire. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.285] [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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Polonsky WH, Fisher L, Hessler D, Edelman SV. Identifying the worries and concerns about hypoglycemia in adults with type 2 diabetes. J Diabetes Complications 2015; 29:1171-6. [PMID: 26338296 DOI: 10.1016/j.jdiacomp.2015.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
AIMS To identify the hypoglycemic concerns of adults with type 2 diabetes (T2D) and examine how these concerns are associated with key patient characteristics. METHODS Qualitative interviews with 16 T2D adults and 11 diabetes care providers were conducted. Survey items were then developed and submitted to exploratory factor analyses (EFAs). Construct validity was assessed by correlations with diabetes distress, anxiety and depressive symptoms, well-being, hypoglycemic fear, hypoglycemia history and glycemic control (A1C). RESULTS An EFA with 226 insulin users and 198 non-insulin users yielded 3 factors (14 items): Hypoglycemia Anxiety, Avoidance and Confidence. For both T2D groups, higher Anxiety and Avoidance were significantly associated with more hypoglycemia, lower well-being, and greater diabetes distress, depressive symptoms and hypoglycemic fear. Similar associations, in the converse direction, were found for Confidence. Among insulin users only, Anxiety was independently associated with greater emotional distress and more hypoglycemia, while Confidence was independently linked to less emotional distress and lower A1C. Avoidance was independently associated with greater emotional distress in both groups. CONCLUSIONS Using the new 14-item Hypoglycemic Attitudes and Behavior Scale (HABS), we found that hypoglycemic concerns are significant in T2D adults, are linked to emotional distress and A1C, and merit attention in clinical practice.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of CA, San Diego, USA; Behavioral Diabetes Institute, San Diego, USA.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco
| | - S V Edelman
- Division of Endocrinology and Metabolism, University of California, San Diego, and Veterans Affairs Medical Center, San Diego
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Fisher L, Matthews D. PEDIATRICSB-104The Neuropathology of Disruptive Mood Dysregulation Disorder: Preliminary Hypothesis. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.199] [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: 11/13/2022] Open
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Dong B, Belkhair S, Zaarour M, Fisher L, Verran J, Tosheva L, Retoux R, Gilson JP, Mintova S. Silver confined within zeolite EMT nanoparticles: preparation and antibacterial properties. Nanoscale 2014; 6:10859-10864. [PMID: 25117582 DOI: 10.1039/c4nr03169e] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The preparation of pure zeolite nanocrystals (EMT-type framework) and their silver ion-exchanged (Ag(+)-EMT) and reduced silver (Ag(0)-EMT) forms is reported. The template-free zeolite nanocrystals are stabilized in water suspensions and used directly for silver ion-exchange and subsequent chemical reduction under microwave irradiation. The high porosity, low Si/Al ratio, high concentration of sodium and ultrasmall crystal size of the EMT-type zeolite permitted the introduction of a high amount of silver using short ion-exchange times in the range of 2-6 h. The killing efficacy of pure EMT, Ag(+)-EMT and Ag(0)-EMT against Escherichia coli was studied semi-quantitatively. The antibacterial activity increased with increasing Ag content for both types of samples (Ag(+)-EMT and Ag(0)-EMT). The Ag(0)-EMT samples show slightly enhanced antimicrobial efficacy compared to that of Ag(+)-EMT, however, the differences are not substantial and the preparation of Ag nanoparticles is not viable considering the complexity of preparation steps.
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Affiliation(s)
- B Dong
- Laboratoire Catalyse & Spectrochimie, University of Caen, CNRS, 6, boulevard du Maréchal Juin, 14050 Caen Cedex, France.
