1
|
Lopez Naranjo C, Razzaq FA, Li M, Wang Y, Bosch‐Bayard JF, Lindquist MA, Gonzalez Mitjans A, Garcia R, Rabinowitz AG, Anderson SG, Chiarenza GA, Calzada‐Reyes A, Virues‐Alba T, Galler JR, Minati L, Bringas Vega ML, Valdes‐Sosa PA. EEG functional connectivity as a Riemannian mediator: An application to malnutrition and cognition. Hum Brain Mapp 2024; 45:e26698. [PMID: 38726908 PMCID: PMC11082925 DOI: 10.1002/hbm.26698] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024] Open
Abstract
Mediation analysis assesses whether an exposure directly produces changes in cognitive behavior or is influenced by intermediate "mediators". Electroencephalographic (EEG) spectral measurements have been previously used as effective mediators representing diverse aspects of brain function. However, it has been necessary to collapse EEG measures onto a single scalar using standard mediation methods. In this article, we overcome this limitation and examine EEG frequency-resolved functional connectivity measures as a mediator using the full EEG cross-spectral tensor (CST). Since CST samples do not exist in Euclidean space but in the Riemannian manifold of positive-definite tensors, we transform the problem, allowing for the use of classic multivariate statistics. Toward this end, we map the data from the original manifold space to the Euclidean tangent space, eliminating redundant information to conform to a "compressed CST." The resulting object is a matrix with rows corresponding to frequencies and columns to cross spectra between channels. We have developed a novel matrix mediation approach that leverages a nuclear norm regularization to determine the matrix-valued regression parameters. Furthermore, we introduced a global test for the overall CST mediation and a test to determine specific channels and frequencies driving the mediation. We validated the method through simulations and applied it to our well-studied 50+-year Barbados Nutrition Study dataset by comparing EEGs collected in school-age children (5-11 years) who were malnourished in the first year of life with those of healthy classmate controls. We hypothesized that the CST mediates the effect of malnutrition on cognitive performance. We can now explicitly pinpoint the frequencies (delta, theta, alpha, and beta bands) and regions (frontal, central, and occipital) in which functional connectivity was altered in previously malnourished children, an improvement to prior studies. Understanding the specific networks impacted by a history of postnatal malnutrition could pave the way for developing more targeted and personalized therapeutic interventions. Our methods offer a versatile framework applicable to mediation studies encompassing matrix and Hermitian 3D tensor mediators alongside scalar exposures and outcomes, facilitating comprehensive analyses across diverse research domains.
Collapse
Affiliation(s)
- Carlos Lopez Naranjo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Fuleah Abdul Razzaq
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Min Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Hangzhou Dianzi UniversityZhejiangHangzhouChina
| | - Ying Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | | | | | - Anisleidy Gonzalez Mitjans
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Montreal Neurological Institute‐HospitalMcGill UniversityMontrealQuebecCanada
| | - Ronaldo Garcia
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | | | - Simon G. Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health ResearchUniversity of the West IndiesCave HillBarbados
| | - Giuseppe A. Chiarenza
- Centro Internazionale Disturbi di Apprendimento, Attenzione, Iperattività (CIDAAI)MilanItaly
| | | | | | - Janina R. Galler
- Division of Pediatric Gastroenterology and NutritionMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
| | - Ludovico Minati
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Center for Mind/Brain Science (CIMeC)University of TrentoTrentoItaly
| | - Maria L. Bringas Vega
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Cuban Center for NeuroscienceLa HabanaCuba
| | - Pedro A. Valdes‐Sosa
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Cuban Center for NeuroscienceLa HabanaCuba
| |
Collapse
|
2
|
Sobers N, Murphy M, Hassan S, Norville K, Brathwaite-Graham L, Hambleton I, Anderson SG, Lewis K, Ferguson T. Faith-based leaders' perceptions on the implementation of programs to promote healthy lifestyles in churches in Barbados-a mixed-methods analysis. Res Sq 2024:rs.3.rs-4014464. [PMID: 38496638 PMCID: PMC10942560 DOI: 10.21203/rs.3.rs-4014464/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background There is a high burden of chronic diseases such as hypertension and diabetes in small island developing states (SIDS). SIDS governments have committed to a range of public health, healthcare, and fiscal measures to reduce this burden including community-based health education in collaboration with civil society organizations. We sought to explore perceived acceptability, appropriateness, and feasibility of implementing self-management health programs in 20 faith-based organizations in the small island developing state of Barbados. Methods This was a concurrent mixed methods study - a quantitative online survey and a qualitative inquiry using semi-structured interviews. Acceptability, appropriateness and feasibility of the intervention were assessed using the following quantitative assessment tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Thirteen in-depth interviews were conducted virtually, recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis based on deductive codes from Proctor's implementation outcomes definitions. Results From the 52 respondents of the survey, the median and interquartile ranges for the AIM, IAM and FIM scales were 16 (15-20), 16 (16-20) and 16 (15-17) (out of 20), respectively. We found high levels of acceptability, 82% (95% CI (69%, 95%)) of leaders indicating that health programs in churches met with their approval; and high levels of appropriateness-90% (95% CI (80%, 100%)) indicating health programs in churches were "fitting" and "a good match". Feasibility scores were lower, with 60% (95% CI (44%, 76%)) indicating that health programs in churches would be easy to use. In interviews, leaders expressed acceptance of healthy lifestyle programs in churches and described their appropriateness through alignment with church doctrines stating, "the body is the temple of God". They felt that economic impacts from COVID-19 were likely to be a barrier to the success of programs. Leaders expressed the need for support from healthcare providers who are sensitive and respectful of church culture. Conclusion We found that health-based programs in churches align well with church doctrines, but the success of these programs will depend on establishing trust through the engagement of church-based champions, tailoring programming to include a biblical perspective and engaging entire households.
Collapse
Affiliation(s)
- Natasha Sobers
- George Alleyne Chronic Disease Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Madhuvanti Murphy
- George Alleyne Chronic Disease Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Saria Hassan
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Katrina Norville
- George Alleyne Chronic Disease Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | | | - Ian Hambleton
- George Alleyne Chronic Disease Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Simon G Anderson
- George Alleyne Chronic Disease Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Kia Lewis
- George Alleyne Chronic Disease Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Trevor Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Jamaica
| |
Collapse
|
3
|
Harvey A, Howitt C, Campbell JM, Forde SAA, Hambleton I, Bascombe I, Anderson SG, Scantlebury D, Delice R, Sobers NP. Gender Differences in Trends in Incidence and Mortality of Acute Myocardial Infarction in the Small Island Developing State of Barbados. Cureus 2024; 16:e56729. [PMID: 38646357 PMCID: PMC11032732 DOI: 10.7759/cureus.56729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To determine trends, identify predictors of acute myocardial infarction (AMI) incidence and mortality, and explore performance metrics for AMI care in Barbados. Methods Data on all cases diagnosed with AMI were collected by the Barbados National Registry for Non-Communicable Diseases (BNR) from the island's only tertiary hospital, the Queen Elizabeth Hospital, and the National Vital Registration Department. Participants who survived hospital admission were then followed up at 28 days and one year post event via telephone survey and retrieval of death certificates. Age-standardized incidence and mortality rates were calculated. Determinants of mortality at 28 days were examined in multivariable logistic regression models. Median and interquartile ranges (IQR) were calculated for performance metrics (e.g., time from pain onset to reperfusion). Results In a 10-year period between 2010 and 2019, 4,065 cases of myocardial infarction were recorded. The median age of the sample was 73 years (IQR: 61,83), and approximately half (47%) were female. Over a 10-year period, standardized incidence increased in women on average yearly by three per 100,000 (95% CI: 1 to 6; p=0.02), while in men, the average increase per year was six per 100,000 (95% CI: 4 to 8; p<0.001). There was no increase in 28-day mortality in women; mortality in men increased each year by 2.5 per 100,000 (95% CI: 0.4 to 4.5; p=0.02). The time from arrival at the hospital to the ECG was 44 minutes IQR (20,113). Conclusion AMI incidence and mortality are increasing in Barbados, and men have a higher velocity of mortality rate increase than women, which contradicts global data.
Collapse
Affiliation(s)
- Arianne Harvey
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, BRB
| | - Christina Howitt
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Jacqueline M Campbell
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Shelly-Ann A Forde
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Ian Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Ivanna Bascombe
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Dawn Scantlebury
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, BRB
| | - Rudolph Delice
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, BRB
| | - Natasha P Sobers
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| |
Collapse
|
4
|
Chen N, McGrath CB, Ericsson CI, Vaselkiv JB, Rencsok EM, Stopsack KH, Guard HE, Autio KA, Rathkopf DE, Enting D, Bitting RL, Mateo J, Githiaka CW, Chi KN, Cheng HH, Davis ID, Anderson SG, Badal SAM, Bjartell A, Russnes KM, Heath EI, Pomerantz MM, Henegan JC, Hyslop T, Esteban E, Omlin A, McDermott R, Fay AP, Popoola AA, Ragin C, Nowak J, Gerke T, Kantoff PW, George DJ, Penney KL, Mucci LA. Marital Status, Living Arrangement, and Survival among Individuals with Advanced Prostate Cancer in the International Registry for Men with Advanced Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:419-425. [PMID: 38189661 PMCID: PMC10922505 DOI: 10.1158/1055-9965.epi-23-1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Studies have shown improved survival among individuals with cancer with higher levels of social support. Few studies have investigated social support and overall survival (OS) in individuals with advanced prostate cancer in an international cohort. We investigated the associations of marital status and living arrangements with OS among individuals with advanced prostate cancer in the International Registry for Men with Advanced Prostate Cancer (IRONMAN). METHODS IRONMAN is enrolling participants diagnosed with advanced prostate cancer (metastatic hormone-sensitive prostate cancer, mHSPC; castration-resistant prostate cancer, CRPC) from 16 countries. Participants in this analysis were recruited between July 2017 and January 2023. Adjusting for demographics and tumor characteristics, the associations were estimated using Cox regression and stratified by disease state (mHSPC, CRPC), age (<70, ≥70 years), and continent of enrollment (North America, Europe, Other). RESULTS We included 2,119 participants with advanced prostate cancer, of whom 427 died during up to 5 years of follow-up (median 6 months). Two-thirds had mHSPC. Most were married/in a civil partnership (79%) and 6% were widowed. Very few married participants were living alone (1%), while most unmarried participants were living alone (70%). Married participants had better OS than unmarried participants [adjusted HR: 1.44; 95% confidence interval (CI): 1.02-2.02]. Widowed participants had the worst survival compared with married individuals (adjusted HR: 1.89; 95% CI: 1.22-2.94). CONCLUSIONS Among those with advanced prostate cancer, unmarried and widowed participants had worse OS compared with married participants. IMPACT This research highlighted the importance of social support in OS within this vulnerable population.