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Fisher L, Ostovapour S, Kelly P, Whitehead KA, Cooke K, Storgårds E, Verran J. Molybdenum doped titanium dioxide photocatalytic coatings for use as hygienic surfaces: the effect of soiling on antimicrobial activity. Biofouling 2014; 30:911-919. [PMID: 25184432 DOI: 10.1080/08927014.2014.939959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Titanium dioxide (TiO2) surfaces doped with molybdenum (Mo) were investigated to determine if their photocatalytic ability could enhance process hygiene in the brewery industry. Doping TiO2 with Mo showed a 5-log reduction in bacterial counts within 4 to 24 h and a 1-log reduction in yeast numbers within 72 h. The presence of a dilute brewery soil on the surface did not interfere with antimicrobial activity. The TiO2-Mo surface was also active in the dark, showing a 5-log reduction in bacteria within 4 to 24 h and a 1-log reduction in yeast numbers within 72 h, suggesting it could have a novel dual function, being antimicrobial and photocatalytic. The study suggests the TiO2-Mo coating could act as a secondary barrier in helping prevent the build-up of microbial contamination on surfaces within the brewery industry, in particular in between cleaning/disinfection regimes during long production runs.
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Affiliation(s)
- L Fisher
- a School of Healthcare Science , Manchester Metropolitan University , Manchester , UK
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Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med 2014; 31:764-72. [PMID: 24606397 PMCID: PMC4065190 DOI: 10.1111/dme.12428] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [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] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 03/04/2014] [Indexed: 01/05/2023]
Abstract
Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure 'depression' in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of 'emotional distress' be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder (MDD). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, San Francisco, CA
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Kong LM, Fok KC, Tsui A, Qian C, Fisher L. Peripheral T-cell lymphoma mimicking 5-aminosalicylate hypersensitivity in ulcerative colitis. Intern Med J 2014; 43:1137-40. [PMID: 24134170 DOI: 10.1111/imj.12240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 07/03/2013] [Indexed: 01/20/2023]
Abstract
5-aminosalicylates (5-ASA) remain an important strategy in the induction and maintenance of remission of inflammatory bowel diseases especially in ulcerative colitis. The prototypical drug of this class, sulfasalazine is generally well tolerated with severe hypersensitivity reactions and hepatotoxicity also described within the literature. When approaching a patient with an adverse reaction to 5-ASA, it can be difficult to differentiate clinically between a sulfa allergy versus a 5-ASA allergy versus a malignancy. We report on a case with initial signs and symptoms suggestive of a sulfa/5-ASA allergy that was subsequently found to be malignant in nature.
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Affiliation(s)
- L M Kong
- Department of Gastroenterology, Frankston Hospital, Frankston, Victoria, Australia
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Fisher L, Hessler D, Masharani U, Strycker L. Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy. Diabet Med 2014; 31:739-46. [PMID: 24494593 PMCID: PMC4028368 DOI: 10.1111/dme.12403] [Citation(s) in RCA: 28] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/13/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
AIMS To improve patient-centred care by determining the impact of baseline levels of conscientiousness and diabetes self-efficacy on the outcomes of efficacious interventions to reduce diabetes distress and improve disease management. METHODS Adults with Type 2 diabetes with diabetes distress and self-care problems (N = 392) were randomized to one of three distress reduction interventions: computer-assisted self-management; computer-assisted self-management plus problem-solving therapy; and health education. The baseline assessment included conscientiousness and self-efficacy, demographics, diabetes status, regimen distress, emotional burden, medication adherence, diet and physical activity. Changes in regimen distress, emotional burden and self-care between baseline and 12 months were recorded and ancova models assessed how conscientiousness and self-efficacy qualified the significant improvements in distress and management outcomes. RESULTS Participants with high baseline conscientiousness displayed significantly larger improvements in medication adherence and emotional burden than participants with low baseline conscientiousness. Participants with high baseline self-efficacy showed greater improvements in diet, physical activity and regimen distress than participants with low baseline self-efficacy. The impact of conscientiousness and self-efficacy were independent of each other and occurred across all three intervention groups. A significant interaction indicated that those with both high self-efficacy and high conscientiousness at baseline had the biggest improvement in physical activity by 12 months. CONCLUSIONS Both broad personal traits and disease-specific expectations qualify the outcomes of efficacious interventions. These findings reinforce the need to change from a one-size-fits-all approach to diabetes interventions to an approach that crafts clinical interventions in ways that fit the personal traits and skills of individual people.