Collapse
Affiliation(s)
- Naiyu Chen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Colleen B. McGrath
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Caroline I. Ericsson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jane B. Vaselkiv
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emily M. Rencsok
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA
| | - Konrad H. Stopsack
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hannah E. Guard
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Karen A. Autio
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana E. Rathkopf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Joaquin Mateo
- Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital Campus, Barcelona, Spain
| | | | - Kim N. Chi
- BC Cancer, Vancouver, British Columbia, Canada
| | - Heather H. Cheng
- University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ian D. Davis
- Monash University Faculty of Medicine, Melbourne, Australia
- Eastern Health, Melbourne, Australia
| | - Simon G. Anderson
- The Glasgow-Caribbean Centre for Development Research and the Caribbean Institute of Health Research, The University of the West Indies, Bridgetown, Barbados
- African–Caribbean Cancer Consortium, Philadelphia, PA, USA
| | - Simone Ann Marie Badal
- African–Caribbean Cancer Consortium, Philadelphia, PA, USA
- The University of the West Indies Mona, Kingston, Jamaica
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - Elisabeth I. Heath
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Mark M. Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John C. Henegan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Emilio Esteban
- Department of Medical Oncology, Hospital Universitario Central of Asturias, ISPA, Oviedo, Spain
| | | | - Ray McDermott
- St Vincent’s University Hospital & Cancer Trials Ireland, Dublin, Ireland
| | - Andre P. Fay
- PUCRS School of Medicine, Hospital Nora Teixeira, Porto Alegre, Brazil
| | | | - Camille Ragin
- African–Caribbean Cancer Consortium, Philadelphia, PA, USA
- Fox Chase Cancer Center, Philadelphia, PA
| | | | - Travis Gerke
- Prostate Cancer Clinical Trials Consortium, New York, NY, USA
| | - Philip W. Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kathryn L. Penney
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
5
|
Heald A, Qin R, Williams R, Warner-Levy J, Narayanan RP, Fernandez I, Peng Y, Gibson JM, McCay K, Anderson SG, Ollier W. A Longitudinal Clinical Trajectory Analysis Examining the Accumulation of Co-morbidity in People with Type 2 Diabetes (T2D) Compared with Non-T2D Individuals. Diabetes Ther 2023; 14:1903-1913. [PMID: 37707702 PMCID: PMC10570249 DOI: 10.1007/s13300-023-01463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is commonly associated with an increasing complexity of multimorbidity. While some progress has been made in identifying genetic and non-genetic risk factors for T2D, understanding the longitudinal clinical history of individuals before/after T2D diagnosis may provide additional insights. METHODS In this study, we utilised longitudinal data from the DARE (Diabetes Alliance for Research in England) study to examine the trajectory of clinical conditions in individuals with and without T2D. Data from 1932 individuals (T2D n = 1196 vs. matched non-T2D controls n = 736) were extracted and subjected to trajectory analysis over a period of up to 50 years (25 years pre-diagnosis/25 years post-diagnosis). We also analysed the cumulative proportion of people with diagnosed coronary artery disease (CAD) in their general practice (GP) record with an analysis of lower respiratory tract infection (RTI) as a comparator group. RESULTS The mean age of diagnosis of T2D was 52.6 (95% confidence interval 52.0-53.4) years. In the years leading up to T2D diagnosis, individuals who eventually received a T2D diagnosis consistently exhibited a considerable increase in several clinical phenotypes. Additionally, immediately prior to T2D diagnosis, a significantly greater prevalence of hypertension (35%)/RTI (34%)/heart conditions (17%)/eye, nose, throat infection (19%) and asthma (12%) were observed. The corresponding trajectory of each of these conditions was much less dramatic in the matched controls. Post-T2D diagnosis, proportions of T2D individuals exhibiting hypertension/chronic kidney disease/retinopathy/infections climbed rapidly before plateauing. At the last follow-up by quintile of disadvantage, the proportion (%) of people with diagnosed CAD was 6.4% for quintile 1 (least disadvantaged) and 11% for quintile 5 (F = 3.4, p = 0.01 for the difference between quintiles). CONCLUSION These findings provide novel insights into the onset/natural progression of T2D, suggesting an early phase of inflammation-related disease activity before any clinical diagnosis of T2D is made. Measures that reduce social inequality have the potential in the longer term to reduce the social gradient in health outcomes reported here.
Collapse
Affiliation(s)
- Adrian Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK.
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Rui Qin
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester, UK
| | - John Warner-Levy
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Israel Fernandez
- Stroke Pharmacogenomics and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - J Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kevin McCay
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Simon G Anderson
- University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
6
|
Ferguson TS, Younger-Coleman NOM, Webster-Kerr K, Tulloch-Reid MK, Bennett NR, Davidson T, Grant AS, Gordon-Johnson KAM, Govia I, Soares-Wynter S, McKenzie JA, Walker E, Cunningham-Myrie CA, Anderson SG, Blake AL, Ho J, Stephenson R, Edwards SE, McFarlane SR, Spence S, Wilks RJ. Sodium and potassium consumption in Jamaica: National estimates and associated factors from the Jamaica Health and Lifestyle Survey 2016-2017. Medicine (Baltimore) 2023; 102:e35308. [PMID: 37800785 PMCID: PMC10553171 DOI: 10.1097/md.0000000000035308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
This study aimed to estimate dietary sodium and potassium consumption among Jamaicans and evaluate associations with sociodemographic and clinical characteristics. A cross-sectional study was conducted using data from the Jamaica Health and Lifestyle Survey 2016-2017. Participants were noninstitutionalized Jamaicans aged ≥15 years. Trained staff collected sociodemographic and health data via interviewer-administered questionnaires and spot urine samples. The Pan American Health Organization formula was used to estimate 24-hour urine sodium and potassium excretion. High sodium level was defined as ≥2000 mg/day, and low potassium levels as <3510 mg/day (World Health Organization criteria). Associations between these outcomes and sociodemographic and clinical characteristics were explored using multivariable ANOVA models using log-transformed 24-hour urine sodium and potassium as outcome variables. Analyses included 1009 participants (368 males, 641 females; mean age 48.5 years). The mean sodium excretion was 3582 mg/day (males 3943 mg/day, females 3245 mg/day, P < .001). The mean potassium excretion was 2052 mg/day (males, 2210 mg/day; females, 1904 mg/day; P = .001). The prevalence of high sodium consumption was 66.6% (males 72.8%, females 60.7%, P < .001) and that of low potassium intake was 88.8% (85.1% males, 92.3% females, P < .001). Sodium consumption was inversely associated with older age, higher education, and low glomerular filtration rate but was directly associated with being male, current smoking, and obesity. Overall, males had higher sodium consumption than women, with the effect being larger among hypertensive men. Women with hypertension had lower sodium consumption than nonhypertensive women; however, hypertensive men had higher sodium consumption than nonhypertensive men. Potassium consumption was higher among men, persons with obesity, and those with high total cholesterol but was lower among men with "more than high school" education compared to men with "less than high school" education. We conclude that most Jamaican adults have diets high in sodium and low in potassium. In this study, sodium consumption was directly associated with male sex, obesity, and current smoking but was inversely associated with older age and higher education. High potassium consumption was associated with obesity and high cholesterol levels. These associations should be further explored in longitudinal studies and population-based strategies should be developed to address these cardiovascular risk factors.
Collapse
Affiliation(s)
- Trevor S. Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Novie O. M. Younger-Coleman
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | | | - Marshall K. Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Nadia R. Bennett
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | | | | | | | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Suzanne Soares-Wynter
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Joette A. McKenzie
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Evelyn Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Colette A. Cunningham-Myrie
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston, Jamaica
| | | | - Alphanso L. Blake
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - James Ho
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | | | | | - Shelly R. McFarlane
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston, Jamaica
| | | | - Rainford J. Wilks
- Epidemiology Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Mona, Kingston, Jamaica
| |
Collapse
|
7
|
Razzaq FA, Calzada-Reyes A, Tang Q, Guo Y, Rabinowitz AG, Bosch-Bayard J, Galan-Garcia L, Virues-Alba T, Suarez-Murias C, Miranda I, Riaz U, Bernardo Lagomasino V, Bryce C, Anderson SG, Galler JR, Bringas-Vega ML, Valdes-Sosa PA. Spectral quantitative and semi-quantitative EEG provide complementary information on the life-long effects of early childhood malnutrition on cognitive decline. Front Neurosci 2023; 17:1149102. [PMID: 37781256 PMCID: PMC10540225 DOI: 10.3389/fnins.2023.1149102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study compares the complementary information from semi-quantitative EEG (sqEEG) and spectral quantitative EEG (spectral-qEEG) to detect the life-long effects of early childhood malnutrition on the brain. Methods Resting-state EEGs (N = 202) from the Barbados Nutrition Study (BNS) were used to examine the effects of protein-energy malnutrition (PEM) on childhood and middle adulthood outcomes. sqEEG analysis was performed on Grand Total EEG (GTE) protocol, and a single latent variable, the semi-quantitative Neurophysiological State (sqNPS) was extracted. A univariate linear mixed-effects (LME) model tested the dependence of sqNPS and nutritional group. sqEEG was compared with scores on the Montreal Cognitive Assessment (MoCA). Stable sparse classifiers (SSC) also measured the predictive power of sqEEG, spectral-qEEG, and a combination of both. Multivariate LME was applied to assess each EEG modality separately and combined under longitudinal settings. Results The univariate LME showed highly significant differences between previously malnourished and control groups (p < 0.001); age (p = 0.01) was also significant, with no interaction between group and age detected. Childhood sqNPS (p = 0.02) and adulthood sqNPS (p = 0.003) predicted MoCA scores in adulthood. The SSC demonstrated that spectral-qEEG combined with sqEEG had the highest predictive power (mean AUC 0.92 ± 0.005). Finally, multivariate LME showed that the combined spectral-qEEG+sqEEG models had the highest log-likelihood (-479.7). Conclusion This research has extended our prior work with spectral-qEEG and the long-term impact of early childhood malnutrition on the brain. Our findings showed that sqNPS was significantly linked to accelerated cognitive aging at 45-51 years of age. While sqNPS and spectral-qEEG produced comparable results, our study indicated that combining sqNPS and spectral-qEEG yielded better performance than either method alone, suggesting that a multimodal approach could be advantageous for future investigations. Significance Based on our findings, a semi-quantitative approach utilizing GTE could be a valuable diagnostic tool for detecting the lasting impacts of childhood malnutrition. Notably, sqEEG has not been previously explored or reported as a biomarker for assessing the longitudinal effects of malnutrition. Furthermore, our observations suggest that sqEEG offers unique features and information not captured by spectral quantitative EEG analysis and could lead to its improvement.
Collapse
Affiliation(s)
- Fuleah A. Razzaq
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformatics, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformatics, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanbo Guo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformatics, University of Electronic Science and Technology of China, Chengdu, China
| | | | | | | | | | | | - Ileana Miranda
- National Center for Animal and Plant Health, CENSA, San José de las Lajas, Mayabeque, Cuba
| | - Usama Riaz
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformatics, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Cyralene Bryce
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
| | - Simon G. Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
| | - Janina R. Galler
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Maria L. Bringas-Vega
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformatics, University of Electronic Science and Technology of China, Chengdu, China
| | - Pedro A. Valdes-Sosa
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformatics, University of Electronic Science and Technology of China, Chengdu, China
- Cuban Neuroscience Center, La Habana, Cuba
| |
Collapse
|
8
|
Heald AH, Stedman M, Horne L, Rea R, Whyte MB, Syed AA, Paisley A, Gibson JM, Anderson SG, Ollier W. The change in glycaemic control immediately after the 3rd COVID-19 vaccination in people with type 1 diabetes. Diabet Med 2023; 40:e15119. [PMID: 37083020 DOI: 10.1111/dme.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Affiliation(s)
- A H Heald
- The School of Medicine and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - M Stedman
- Res Consortium, Andover, Hampshire, UK
| | - L Horne
- Vernova Healthcare, Watersgreen Medical Centre, Macclesfield, UK
| | - R Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS FT, Oxford, UK
| | - M B Whyte
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - A A Syed
- The School of Medicine and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - A Paisley
- The School of Medicine and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - J M Gibson
- The School of Medicine and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - S G Anderson
- Glasgow-Caribbean Centre for Development Research and The George Alleyne Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - W Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
9
|
Gill A, Felker-Kantor E, Cunningham-Myrie C, Greene LG, Lyew-Ayee P, Atkinson U, Abel W, Anderson SG, Theall KP. Neighborhoods and adolescent polysubstance use in Jamaica. PeerJ 2023; 11:e14297. [PMID: 36815978 PMCID: PMC9933737 DOI: 10.7717/peerj.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 10/03/2022] [Indexed: 02/15/2023] Open
Abstract
Background The purpose of this study was to identify latent classes of polysubstance use among adolescents in Jamaica and the role of neighborhood factors in the association with polysubstance use class membership. Methods This secondary analysis utilized a national cross-sectional household drug use survey conducted across 357 households in Jamaica (April 2016-July 2016) among a total of 4,625 individuals. A total of 750 adolescents (11-17 years) were included in this analysis. Latent class analysis (LCA) was conducted to identify polysubstance use patterns as well as latent neighborhood constructs. Neighborhood factors included social disorganization, concentrated disadvantage, community resources, community violence, and police station concentration. Multinomial regression analysis was implemented to evaluate the association between polysubstance use class membership and latent classes of neighborhood factors. Result The prevalence of lifetime polysubstance use was 27.56%. Four classes of polysubstance use were identified by comparing a series of five class models. The Bootstrap Likelihood Ratio Test (BLRT) indicated a good fit for the four-class model (<0.001). The prevalence of alcohol latent classes was: (1) heavy alcohol users and experimental smokers (Class I) (15.20%), (2) most hazardous polysubstance users (Class II) (5.33%), (3) heavy smokers and moderate alcohol users (Class III) (7.07%), and (4) experimental alcohol users (Class IV) (72.44%). Three classes of neighborhoods were identified by comparing a series of four-class models. The prevalence of the neighborhood classes was: (1) low social disorganization and disadvantage (Class I) (58.93%), (2) high social disorganization and moderate disadvantage (Class II) (10.93%), and (3) high social disorganization related to perceived drug use and disadvantage (Class III) (30.13%). The BLRT indicated a good fit for the three-class model (p = < 0.004). Multinomial regression analysis indicated that adolescents living in neighborhoods with high disorder and moderate disadvantage (Class II) were 2.43 times (odds ratio (OR)) = 2.43, confidence interval (CI)) = 1.30-4.56) more likely to be heavy alcohol users and experimental smokers (Class I) compared to experimental alcohol users, adjusting for sex, age, ethnicity, religion, and income. Class II of neighborhood classes presented with the highest levels of community violence (100%), perceived disorder crime (64.6%), police station concentration (6.7%), and community resources (low resources is 87.6%), while the concentrated disadvantage was moderate (14.8%). Conclusions Alcohol polysubstance use latent classes were identified among youth in this context. Neighborhoods with high disorder and moderate disadvantage (Class II) were associated with a higher likelihood of polysubstance use. The role of neighborhood conditions in shaping adolescent polysubstance use should be considered in policy, prevention, and treatment interventions.
Collapse
Affiliation(s)
- Amrita Gill
- Department of Social, Behavioural and Population Sciences, Tulane University, New Orleans, LA, United States of America
| | - Erica Felker-Kantor
- Department of Social, Behavioural and Population Sciences, Tulane University, New Orleans, LA, United States of America
| | - Colette Cunningham-Myrie
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Lisa-Gaye Greene
- Mona Geoinformatics Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Parris Lyew-Ayee
- Mona Geoinformatics Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Uki Atkinson
- Ministry of Health and Wellness, National Council on Drug Abuse, Kingston, Jamaica
| | - Wendel Abel
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Simon G. Anderson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, University of the West Indies, Cave Hill, Barbados
| | - Katherine P. Theall
- Department of Social, Behavioural and Population Sciences, Tulane University, New Orleans, LA, United States of America,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
| |
Collapse
|
10
|
Mucci LA, Vinson J, Gold T, Gerke T, Filipenko J, Green RM, Anderson SG, Badal S, Bjartell A, Chi KN, Davis ID, Enting D, Fay AP, Lazarus J, Mateo J, McDermott R, Odedina FT, Olmos D, Omlin A, Popoola AA, Ragin C, Roberts R, Russnes KM, Waihenya C, Stopsack KH, Hyslop T, Villanti P, Kantoff PW, George DJ. IRONMAN: A Novel International Registry of Men With Advanced Prostate Cancer. JCO Glob Oncol 2022; 8:e2200154. [PMID: 36332173 PMCID: PMC9668562 DOI: 10.1200/go.22.00154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To describe a newly established international registry recruiting diverse patients with advanced prostate cancer across academic and community practices to address unmet needs in this population. PATIENTS AND METHODS Initiated in 2017, IRONMAN (International Registry for Men with Advanced Prostate Cancer) is a prospective cohort of patients with advanced prostate cancer. The study will enroll 5,000 patients with metastatic hormone-sensitive prostate cancer (mHSPC) or castration-resistant prostate cancer (CRPC), recruited from Australia, the Bahamas, Barbados, Brazil, Canada, Ireland, Jamaica, Kenya, Nigeria, Norway, South Africa, Spain, Sweden, Switzerland, the United Kingdom, and the United States. The study is collecting datatypes to study variation in care and treatment of advanced prostate cancer across countries and across academic, community-based, and government practices with a focus on clinical outcomes, patient-reported outcomes, epidemiologic data, biologic subtypes, and clinician questionnaires. RESULTS Through July 2022, 2,682 eligible patients were enrolled in 11 of 12 active countries. Sixty-six percent of patients have mHSPC, and 34% have CRPC. On the basis of self-report, 11% of patients are Black and 9% are Hispanic. Five Veterans Affairs Medical Centers are enrolling patients. Globally, 23% of patients report being veterans of military service. CONCLUSION To our knowledge, this is the first international cohort of people newly diagnosed with advanced prostate cancer designed to describe variations in patient management, experiences, and outcomes. IRONMAN aims to identify optimal treatment sequences to improve survival, understand patient-reported outcomes, and explore novel biomarkers to understand treatment resistance mechanisms. Insights from IRONMAN will inform and guide future clinical management of people with mHSPC and CRPC. This cohort study will provide real-world evidence to facilitate a better understanding of the survivorship of people with advanced prostate cancer.
Collapse
Affiliation(s)
- Lorelei A. Mucci
- Harvard T.H. Chan School of Public Health, Boston, MA,Lorelei A. Mucci, ScD, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Room 920, Boston, MA 02115; e-mail:
| | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Theresa Gold
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Travis Gerke
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | | | | | - Simon G. Anderson
- The Glasgow-Caribbean Centre for Development Research and the Caribbean Institute of Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Simone Badal
- The University of the West Indies Mona, Kingston, Jamaica
| | | | - Kim N. Chi
- BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian D. Davis
- Monash University, Melbourne, Australia,Eastern Health, Melbourne, Australia
| | - Deborah Enting
- Guys St Thomas NHS Foundation Trust, London, United Kingdom
| | - André P. Fay
- Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil
| | - John Lazarus
- University of Cape Town, Cape Town, South Africa
| | - Joaquin Mateo
- Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Ray McDermott
- St Vincent's University Hospital & Cancer Trials Ireland, Dublin, Ireland
| | | | - David Olmos
- Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | | | | | - Robin Roberts
- UWI School of Clinical Medicine and Research, Nassau, The Bahamas
| | | | | | | | | | | | - Philip W. Kantoff
- Convergent Therapeutics, Cambridge, MA,Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | |
Collapse
|
11
|
Fisher LA, Stephenson S, Reid MT, Anderson SG. Acute kidney injury following cardiopulmonary bypass in Jamaica. JTCVS Open 2022; 11:161-175. [PMID: 36172431 PMCID: PMC9510884 DOI: 10.1016/j.xjon.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
Objectives The study objectives were to describe the incidence, risk factors, and outcomes of acute kidney injury after cardiopulmonary bypass in Jamaica. Method We performed a review of the medical records of adult patients (aged ≥ 18 years) with no prior dialysis requirement undergoing cardiopulmonary bypass at the University Hospital of the West Indies, Mona, between January 1, 2016, and June 30, 2019. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Acute kidney injury was defined using Kidney Disease Improving Global Outcomes criteria. The primary outcomes were acute kidney injury incidence and all-cause 30-day mortality. Multivariable logistic regression and Cox proportional analyses were used to examine the association between the acute kidney injury risk factors and the primary outcome. Results Data for 210 patients (58% men, mean age 58.1 ± 12.9 years) were analyzed. Acute kidney injury occurred in 80 patients (38.1%), 44% with Kidney Disease Improving Global Outcomes I, 33% with Kidney Disease Improving Global Outcomes II, and 24% with Kidney Disease Improving Global Outcomes III. From multivariable logistic regression models, European System for Cardiac Operative Risk Evaluation II (odds ratio, 1.19; 95% confidence interval, 1.01-1.39 per unit), bypass time (odds ratio, 1.94; 95% confidence interval, 1.40-2.67 per hour), perioperative red cell transfusion (odds ratio, 3.03; 95% confidence interval, 1.36-6.76), and postoperative neutrophil lymphocyte ratio (odds ratio, 1.65; 95% confidence interval, 1.01-2.68 per 10-unit difference) were positively associated with acute kidney injury. Acute kidney injury resulted in greater median hospital stay (18 vs 11 days, P < .001) and intensive care unit stay (5 vs 3 days, P < .001), and an 8-fold increase in 30-day mortality (hazard ratio, 8.15; 95% confidence interval, 2.76-24.06, P < .001). Conclusions Acute kidney injury after cardiopulmonary bypass surgery occurs frequently in Jamaica and results in poor short-term outcomes. Further studies coupled with quality interventions to reduce the mortality of those with acute kidney injury are needed in the Caribbean.
Collapse
|
12
|
Greenidge AR, Naitram S, Quimby KR, Anderson SG, Landis RC. Indirect costs of non-healing diabetic foot wounds in an African origin population in Barbados. Diabet Med 2022; 39:e14888. [PMID: 35593667 DOI: 10.1111/dme.14888] [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] [Received: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- André R Greenidge
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Simon Naitram
- Department of Economics, Faculty of Social Sciences, The University of the West Indies, Cave Hill Campus, Barbados
| | - Kim R Quimby
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - R Clive Landis
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| |
Collapse
|
13
|
Augustus E, Haynes E, Guell C, Morrissey K, Murphy MM, Halliday C, Jia L, Iese V, Anderson SG, Unwin N. The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: A Systematic Review and Narrative Synthesis. Nutrients 2022; 14:nu14173529. [PMID: 36079787 PMCID: PMC9460279 DOI: 10.3390/nu14173529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000−2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level.