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Affiliation(s)
- L Fisher
- Departments of Family and Community Medicine, San Francisco, CA, USA
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Asif I, Price D, Fisher L, Zakrajsek R, Raabe J, Bejar M, Larsen L, Rao A, Harmon K, Drezner J. SCREENING FOR SUDDEN CARDIAC DEATH IN ATHLETES: THE PSYCHOLOGICAL IMPACT OF BEING DIAGNOSED WITH POTENTIALLY LETHAL DISEASE. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.8] [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: 11/03/2022]
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Matsumoto A, Angle J, Secic M, Carlson G, Fisher L, Fairman R. Secondary procedures after TEVAR in the first 3 years of the valor test and VALOR II trials. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.028] [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: 11/30/2022] Open
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Polonsky WH, Fisher L, Hessler D, Edelman SV. What is so tough about self-monitoring of blood glucose? Perceived obstacles among patients with Type 2 diabetes. Diabet Med 2014; 31:40-6. [PMID: 23819529 DOI: 10.1111/dme.12275] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Accepted: 06/27/2013] [Indexed: 11/27/2022]
Abstract
AIMS To identify patient-reported obstacles to self-monitoring of blood glucose among those with Type 2, both insulin users and non-insulin users, and to investigate how obstacles are associated with frequency of self-monitoring and use of self-monitoring data. METHODS Patients with Type 2 diabetes (n = 886, 65% insulin users) who attended a 1-day diabetes education conference in cities across the USA completed a survey on current and recommended self-monitoring of blood glucose frequency, how they used self-monitoring results and perceived obstacles to self-monitoring use. Exploratory factor analysis examined 12 obstacle items to identify underlying factors. Regression analyses examined associations between self-monitoring of blood glucose use and the key obstacle factors identified in the exploratory factor analysis. RESULTS Three obstacle factors emerged: Avoidance, Pointlessness and Burden. Avoidance was the only significant independent predictor of self-monitoring frequency (β = -0.23, P < 0.001). Avoidance (β = -0.12, P < 0.01) and Pointlessness (β = -0.15, P < 0.001) independently predicted how often self-monitoring data were shared with healthcare professionals and whether or not data were used to make management adjustments (Avoidance: odds ratio = 0.74, P < 0.001; Pointlessness: odds ratio = 0.75, P < 0.01). Burden was not associated with any of the self-monitoring behavioural measures. Few differences between insulin users and non-insulin users were noted. CONCLUSIONS Obstacles to self-monitoring of blood glucose use, both practical and emotional, were common. Higher levels of Avoidance and Pointlessness, but not Burden, were associated with less frequent self-monitoring use. Addressing patients' self-monitoring-related emotional concerns (Avoidance and Pointlessness) may be more beneficial in enhancing interest and engagement with self-monitoring of blood glucose than focusing on day-to-day, behavioural issues (Burden).
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA
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Abstract
BACKGROUND Using conscious subjects, measurement of the effects of low concentrations of anaesthetic agents can allow the dynamics of onset and offset of the agent to be measured and kinetic values estimated. However, the tests have to be rapid and preferably assess cerebral function. METHODS We used a short version of the digit symbol substitution test (DSST) that allowed frequent measurement of the impairment caused by nitrous oxide. We compared 10 min of onset and offset of breathing 5% and 30% nitrous oxide in 30% oxygen, compared with 30% oxygen only. End-tidal nitrous oxide concentrations were used to predict the concentration in a central compartment, according to a range of T(1/2) values chosen to be consistent with possible cerebral blood flow values. RESULTS We studied 19 volunteers and estimated a mean response. Only 30% nitrous oxide decreased the DSST. When DSST scores were related to the values in the predicted central compartment, the best dose-effect relationship was found when the T(1/2) was 37 s, consistent with a regional blood flow of about 120 ml 100 g(-1) min(-1). CONCLUSIONS The onset of nitrous oxide effect on DSST is rapid, consistent with the perfusion of metabolically active cerebral cortical tissues. The rate of onset is greater than previous measures based on a motor test which involved the function of subcortical structures in the central nervous system.