Collapse
Affiliation(s)
- Eden Augustus
- The Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, P.O. Box 64, Bridgetown BB11000, Barbados
- Correspondence:
| | - Emily Haynes
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
| | - Karyn Morrissey
- Division of Sustainability, Society and Economics, Department of Technology, Management and Economics, Technical University of Denmark, Produktionstorvet 358, DK-2800 Kgs. Lyngby, Denmark
| | - Madhuvanti M. Murphy
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, The University of the West Indies, Bridgetown BB11000, Barbados
| | - Cassandra Halliday
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
| | - Lili Jia
- Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK
| | - Viliamu Iese
- Pacific Centre for Environment and Sustainable Development, University of the South Pacific, Suva 0101, Fiji
| | - Simon G. Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, The University of the West Indies, Bridgetown BB11000, Barbados
- Glasgow-Caribbean Centre for Development Research, University of the West Indies, Bridgetown BB11000, Barbados
| | - Nigel Unwin
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| |
Collapse
|
14
|
Greenidge AR, Quimby KR, Rose AMC, Speede A, Hambleton IR, Anderson SG, Landis RC. Direct healthcare services cost of non-healing diabetic foot wounds in an African origin population in Barbados. Diabet Med 2022; 39:e14773. [PMID: 34936707 DOI: 10.1111/dme.14773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 06/22/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022]
Affiliation(s)
- André R Greenidge
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Kim R Quimby
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Angela M C Rose
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Amy Speede
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Ian R Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - R Clive Landis
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| |
Collapse
|
15
|
Heald AH, Jenkins DA, Williams R, Sperrin M, Mudaliar RN, Syed A, Naseem A, Bowden Davies KA, Peng Y, Peek N, Ollier W, Anderson SG, Delanerolle G, Gibson JM. Mortality in People with Type 2 Diabetes Following SARS-CoV-2 Infection: A Population Level Analysis of Potential Risk Factors. Diabetes Ther 2022; 13:1037-1051. [PMID: 35416588 PMCID: PMC9006208 DOI: 10.1007/s13300-022-01259-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Research is ongoing to increase our understanding of how much a previous diagnosis of type 2 diabetes mellitus (T2DM) affects someone's risk of becoming seriously unwell following a COVID-19 infection. In this study we set out to determine the relative likelihood of death following COVID-19 infection in people with T2DM when compared to those without T2DM. This was conducted as an urban population study and based in the UK. METHODS Analysis of electronic health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of T2DM and subsequent COVID-19 confirmed infection. Each individual with T2DM (n = 13,807) was matched with three COVID-19-infected non-diabetes controls (n = 39,583). Data were extracted from the Greater Manchester Care Record (GMCR) database for the period 1 January 2020 to 30 June 2021. Social disadvantage was assessed through Townsend scores. Death rates were compared in people with T2DM to their respective non-diabetes controls; potential predictive factors influencing the relative likelihood of admission were ascertained using univariable and multivariable logistic regression. RESULTS For individuals with T2DM, their mortality rate after a COVID-19 positive test was 7.7% vs 6.0% in matched controls; the relative risk (RR) of death was 1.28. From univariate analysis performed within the group of individuals with T2DM, the likelihood of death following a COVID-19 recorded infection was lower in people taking metformin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i) or a glucagon-like peptide 1 (GLP-1) agonist. Estimated glomerular filtration rate (eGFR) and hypertension were associated with increased mortality and had odds ratios of 0.96 (95% confidence interval 0.96-0.97) and 1.92 (95% confidence interval 1.68-2.20), respectively. Likelihood of death following a COVID-19 infection was also higher in those people with a diagnosis of chronic obstructive pulmonary disease (COPD) or severe enduring mental illness but not with asthma, and in people taking aspirin/clopidogrel/insulin. Smoking in people with T2DM significantly increased mortality rate (odds ratio of 1.46; 95% confidence interval 1.29-1.65). In a combined analysis of patients with T2DM and controls, multiple regression modelling indicated that the factors independently relating to a higher likelihood of death (accounting for 26% of variance) were T2DM, age, male gender and social deprivation (higher Townsend score). CONCLUSION Following confirmed infection with COVID-19 a number of factors are associated with mortality in individuals with T2DM. Prescription of metformin, SGLT2is or GLP-1 agonists and non-smoking status appeared to be associated with a reduced the risk of death for people with T2DM. Age, male sex and social disadvantage are associated with an increased risk of death.
Collapse
Affiliation(s)
- Adrian H Heald
- The School of Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
| | - David A Jenkins
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Rajshekhar N Mudaliar
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Akheel Syed
- The School of Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Asma Naseem
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Simon G Anderson
- University of the West Indies, Cavehill Campus, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Gayathri Delanerolle
- Nuffield Department of Primary Health Care Science, Clinical Research Facility, University of Oxford, Oxford, UK
| | - J Martin Gibson
- The School of Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
16
|
Heald AH, Jenkins DA, Williams R, Sperrin M, Fachim H, Mudaliar RN, Syed A, Naseem A, Gibson JM, Bowden Davies KA, Peek N, Anderson SG, Peng Y, Ollier W. The Risk Factors Potentially Influencing Hospital Admission in People with Diabetes, Following SARS-CoV-2 Infection: A Population-Level Analysis. Diabetes Ther 2022; 13:1007-1021. [PMID: 35325361 PMCID: PMC8944405 DOI: 10.1007/s13300-022-01230-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus and the associated global pandemic (Covid-19). People with diabetes are particularly at high risk of becoming seriously unwell after contracting this virus. METHODS This population-based study included people living in the Greater Manchester conurbation who had a recorded diagnosis of type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and subsequent Covid-19 infection. Each individual with T1DM (n = 862) or T2DM (n = 13,225) was matched with three Covid-19-infected non-diabetes controls. RESULTS For individuals with T1DM, hospital admission rate in the first 28 days after a positive Covid-19 test was 10% vs 4.7% in age/gender-matched controls [relative risk (RR) 2.1]. For individuals with T2DM, hospital admission rate after a positive Covid-19 test was 16.3% vs 11.6% in age/gender-matched controls (RR 1.4). The average Townsend score was higher in T2DM (1.8) vs matched controls (0.4), with a higher proportion of people with T2DM observed in the top two quintiles of greatest disadvantage (p < 0.001). For Covid-19-infected individuals with T1DM, factors influencing admission likelihood included age, body mass index (BMI), hypertension, HbA1c, low HDL-cholesterol, lower estimated glomerular filtration rate (eGFR), chronic obstructive pulmonary disease (COPD) and being of African/mixed ethnicity. In Covid-19-infected individuals with T2DM, factors related to a higher admission rate included age, Townsend index, comorbidity with COPD/asthma and severe mental illness (SMI), lower eGFR. Metformin prescription lowered the likelihood. For multivariate analysis in combined individuals with T2DM/controls, factors relating to higher likelihood of admission were having T2DM/age/male gender/diagnosed COPD/diagnosed hypertension/social deprivation (higher Townsend index) and non-white ethnicity (all groups). CONCLUSION In a UK population we have confirmed a significantly higher likelihood of admission in people with diabetes following Covid-19 infection. A number of factors mediate that increased likelihood of hospital admission. For T2DM, the majority of factors related to increased admission rate are common to the general population but more prevalent in T2DM. There was a protective effect of metformin in people with T2DM.
Collapse
Affiliation(s)
- Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
| | - David A Jenkins
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Helene Fachim
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Rajshekhar N Mudaliar
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Akheel Syed
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Asma Naseem
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - J Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Kelly A Bowden Davies
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Simon G Anderson
- University of the West Indies, Cavehill Campus, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
17
|
Heald AH, Stedman M, Horne L, Rea R, Whyte M, Gibson JM, Anderson SG, Ollier W. The change in glycaemic control immediately after COVID-19 vaccination in people with type 1 diabetes. Diabet Med 2022; 39:e14774. [PMID: 34936128 DOI: 10.1111/dme.14774] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/20/2021] [Indexed: 01/17/2023]
Abstract
AIMS Evidence suggests that some people with type 1 diabetes mellitus (T1DM) experience temporary instability of blood glucose (BG) levels after COVID-19 vaccination. We aimed to assess this objectively. METHODS We examined the interstitial glucose profile of 97 consecutive adults (age ≥ 18 years) with T1DM using the FreeStyle Libre® flash glucose monitor in the periods immediately before and after their first COVID-19 vaccination. The primary outcome measure was percentage (%) interstitial glucose readings within the target range 3.9-10 mmol/L for 7 days prior to the vaccination and the 7 days after the vaccination. Data are mean ± standard error. RESULTS There was a significant decrease in the % interstitial glucose on target (3.9-10.0) for the 7 days following vaccination (mean 52.2% ± 2.0%) versus pre-COVID-19 vaccination (mean 55.0% ± 2.0%) (p = 0.030). 58% of individuals with T1DM showed a reduction in the 'time in target range' in the week after vaccination. 30% showed a decrease of time within the target range of over 10%, and 10% showed a decrease in time within target range of over 20%. The change in interstitial glucose proportion on target in the week following vaccination was most pronounced for people taking metformin/dapagliflozin + basal bolus insulin (change -7.6%) and for people with HbA1c below the median (change -5.7%). CONCLUSION In T1DM, we have shown that initial COVID-19 vaccination can cause temporary perturbation of interstitial glucose, with this effect more pronounced in people talking oral hypoglycaemic medication plus insulin, and when HbA1c is lower.
Collapse
Affiliation(s)
- Adrian H Heald
- The School of Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | | | - Linda Horne
- Vernova Healthcare, Watersgreen Medical Centre, Macclesfield, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS FT, Oxford, UK
| | - Martin Whyte
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - J Martin Gibson
- The School of Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Simon G Anderson
- University of the West Indies, Cavehill Campus, Bridgetown, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Willam Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
18
|
Liu J, Richmond RC, Bowden J, Barry C, Dashti HS, Daghlas I, Lane JM, Jones SE, Wood AR, Frayling TM, Wright AK, Carr MJ, Anderson SG, Emsley RA, Ray DW, Weedon MN, Saxena R, Lawlor DA, Rutter MK. Assessing the Causal Role of Sleep Traits on Glycated Hemoglobin: A Mendelian Randomization Study. Diabetes Care 2022; 45:772-781. [PMID: 35349659 PMCID: PMC9114722 DOI: 10.2337/dc21-0089] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the effects of sleep traits on glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS This study triangulated evidence across multivariable regression (MVR) and one- (1SMR) and two-sample Mendelian randomization (2SMR) including sensitivity analyses on the effects of five self-reported sleep traits (i.e., insomnia symptoms [difficulty initiating or maintaining sleep], sleep duration, daytime sleepiness, napping, and chronotype) on HbA1c (in SD units) in adults of European ancestry from the UK Biobank (for MVR and 1SMR analyses) (n = 336,999; mean [SD] age 57 [8] years; 54% female) and in the genome-wide association studies from the Meta-Analyses of Glucose and Insulin-Related Traits Consortium (MAGIC) (for 2SMR analysis) (n = 46,368; 53 [11] years; 52% female). RESULTS Across MVR, 1SMR, 2SMR, and their sensitivity analyses, we found a higher frequency of insomnia symptoms (usually vs. sometimes or rarely/never) was associated with higher HbA1c (MVR 0.05 SD units [95% CI 0.04-0.06]; 1SMR 0.52 [0.42-0.63]; 2SMR 0.24 [0.11-0.36]). Associations remained, but point estimates were somewhat attenuated after excluding participants with diabetes. For other sleep traits, there was less consistency across methods, with some but not all providing evidence of an effect. CONCLUSIONS Our results suggest that frequent insomnia symptoms cause higher HbA1c levels and, by implication, that insomnia has a causal role in type 2 diabetes. These findings could have important implications for developing and evaluating strategies that improve sleep habits to reduce hyperglycemia and prevent diabetes.
Collapse
Affiliation(s)
- Junxi Liu
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Rebecca C. Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Jack Bowden
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K
- College of Medicine and Health, University of Exeter, Exeter, U.K
| | - Ciarrah Barry
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Hassan S. Dashti
- Centre for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Iyas Daghlas
- Centre for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Jacqueline M. Lane
- Centre for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Samuel E. Jones
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Andrew R. Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, U.K
| | - Timothy M. Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, U.K
| | - Alison K. Wright
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Matthew J. Carr
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
- Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, U.K
| | - Simon G. Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, University of the West Indies, Kingston, Jamaica
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Richard A. Emsley
- Department of Biostatistics and Health Informatics, King’s College London, London, U.K
| | - David W. Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, U.K
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
| | - Michael N. Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, U.K
| | - Richa Saxena
- Centre for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service (NHS) Foundation Trust, University of Bristol, Bristol, U.K
| | - Martin K. Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| |
Collapse
|
19
|
Bosch-Bayard J, Razzaq FA, Lopez-Naranjo C, Wang Y, Li M, Galan-Garcia L, Calzada-Reyes A, Virues-Alba T, Rabinowitz AG, Suarez-Murias C, Guo Y, Sanchez-Castillo M, Rogers K, Gallagher A, Prichep L, Anderson SG, Michel CM, Evans AC, Bringas-Vega ML, Galler JR, Valdes-Sosa PA. Early protein energy malnutrition impacts life-long developmental trajectories of the sources of EEG rhythmic activity. Neuroimage 2022; 254:119144. [PMID: 35342003 DOI: 10.1016/j.neuroimage.2022.119144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
Protein Energy Malnutrition (PEM) has lifelong consequences on brain development and cognitive function. We studied the lifelong developmental trajectories of resting-state EEG source activity in 66 individuals with histories of Protein Energy Malnutrition (PEM) limited to the first year of life and in 83 matched classmate controls (CON) who are all participants of the 49 years longitudinal Barbados Nutrition Study (BNS). qEEGt source z-spectra measured deviation from normative values of EEG rhythmic activity sources at 5-11 years of age and 40 years later at 45-51 years of age. The PEM group showed qEEGt abnormalities in childhood, including a developmental delay in alpha rhythm maturation and an insufficient decrease in beta activity. These profiles may be correlated with accelerated cognitive decline.
Collapse
Affiliation(s)
- Jorge Bosch-Bayard
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China; McGill Center for Integrative Neuroscience Center MCIN. Ludmer Center for Mental Health. Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Fuleah Abdul Razzaq
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.
| | - Carlos Lopez-Naranjo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | | | | | | | - Arielle G Rabinowitz
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | - Yanbo Guo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Kassandra Rogers
- LION Lab, Sainte-Justine University Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | - Anne Gallagher
- LION Lab, Sainte-Justine University Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | | | - Simon G Anderson
- Caribbean Institute for Health Research, University of the West Indies, Barbados
| | | | - Alan C Evans
- McGill Center for Integrative Neuroscience Center MCIN. Ludmer Center for Mental Health. Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Maria L Bringas-Vega
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China; Cuban Neuroscience Center, La Habana, Cuba
| | - Janina R Galler
- Division of Pediatric Gastroenterology and Nutrition, Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Boston, MA, USA
| | - Pedro A Valdes-Sosa
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China; McGill Center for Integrative Neuroscience Center MCIN. Ludmer Center for Mental Health. Montreal Neurological Institute, McGill University, Montreal, Canada; Cuban Neuroscience Center, La Habana, Cuba.
| |
Collapse
|
20
|
McGrowder D, Tulloch-Reid MK, Coard KCM, McCaw-Binns AM, Ferguson TS, Aiken W, Harrison L, Anderson SG, Jackson MD. Vitamin D Deficiency at Diagnosis Increases All-Cause and Prostate Cancer-specific Mortality in Jamaican Men. Cancer Control 2022; 29:10732748221131225. [PMID: 36180132 PMCID: PMC9527998 DOI: 10.1177/10732748221131225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background 25 hydroxyvitamin D [25(OH)D] and serum calcium have been associated with incident prostate cancer (PCa). However, there is limited data on whether these metabolites predict survival in men of African descent, a population disproportionately affected by PCa. We studied the relationship of 25(OH)D at PCa diagnosis with all-cause and cancer-specific mortality among Jamaican men and examined whether serum calcium modified any associations. Methods Serum 25(OH)D from 152 Jamaican men with incident PCa within the Prostate Cancer Risk Evaluation (PROSCARE) study were re-evaluated approximately 11 years after enrollment. 25(OH)D analyses were stratified using the using Holick criteria. PCa-specific and all-cause mortality were examined in Kaplan–Meier survival curves and Cox regression models adjusted for age, body mass index (BMI), smoking and Gleason score. Restricted cubic splines evaluated nonlinear associations. Serum calcium was assessed as an effect modifier of the association between 25(OH)D and mortality. Results Of cases with available 25(OH)D, 64 men with PCa survived, 38 deaths were PCa specific and 36 died of other causes. At baseline, 9.9% of cases were vitamin D deficient and 61.2% were vitamin D sufficient. Compared to 25(OH)D sufficient men, those with 25(OH)D <20.0 ng/mL concentrations were associated with higher PCa-specific mortality (adjusted HR, 4.95; 95% CI, 1.68, 14.63, P = .004) and all-cause mortality (adjusted HR, 2.40; 95%CI, 1.33, 4. 32, P = .003). Serum calcium was not associated with survival and did not modify any associations with 25(OH)D. Conclusions 25(OH)D deficiency at PCa diagnosis predicted decreased survival for overall and PCa-specific cancer in Caribbean men of African ancestry.
Collapse
Affiliation(s)
- Donovan McGrowder
- Department of Pathology, Faculty of Medical Sciences, 462834The University of the West Indies, Mona, Jamaica
| | - Marshall K Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica
| | - Kathleen C M Coard
- Department of Pathology, Faculty of Medical Sciences, 462834The University of the West Indies, Mona, Jamaica
| | - Afette M McCaw-Binns
- Department of Community Health & Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica
| | - Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica
| | - William Aiken
- Department of Surgery, Radiology, Anaesthesia, & Intensive Care, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica
| | | | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, The University of the West Indies, Cave Hill, Barbados
| | - Maria D Jackson
- Department of Community Health & Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica
| |
Collapse
|
21
|
Auguste A, Gathere S, Pinheiro PS, Adebamowo C, Akintola A, Alleyne-Mike K, Anderson SG, Ashing K, Awittor FK, Awuah B, Bhakkan B, Deloumeaux J, du Plessis M, Ekanem IOA, Ekanem U, Ezeome E, Felix N, Gachii AK, Gaete S, Gibson T, Hage R, Harrison S, Igbinoba F, Iseh K, Kiptanui E, Korir A, Lawson-Myers HD, Llanos A, Luce D, McNaughton D, Odutola M, Omonisi A, Otu T, Peruvien J, Raheem N, Roach V, Sobers N, Uamburu N, Ragin C. Heterogeneity in head and neck cancer incidence among black populations from Africa, the Caribbean and the USA: Analysis of cancer registry data by the AC3. Cancer Epidemiol 2021; 75:102053. [PMID: 34743058 PMCID: PMC8627451 DOI: 10.1016/j.canep.2021.102053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA. METHODS Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013-2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness. RESULTS In 2013-2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6-18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3-8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5-3.7) and women (IR: 1.5, 95%CI = 1.0-1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0-4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2-5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9-5.0). CONCLUSION We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race.
Collapse
Affiliation(s)
- Aviane Auguste
- Guadeloupe Cancer Registry, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France; African Caribbean Cancer Consortium USA.