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Affiliation(s)
- G B Drummond
- Department of Anaesthesia and Pain Medicine, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh, UK.
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Saifee TA, Kassavetis P, Pareés I, Kojovic M, Fisher L, Morton L, Foong J, Price G, Joyce EM, Edwards MJ. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol 2012; 259:1958-63. [DOI: 10.1007/s00415-012-6530-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
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Fisher L, Polonsky W, Parkin CG, Jelsovsky Z, Amstutz L, Wagner RS. The impact of blood glucose monitoring on depression and distress in insulin-naïve patients with type 2 diabetes. Curr Med Res Opin 2011; 27 Suppl 3:39-46. [PMID: 21916532 DOI: 10.1185/03007995.2011.619176] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test whether a structured self-monitoring of blood glucose (SMBG) protocol reduces depressive symptoms and diabetes distress. RESEARCH DESIGN AND METHODS A 12-month, cluster-randomised, clinical trial compared patients who received a collaborative, structured SMBG, physician/patient intervention with an active control. Studied were 483 insulin naïve type 2 diabetes patients (experimental = 256, control = 227) (≥ 7.5% HbA1c) from 34 primary care practices (experimental = 21, control = 13). Experimental patients used a paper tool to record a 7-point SMBG profile on each of three consecutive days prior to their quarterly physician visit. Patients and physicians interpreted SMBG results to make medication and lifestyle changes. CLINICAL TRIAL REGISTRATION NIH Trial Registry Number: NCT00674986. MAIN OUTCOME MEASURES Depressive symptoms (Patient Health Questionnaire: PHQ-8), diabetes-related distress (Diabetes Distress Scale: DDS). HbA1c and SMBG frequency were assessed quarterly; data were analysed using Linear Mixed Models (LMM) for intent-to-treat (ITT) and per protocol (PP) analyses. RESULTS ITT analyses showed significant improvement in depression and disease-related distress among experimental and control patients from baseline to 12 months (p < 0.01 in both cases) with no between-group differences. Experimental patients displayed significantly greater reductions in distress related to regimen adherence than controls. Also, experimental patients with elevated diabetes distress or depressive symptoms at baseline showed significantly greater reductions in distress and depressive symptoms than control patients at 12 months. The greater improvement in mood in the experimental than control group was independent of improvements in glycaemic control and changes in SMBG frequency. CONCLUSIONS Using well standardised measures, collaborative, structured SMBG leads to reductions, not increases, in depressive symptoms and diabetes distress over time, for the large number of moderately depressed or distressed type 2 patients in poor glycaemic control. Changes in affective status are independent of improvements in glycaemic control and changes in SMBG frequency for these patients.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, San Francisco, CA, USA
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Bristow K, Edwards S, Funnel E, Fisher L, Gask L, Dowrick C, Chew Graham C. Help Seeking and Access to Primary Care for People from "Hard-to-Reach" Groups with Common Mental Health Problems. Int J Family Med 2011; 2011:490634. [PMID: 22312546 PMCID: PMC3268206 DOI: 10.1155/2011/490634] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/15/2011] [Accepted: 04/13/2011] [Indexed: 05/31/2023]
Abstract
Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from "hard-to-reach" groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from "hard-to-reach" groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from "hard-to-reach" groups including the need to offer a flexible, non-biomedical response to distress.
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Affiliation(s)
- K. Bristow
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - S. Edwards
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - E. Funnel
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - L. Fisher
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - L. Gask
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - C. Dowrick
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - C. Chew Graham
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
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Mast O, Polonsky W, Fisher L, Jelsovsky Z, Weissmann J, Wagner R. Reduzierung von HbA1c-Wert und Teststreifenverbrauch durch strukturierte Blutzuckerselbstkontrolle bei schlecht eingestelltem, nicht mit Insulin behandeltem Typ-2-Diabetes: Ergebnisse der STeP-Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277314] [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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