| | - Samuel Gathere
- The National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya; African Caribbean Cancer Consortium USA
| | - Paulo S Pinheiro
- University of Miami, Sylvester Comprehensive Cancer Center, FL, USA; African Caribbean Cancer Consortium USA
| | - Clement Adebamowo
- Department of Epidemiology and Public Health and the Institute of Human Virology, The Marlene and Stewart Greenebaum Comprehensive Cancer Centre, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Bioethics and Research, Ibadan, Nigeria; Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria
| | - Adeola Akintola
- Center for Bioethics and Research, Ibadan, Nigeria; Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria
| | - Kellie Alleyne-Mike
- Cancer Centre of Trinidad and Tobago, St. James, Trinidad and Tobago; African Caribbean Cancer Consortium USA
| | - Simon G Anderson
- Barbados National Registry, The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados; African Caribbean Cancer Consortium USA
| | - Kimlin Ashing
- City of Hope Cancer Center, Duarte, CA, USA; African Caribbean Cancer Consortium USA
| | | | - Baffour Awuah
- Kumasi Cancer Registry, Komfo Anokye Teaching Hospital, Kumasi, Ghana; African Caribbean Cancer Consortium USA
| | - Bernard Bhakkan
- Guadeloupe Cancer Registry, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France; African Caribbean Cancer Consortium USA
| | - Jacqueline Deloumeaux
- Guadeloupe Cancer Registry, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France; Biological Resource Center Karubiotec™, BRIF n° KARUBIOTEC-GUA-00971, Pointe-à-Pitre, Guadeloupe; African Caribbean Cancer Consortium USA
| | - Maira du Plessis
- Department of Anatomical Sciences, St Georges University, Grenada, West Indies; African Caribbean Cancer Consortium USA
| | - Ima-Obong A Ekanem
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Calabar Cancer Registry, Department of Pathology, College of Medical Sciences, University of Calabar and Teaching Hospital, Calabar, Nigeria
| | - Uwemedimbuk Ekanem
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo/University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Emmanuel Ezeome
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Enugu Cancer Registry, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Nkese Felix
- Dr. Elizabeth Quamina Cancer Registry, the National Cancer Registry of Trinidad and Tobago, Mount Hope, Trinidad and Tobago
| | - Andrew K Gachii
- Department of Lab Medicine, Kenyatta National Hospital, Nairobi, Kenya; African Caribbean Cancer Consortium USA
| | - Stanie Gaete
- Biological Resource Center Karubiotec™, BRIF n° KARUBIOTEC-GUA-00971, Pointe-à-Pitre, Guadeloupe; African Caribbean Cancer Consortium USA
| | - Tracey Gibson
- Jamaica Cancer Registry, Department of Pathology, University of the West Indies, Kingston, Jamaica; African Caribbean Cancer Consortium USA
| | - Robert Hage
- Department of Anatomical Sciences, St Georges University, Grenada, West Indies; African Caribbean Cancer Consortium USA
| | - Sharon Harrison
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; African Caribbean Cancer Consortium USA
| | - Festus Igbinoba
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; National Hospital Abuja, Abuja, Nigeria
| | - Kufre Iseh
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Department of Otorhinolaryngology/Head &Neck Surgery, Faculty of Clinical sciences, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; Population Based Cancer Registry, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Evans Kiptanui
- The National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ann Korir
- The National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya; African Caribbean Cancer Consortium USA
| | - Heather-Dawn Lawson-Myers
- Liguanea Family Dental Centre, Seymour Park, Kingston, Jamaica; African Caribbean Cancer Consortium USA
| | - Adana Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA; African Caribbean Cancer Consortium USA
| | - Daniele Luce
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Pointe-à-Pitre, Guadeloupe, France; African Caribbean Cancer Consortium USA
| | - Dawn McNaughton
- Jamaica Cancer Registry, Department of Pathology, University of the West Indies, Kingston, Jamaica; African Caribbean Cancer Consortium USA
| | - Michael Odutola
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Center for Big Data Research in Health, University of New South Wales, Sydney, Australia; African Caribbean Cancer Consortium USA
| | - Abidemi Omonisi
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Department of Anatomic Pathology, Ekiti State University and Teaching Hospital, Ado-Ekiti, Nigeria
| | - Theresa Otu
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Abuja Cancer Registry, Department of Haematology and Blood Transfusion, University of Abuja Teaching Hospital, Gawgwalada, Nigeria
| | - Jessica Peruvien
- Guadeloupe Cancer Registry, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France
| | - Nasiru Raheem
- Nigerian National System of Cancer Registries, Federal Ministry of Health, Abuja, Nigeria; Department of Pathology, Federal Medical Centre, Yola, Nigeria
| | | | - Natasha Sobers
- Barbados National Registry, The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados; African Caribbean Cancer Consortium USA
| | - Nguundja Uamburu
- Dental Department, Katutura State Hospital, Windhoek, Namibia; African Caribbean Cancer Consortium USA
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; African Caribbean Cancer Consortium USA
| |
Collapse
|
22
|
Heald AH, Chang K, Jia T, Sun H, Zheng Q, Wang X, Xia J, Stedman M, Fachim H, Gibson M, Zhou X, Anderson SG, Peng Y, Ollier W. Longitudinal clinical trajectory analysis of individuals before and after diagnosis of Type 2 Diabetes Mellitus (T2DM) indicates that vascular problems start early. Int J Clin Pract 2021; 75:e14695. [PMID: 34338416 DOI: 10.1111/ijcp.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) frequently associates with increasing multi-morbidity/treatment complexity. Some headway has been made to identify genetic and non-genetic risk factors for T2DM. However, longitudinal clinical histories of individuals both before and after diagnosis of T2DM are likely to provide additional insight into both diabetes aetiology/further complex trajectory of multi-morbidity. METHODS This study utilised diabetes patients/controls enrolled in the DARE (Diabetes Alliance for Research in England) study where pre- and post-T2DM diagnosis longitudinal data was available for trajectory analysis. Longitudinal data of 281 individuals (T2DM n = 237 vs matched non-T2DM controls n = 44) were extracted, checked for errors and logical inconsistencies and then subjected to Trajectory Analysis over a period of up to 70 years based on calculations of the proportions of most prominent clinical conditions for each year. RESULTS For individuals who eventually had a diagnosis of T2DM made, a number of clinical phenotypes were seen to increase consistently in the years leading up to diagnosis of T2DM. Of these documented phenotypes, the most striking were diagnosed hypertension (more than in the control group) and asthma. This trajectory over time was much less dramatic in the matched control group. Immediately prior to T2DM diagnosis, a greater indication of ischaemic heart disease proportions was observed. Post-T2DM diagnosis, the proportions of T2DM patients exhibiting hypertension and infection continued to climb rapidly before plateauing. Ischaemic heart disease continued to increase in this group as well as retinopathy, impaired renal function and heart failure. CONCLUSION These observations provide an intriguing and novel insight into the onset and natural progression of T2DM. They suggest an early phase of potentially related disease activity well before any clinical diagnosis of diabetes is made. Further studies on a larger cohort of DARE patients are underway to explore the utility of establishing predictive risk scores.
Collapse
Affiliation(s)
- Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kai Chang
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Ting Jia
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Hailong Sun
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Qiguang Zheng
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Xinyan Wang
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Jianan Xia
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | | | - Helene Fachim
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Xuezhong Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Simon G Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Yonghong Peng
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
23
|
Schofield H, Haycocks S, Robinson A, Edmonds M, Anderson SG, Heald AH. Mortality in 98 type 1 diabetes mellitus and type 2 diabetes mellitus: Foot ulcer location is an independent risk determinant. Diabet Med 2021; 38:e14568. [PMID: 33772856 DOI: 10.1111/dme.14568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We previously demonstrated in both a longitudinal study and in meta-analysis (pooled relative-risk RR, 2.45) that all-cause mortality is significantly higher in people with diabetes foot ulceration (DFU) than with those without a foot ulcer. In this prospective study, we looked at the factors linked to mortality after presentation to podiatry with DFU. METHODS Ninety-eight individuals recruited consecutively from the Salford Royal Hospital Multidisciplinary Foot Clinic in Spring 2016 were followed up for up to 48 months. Data concerning health outcomes were extracted from the electronic patient record (EPR). RESULTS Seventeen people (17) had type 1 diabetes mellitus, and 81 had type 2 diabetes mellitus. Thirty-one were women. The mean age (range) was 63.6 (28-90) years with maximum diabetes duration 45 years. Mean HbA1c was 72 (95% CI: 67-77) mmol/mol; 97% had neuropathy (International Working Group on the Diabetic Foot (IWGDF) monofilament); 62% had vascular insufficiency (Doppler studies); 69% of ulcers were forefoot, and 23% of ulcers were hind foot in location. Forty of 98 (40%) patients died in follow-up with 27% of death certificates including sepsis (not foot-related) and 35% renal failure as cause of death. Multivariate regression analysis indicated a 6.3 (95% CI: 3.9-8.1) fold increased risk of death with hind foot ulcer, independent of age/BMI/gender/HbA1c/eGFR/total cholesterol level. CONCLUSION This prospective study has indicated a very high long-term mortality rate in individuals with DFU, greater for those with a hind foot ulcer and shown a close relation between risk of sepsis/renal failure and DFU mortality, highlighting again the importance of addressing all risk factors as soon as people present with a foot ulcer.
Collapse
Affiliation(s)
| | | | - Adam Robinson
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | | | - Simon G Anderson
- University of the West Indies, Cavehill Campus Barbados, Barbados, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| |
Collapse
|
24
|
Heald AH, Stedman M, Horne L, Rea R, Whyte M, Gibson JM, Livingston M, Anderson SG, Ollier W. Analysis of Continuous Blood Glucose Data in People with Type 1 Diabetes (T1DM) After COVID-19 Vaccination Indicates a Possible Link Between the Immune and the Metabolic Response. J Diabetes Sci Technol 2021; 15:1204-1205. [PMID: 34323111 PMCID: PMC8411469 DOI: 10.1177/19322968211026291] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Adrian H. Heald
- The School of Medicine and Manchester
Academic Health Sciences Centre, University of Manchester, UK
- Department of Diabetes and Endocrinology,
Salford Royal Hospital, Salford, UK
- Adrian H. Heald, DM, Department of Diabetes and
Endocrinology, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK.
| | | | - Linda Horne
- Vernova Healthcare, Watersgreen Medical
Centre, Macclesfield, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and
Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS FT,
Oxford, UK
| | - Martin Whyte
- Department of Clinical & Experimental
Medicine, University of Surrey, Guildford, UK
| | - J. Martin Gibson
- The School of Medicine and Manchester
Academic Health Sciences Centre, University of Manchester, UK
- Department of Diabetes and Endocrinology,
Salford Royal Hospital, Salford, UK
| | - Mark Livingston
- Department of Clinical Biochemistry, Black
Country Pathology Services, Walsall Manor Hospital, Walsall, UK
| | - Simon G. Anderson
- University of the West Indies, Cavehill
Campus, Barbados, Saint Michael Barbados
- Division of Cardiovascular Sciences, Faculty
of Biology Medicine and Health, University of Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering,
Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
25
|
Maidstone R, Anderson SG, Ray DW, Rutter MK, Durrington HJ, Blaikley JF. Shift work is associated with positive COVID-19 status in hospitalised patients. Thorax 2021; 76:601-606. [PMID: 33903187 PMCID: PMC8098298 DOI: 10.1136/thoraxjnl-2020-216651] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Shift work is associated with lung disease and infections. We therefore investigated the impact of shift work on significant COVID-19 illness. METHODS 501 000 UK Biobank participants were linked to secondary care SARS-CoV-2 PCR results from Public Health England. Healthcare worker occupational testing and those without an occupational history were excluded from analysis. RESULTS Multivariate logistic regression (age, sex, ethnicity and deprivation index) revealed that irregular shift work (OR 2.42, 95% CI 1.92 to 3.05), permanent shift work (OR 2.5, 95% CI 1.95 to 3.19), day shift work (OR 2.01, 95% CI 1.55 to 2.6), irregular night shift work (OR 3.04, 95% CI 2.37 to 3.9) and permanent night shift work (OR 2.49, 95% CI 1.67 to 3.7) were all associated with positive COVID-19 tests compared with participants that did not perform shift work. This relationship persisted after adding sleep duration, chronotype, premorbid disease, body mass index, alcohol and smoking to the model. The effects of workplace were controlled for in three ways: (1) by adding in work factors (proximity to a colleague combined with estimated disease exposure) to the multivariate model or (2) comparing participants within each job sector (non-essential, essential and healthcare) and (3) comparing shift work and non-shift working colleagues. In all cases, shift work was significantly associated with COVID-19. In 2017, 120 307 UK Biobank participants had their occupational history reprofiled. Using this updated occupational data shift work remained associated with COVID-19 (OR 4.48 (95% CI 1.8 to 11.18). CONCLUSIONS Shift work is associated with a higher likelihood of in-hospital COVID-19 positivity. This risk could potentially be mitigated via additional workplace precautions or vaccination.
Collapse
Affiliation(s)
- Robert Maidstone
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Simon G Anderson
- The George Alleyne Chronic Disease Research Centre, The University of West Indies at Cave Hill, Bridgetown, Barbados
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David W Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Martin K Rutter
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Hannah J Durrington
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - John F Blaikley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
26
|
Tian Z, Stedman M, Whyte M, Anderson SG, Thomson G, Heald A. Personal protective equipment (PPE) and infection among healthcare workers - What is the evidence? Int J Clin Pract 2020; 74:e13617. [PMID: 32734641 DOI: 10.1111/ijcp.13617] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The worldwide outbreak of coronavirus disease-19 (COVID-19) has already put healthcare workers (HCWs) at a high risk of infection. The question of how to give HCWs the best protection against infection is a priority. METHODS We searched systematic reviews and original studies in Medline (via Ovid) and Chinese Wan Fang digital database from inception to May, 2020, using terms 'coronavirus', 'health personnel', and 'personal protective equipment' to find evidence about the use of full-body PPEs and other PPEs by HCW exposed highly infectious diseases. RESULTS Covering more of the body could provide better protection for HCWs. Of importance, it is not just the provision of PPE but the skills in donning and doffing of PPE that are important, this being a key time for potential transmission of pathogen to the HCW and in due time from them to others. In relation to face masks, the evidence indicates that a higher-level specification of face masks and respirators (such as N95) seems to be essential to protect HCWs from coronavirus infection. In community setting, the use of masks in the case of well individuals could be beneficial. Evidence specifically around PPE and protection from the COVID-19 virus is limited. CONCLUSION Covering more of the body, and a higher-level specification of masks and respirators could provide better protection for HCWs. Community mask usecould be beneficial. High quality studies still need to examine the protection of PPE against COVID-19.
Collapse
Affiliation(s)
- Zixing Tian
- Faculty of Biology, Medicine and Health, Medicine and Health, Manchester Academic Health Science Centre, the University of Manchester, Manchester, UK
| | | | - Martin Whyte
- Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon G Anderson
- University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
- Division of Cardiovascular, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - George Thomson
- Acute Medical Unit, The Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Adrian Heald
- Faculty of Biology, Medicine and Health, Medicine and Health, Manchester Academic Health Science Centre, the University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hosptial, Salford, UK
| |
Collapse
|
27
|
Stedman M, Whyte MB, Lunt M, Albanese M, Livingston M, Gadsby R, Hackett G, Anderson SG, Heald AH. The treatment rate of erectile dysfunction (ED) in younger men with type 2 diabetes is up to four times higher than the equivalent non-diabetes population. Int J Clin Pract 2020; 74:e13538. [PMID: 32431020 DOI: 10.1111/ijcp.13538] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) is common in older age and in diabetes mellitus (DM). Phosphodiesterase type 5-inhibitors (PDE5-is) are the first-line for ED. We investigated how the type of diabetes and age of males affect the PDE5-i use in the primary care setting. METHODS From 2018 to 2019, the general practice level quantity of all PDE5-i agents was taken from the general practice (GP) Prescribing Dataset in England. The variation in outcomes across practices was examined across one year, and for the same practice against the previous year. RESULTS We included 5761 larger practices supporting 25.8 million men of whom 4.2 million ≥65 years old. Of these, 1.4 million had T2DM, with 0.8 million of these >65. About 137 000 people had T1DM. About 28.8 million tablets of PDE5-i were prescribed within the 12 months (2018-2019) period in 3.7 million prescriptions (7.7 tablets/prescription), at total costs of £15.8 million (£0.55/tablet). The NHS ED limit of one tablet/user/wk suggests that 540 000 males are being prescribed a PDE5-i at a cost of £29/y each. With approximately 30 000 GPs practising, this is equivalent to one GP providing 2.5 prescriptions/wk to overall 18 males. There was a 3x variation between the highest decile of practices (2.6 tablets/male/y) and lowest decile (0.96 tablets/male/y). The statistical model captured 14% of this variation and showed that T1DM males were the largest users, while men age <65 with T2DM were being prescribed four times as much as non-DM. Those T2DM >65 were prescribed 80% of the non-DM amount. CONCLUSION There is a wide variation in the use of PDE5-is. With only 14% variance capture, other factors including wide variation in patient awareness, prescribing rules of local health providers, and recognition of the importance of male sexual health by GP prescribers might have a significant impact.
Collapse
Affiliation(s)
| | - Martin B Whyte
- Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Mark Lunt
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Marco Albanese
- Herzzentrum Hirslanden Zentralschweiz, Luzern, Switzerland
| | - Mark Livingston
- Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
| | - Roger Gadsby
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Simon G Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, University of the West Indies, Bridgetown, Barbados
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Salford Royal Hospital, Salford, UK
| |
Collapse
|
28
|
Stedman M, Davies M, Lunt M, Verma A, Anderson SG, Heald AH. A phased approach to unlocking during the COVID-19 pandemic-Lessons from trend analysis. Int J Clin Pract 2020; 74:e13528. [PMID: 32378252 PMCID: PMC7261991 DOI: 10.1111/ijcp.13528] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to radical political control of social behaviour. The purpose of this paper is to explore data trends from the pandemic regarding infection rates/policy impact, and draw learning points for informing the unlocking process. METHODS The daily published cases in England in each of 149 Upper Tier Local Authority (UTLA) areas were converted to Average Daily Infection Rate (ADIR), an R-value - the number of further people infected by one infected person during their infectious phase with Rate of Change of Infection Rate (RCIR) also calculated. Stepwise regression was carried out to see what local factors could be linked to differences in local infection rates FINDINGS: By the 19th April 2020 the infection R has fallen from 2.8 on 23rd March before the lockdown and has stabilised at about 0.8, sufficient for suppression. However there remain significant variations between England regions. Regression analysis across UTLAs found that the only factor relating to reduction in ADIR was the historic number of confirmed number infection/000 population, There is however wide variation between Upper Tier Local Authorities (UTLA) areas. Extrapolation of these results showed that unreported community infection may be 150 times higher than reported cases, providing evidence that by the end of the second week in April, 26.8% of the population may already have had the disease and so have increased immunityExtrapolation of these results showed that unreported community infection may be 150 times higher than reported cases, providing evidence that by the end of the second week in April, 26.8% of the population may already have had the disease and so have increased immunity. INTERPRETATION Analysis of current case data using infectious ratio has provided novel insight into the current national state and can be used to make better-informed decisions about future management of restricted social behaviour and movement.
Collapse
Affiliation(s)
| | | | - Mark Lunt
- Division of Musculoskeletal and Dermatological SciencesUniversity of ManchesterManchesterUK
| | - Arpana Verma
- Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
| | - Simon G. Anderson
- University of the West IndiesCave HillBarbados
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Adrian H. Heald
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
- The Faculty of Biology, Medicine and Health and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| |
Collapse
|
29
|
Stedman M, Lunt M, Davies M, Fulton-McAlister E, Hussain A, van Staa T, Anderson SG, Heald AH. Controlling antibiotic usage-A national analysis of General Practitioner/Family Doctor practices links overall antibiotic levels to demography, geography, comorbidity factors with local discretionary prescribing choices. Int J Clin Pract 2020; 74:e13515. [PMID: 32306458 DOI: 10.1111/ijcp.13515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/26/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Ecological studies show association between antimicrobial resistance (AMR), and inappropriate oral antibiotics use. Moderating antibiotic prescribing requires an understanding of all drivers of local prescribing. The aim was to quantify how much is determined by external factors compared with discretionary clinical choices. METHODS Oral antibiotic usage taken from England General Practitioner/Family Doctor practice prescribing data was aggregated using WHO/ATC defined daily doses (DDDs). The average annual antibiotic daily prescribing rate (AAADPR) in each practice was the total DDD of oral antibiotics divided by registered population and 365. The AAADPR of English practices in 2017_18 was linked by regression to factors including demographics, geography, medical comorbidities, clinical performance, patient satisfaction, medical workforce characteristics and prescribing selection. The regression coefficients for modifiable prescribing selection factors were applied to the difference between the median and top decile practice values to establish overall reduction opportunities through changing prescribing behaviour. RESULTS Twenty five factors accounted for 58% of the AAADPR variation in 5889 practices supporting 49.8 million patients. Non-modifiable factors linked increased AAADPR to more northerly location, higher prevalence of diabetes, COPD, CHD, and asthma; higher white ethnicity; higher patient satisfaction and lower population density. Modifiable behaviour accounted for 11% of the variation in AAADPR, with increases associated with a wider range of antibiotics, higher proportion taken as liquids, higher doses in each prescription, lower guideline compliance, lower targeted antibiotics, lower spend/dose, and less seasonal variation. If all practices achieved the level of modifiable factors of the top decile, this model suggests that overall AAADPR could reduce by 31%. CONCLUSION Such analysis is associative and does not infer causation. However, demographics, location, medical condition of the population, and prescribing selection are drivers of overall antibiotic prescribing. This analysis provides benchmarks for both non-modifiable and modifiable factors against which practices could evaluate their opportunities to reduce antibiotic prescribing.
Collapse
Affiliation(s)
| | - Mark Lunt
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Erin Fulton-McAlister
- Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | | | - Tjeerd van Staa
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Simon G Anderson
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- The George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
| | - Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| |
Collapse
|
30
|
Jackson MD, Tulloch-Reid MK, McCaw-Binns AM, Aiken W, Ferguson TS, Bennett NR, Harrison L, Badaloo A, McGrowder D, Grindley A, Walker E, Anderson SG. Central adiposity at diagnosis may reduce prostate cancer-specific mortality in African-Caribbean men with prostate cancer: 10-year follow-up of participants in a case-control study. Cancer Causes Control 2020; 31:651-662. [PMID: 32358695 DOI: 10.1007/s10552-020-01306-z] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/24/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. METHODS Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. RESULTS A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years. CONCLUSION Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.
Collapse
Affiliation(s)
- Maria D Jackson
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Marshall K Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Affette M McCaw-Binns
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - William Aiken
- Department of Surgery, Radiology, Anaesthesia, & Intensive Care, The University of the West Indies, Mona, Jamaica
| | - Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Nadia R Bennett
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | | | - Asha Badaloo
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Donovan McGrowder
- Department of Chemical Pathology, The University of the West Indies, Mona, Jamaica
| | - Annielle Grindley
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Evelyn Walker
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
31
|
Saluja S, Anderson SG, Hambleton I, Shoo H, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis. Diabet Med 2020; 37:211-218. [PMID: 31613404 DOI: 10.1111/dme.14151] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [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: 10/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetic foot ulcers portend an almost twofold increase in all-cause mortality compared with diabetes on its own. AIM To investigate the association between diabetic foot ulcers and risk of death. METHODS We performed a meta-analysis of all observational studies investigating the association between diabetic foot ulcers and all-cause mortality. Risk ratios and risk differences were pooled in a random-effects model. The I2 statistic was used to quantify heterogeneity between studies. RESULTS Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person-years of follow-up. The crude event rate for all-cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person-years) than in those who developed foot ulcers (230.8 per 1000 person-years). Diabetic foot ulceration was associated with an increased risk of all-cause mortality (pooled relative risk 2.45, 95% CI 1.85-2.85). We did not observe any tangible differences in risk of all-cause mortality from diagnosis in studies reporting a mean duration of follow-up of ≤3 years (relative risk 2.43, 95% CI 2.27-2.61) or >3 years (relative risk 2.26, 95% CI 2.13-2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta-analysis. CONCLUSIONS Our study shows an excess rate of all-cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
Collapse
Affiliation(s)
- S Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - S G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
| | - I Hambleton
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
| | - H Shoo
- Diabetes and Endocrine Department, Countess of Chester NHS Foundation Trust, Chester, UK
| | - M Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - E B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
| | - M Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - G Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - A H Heald
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Salford, UK
| |
Collapse
|
32
|
Cunningham PS, Meijer P, Nazgiewicz A, Anderson SG, Borthwick LA, Bagnall J, Kitchen GB, Lodyga M, Begley N, Venkateswaran RV, Shah R, Mercer PF, Durrington HJ, Henderson NC, Piper-Hanley K, Fisher AJ, Chambers RC, Bechtold DA, Gibbs JE, Loudon AS, Rutter MK, Hinz B, Ray DW, Blaikley JF. The circadian clock protein REVERBα inhibits pulmonary fibrosis development. Proc Natl Acad Sci U S A 2020; 117:1139-1147. [PMID: 31879343 PMCID: PMC6969503 DOI: 10.1073/pnas.1912109117] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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] [Indexed: 02/01/2023] Open
Abstract
Pulmonary inflammatory responses lie under circadian control; however, the importance of circadian mechanisms in the underlying fibrotic phenotype is not understood. Here, we identify a striking change to these mechanisms resulting in a gain of amplitude and lack of synchrony within pulmonary fibrotic tissue. These changes result from an infiltration of mesenchymal cells, an important cell type in the pathogenesis of pulmonary fibrosis. Mutation of the core clock protein REVERBα in these cells exacerbated the development of bleomycin-induced fibrosis, whereas mutation of REVERBα in club or myeloid cells had no effect on the bleomycin phenotype. Knockdown of REVERBα revealed regulation of the little-understood transcription factor TBPL1. Both REVERBα and TBPL1 altered integrinβ1 focal-adhesion formation, resulting in increased myofibroblast activation. The translational importance of our findings was established through analysis of 2 human cohorts. In the UK Biobank, circadian strain markers (sleep length, chronotype, and shift work) are associated with pulmonary fibrosis, making them risk factors. In a separate cohort, REVERBα expression was increased in human idiopathic pulmonary fibrosis (IPF) lung tissue. Pharmacological targeting of REVERBα inhibited myofibroblast activation in IPF fibroblasts and collagen secretion in organotypic cultures from IPF patients, thus suggesting that targeting of REVERBα could be a viable therapeutic approach.
Collapse
Affiliation(s)
- Peter S Cunningham
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Peter Meijer
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Alicja Nazgiewicz
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Simon G Anderson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
- The George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown. Barbados BB11000
| | - Lee A Borthwick
- Fibrosis Research Group, Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - James Bagnall
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Gareth B Kitchen
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Monika Lodyga
- Laboratory of Tissue Repair and Regeneration, Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada
| | - Nicola Begley
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Rajamiyer V Venkateswaran
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Rajesh Shah
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Paul F Mercer
- Centre for Inflammation and Tissue Repair, Faculty of Medical Sciences, University College London, London WC1E 6JJ, United Kingdom
| | - Hannah J Durrington
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Neil C Henderson
- Centre for Inflammation Research, University of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Karen Piper-Hanley
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Andrew J Fisher
- Institute of Transplantation, Freeman Hospital, The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne NE7 7DN, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, Faculty of Medical Sciences, University College London, London WC1E 6JJ, United Kingdom
| | - David A Bechtold
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Julie E Gibbs
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Andrew S Loudon
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Martin K Rutter
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada
| | - David W Ray
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, United Kingdom
| | - John F Blaikley
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom;
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| |
Collapse
|
33
|
Schofield H, Haycocks S, Robinson A, Anderson SG, Heald A. P.22 Mortality in 98 Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) Individuals Presenting to a Specialist Podiatry Clinic: Foot Ulcer Location is an Independent Risk Determinant. Artery Res 2020. [DOI: 10.2991/artres.k.201209.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
34
|
Felker-Kantor EA, Cunningham-Myrie C, Greene LG, Lyew-Ayee P, Atkinson U, Abel W, Clarke P, Anderson SG, Theall KP. Neighborhood crime, disorder and substance use in the Caribbean context: Jamaica National Drug Use Prevalence Survey 2016. PLoS One 2019; 14:e0224516. [PMID: 31756190 PMCID: PMC6874353 DOI: 10.1371/journal.pone.0224516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12–65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.
Collapse
Affiliation(s)
- Erica Ann Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Colette Cunningham-Myrie
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
- * E-mail:
| | - Lisa-Gaye Greene
- Mona GeoInformatics Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Parris Lyew-Ayee
- Mona GeoInformatics Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Uki Atkinson
- National Council on Drug Abuse, Ministry of Health, Kingston, Jamaica
| | - Wendel Abel
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Pernell Clarke
- Organization of American States, Inter-American Drug Abuse Control Commission, Washington, District of Columbia, United States of America
| | - Simon G. Anderson
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, University of the West Indies, Cave Hill, Barbados
| | - Katherine P. Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| |
Collapse
|
35
|
Heald A, Lunt M, Rutter MK, Anderson SG, Cortes G, Edmonds M, Jude E, Boulton A, Dunn G. Developing a foot ulcer risk model: what is needed to do this in a real-world primary care setting? Diabet Med 2019; 36:1412-1416. [PMID: 30320946 DOI: 10.1111/dme.13837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/12/2018] [Indexed: 12/24/2022]
Abstract
AIM To determine how routinely collected data can inform a risk model to predict de novo foot ulcer presentation in the primary care setting. METHODS Data were available on 15 727 individuals without foot ulcers and 1125 individuals with new foot ulcers over a 12-year follow-up in UK primary care. We examined known risk factors and added putative risk factors in our logistic model. RESULTS People with foot ulcers were 4.2 years older (95% CI 3.1-5.2) than those without, and had higher HbA1c % (mean 7.9 ± 1.9 vs 7.5 ± 1.7) / HbA1c mmol/mol (63 ± 21 vs 59 ± 19) (p<0.0001) concentration [+0.45 (95% CI 0.33-0.56), creatinine level [+6.9 μmol/L (95% CI 4.1-9.8)] and Townsend score [+0.055 (95% CI 0.033-0.077)]. Absence of monofilament sensation was more common in people with foot ulcers (28% vs 21%; P<0.0001), as was absence of foot pulses (6.4% vs 4.8%; P=0.017). There was no difference between people with or without foot ulcers in smoking status, gender, history of stroke or foot deformity, although foot deformity was extremely rare (0.4% in people with foot ulcers, 0.6% in people without foot ulcers). Combining risk factors in a single logistic regression model gave modest predictive power, with an area under the receiver-operating characteristic curve of 0.65 (95% CI 0.62-0.67). The prevalence of ulceration in the bottom decile of risk was 1.8% and in the top decile it was 13.4% (compared with an overall prevalence of 6.5%); thus, the presence of all six risk factors gave a relative risk of 7.4 for development of a foot ulcer over 12 years. CONCLUSION We have made some progress towards defining a variable set that can be used to create a foot ulcer prediction model. More accurate determination of foot deformity/pedal circulation in primary care may improve the predictive value of such a future risk model, as will identification of additional risk variables.
Collapse
Affiliation(s)
- A Heald
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford
| | - M Lunt
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester
| | - M K Rutter
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - S G Anderson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - G Cortes
- Medical Department, High Speciality Regional Hospital of Ixtapaluca, Mexico City, Mexico
| | - M Edmonds
- Department of Diabetes, Kings College Hospital, London
| | - E Jude
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme
| | - A Boulton
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - G Dunn
- East Cheshire Trust, Cheshire, UK
| |
Collapse
|
36
|
Wang H, Lane JM, Jones SE, Dashti HS, Ollila HM, Wood AR, van Hees VT, Brumpton B, Winsvold BS, Kantojärvi K, Palviainen T, Cade BE, Sofer T, Song Y, Patel K, Anderson SG, Bechtold DA, Bowden J, Emsley R, Kyle SD, Little MA, Loudon AS, Scheer FAJL, Purcell SM, Richmond RC, Spiegelhalder K, Tyrrell J, Zhu X, Hublin C, Kaprio JA, Kristiansson K, Sulkava S, Paunio T, Hveem K, Nielsen JB, Willer CJ, Zwart JA, Strand LB, Frayling TM, Ray D, Lawlor DA, Rutter MK, Weedon MN, Redline S, Saxena R. Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes. Nat Commun 2019; 10:3503. [PMID: 31409809 PMCID: PMC6692391 DOI: 10.1038/s41467-019-11456-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [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: 11/26/2018] [Accepted: 06/27/2019] [Indexed: 01/12/2023] Open
Abstract
Excessive daytime sleepiness (EDS) affects 10-20% of the population and is associated with substantial functional deficits. Here, we identify 42 loci for self-reported daytime sleepiness in GWAS of 452,071 individuals from the UK Biobank, with enrichment for genes expressed in brain tissues and in neuronal transmission pathways. We confirm the aggregate effect of a genetic risk score of 42 SNPs on daytime sleepiness in independent Scandinavian cohorts and on other sleep disorders (restless legs syndrome, insomnia) and sleep traits (duration, chronotype, accelerometer-derived sleep efficiency and daytime naps or inactivity). However, individual daytime sleepiness signals vary in their associations with objective short vs long sleep, and with markers of sleep continuity. The 42 sleepiness variants primarily cluster into two predominant composite biological subtypes - sleep propensity and sleep fragmentation. Shared genetic links are also seen with obesity, coronary heart disease, psychiatric diseases, cognitive traits and reproductive ageing.
Collapse
Affiliation(s)
- Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Jacqueline M Lane
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Samuel E Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Hassan S Dashti
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hanna M Ollila
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Ben Brumpton
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Department of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bendik S Winsvold
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Katri Kantojärvi
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Teemu Palviainen
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Yanwei Song
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Northeastern University College of Science, Boston, MA, USA
| | - Krunal Patel
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Northeastern University College of Science, Boston, MA, USA
| | - Simon G Anderson
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
| | - David A Bechtold
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jack Bowden
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Emsley
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Max A Little
- Department of Mathematics, Aston University, Birmingham, UK
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andrew S Loudon
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Shaun M Purcell
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kai Spiegelhalder
- Clinic for Psychiatry and Psychotherapy, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Christer Hublin
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaakko A Kaprio
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kati Kristiansson
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sonja Sulkava
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Paunio
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kristian Hveem
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Jonas B Nielsen
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Cristen J Willer
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - John-Anker Zwart
- Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Linn B Strand
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - David Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX39DU, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Martin K Rutter
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richa Saxena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
37
|
Anderson SG, Shoaib A, Myint PK, Cleland JG, Hardman SM, McDonagh TA, Dargie H, Keavney B, Garratt CJ, Mamas MA. Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit. Clin Res Cardiol 2019; 108:1276-1286. [PMID: 30963233 PMCID: PMC6805810 DOI: 10.1007/s00392-019-01463-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF. Methods Data were collected between April 2007 and March 2013 across 185 (> 95%) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge. Results Of 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95% CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95% CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years. Conclusion AF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes. Electronic supplementary material The online version of this article (10.1007/s00392-019-01463-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Department of Cardiology, North West Heart Centre, University Hospitals of South, Manchester, UK.,The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Bridgetown, Barbados
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, Scotland, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Suzanna M Hardman
- Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Theresa A McDonagh
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Henry Dargie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bernard Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Clifford J Garratt
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK.
| |
Collapse
|
38
|
Dashti HS, Jones SE, Wood AR, Lane JM, van Hees VT, Wang H, Rhodes JA, Song Y, Patel K, Anderson SG, Beaumont RN, Bechtold DA, Bowden J, Cade BE, Garaulet M, Kyle SD, Little MA, Loudon AS, Luik AI, Scheer FAJL, Spiegelhalder K, Tyrrell J, Gottlieb DJ, Tiemeier H, Ray DW, Purcell SM, Frayling TM, Redline S, Lawlor DA, Rutter MK, Weedon MN, Saxena R. Genome-wide association study identifies genetic loci for self-reported habitual sleep duration supported by accelerometer-derived estimates. Nat Commun 2019; 10:1100. [PMID: 30846698 PMCID: PMC6405943 DOI: 10.1038/s41467-019-08917-4] [Citation(s) in RCA: 297] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/31/2019] [Indexed: 12/22/2022] Open
Abstract
Sleep is an essential state of decreased activity and alertness but molecular factors regulating sleep duration remain unknown. Through genome-wide association analysis in 446,118 adults of European ancestry from the UK Biobank, we identify 78 loci for self-reported habitual sleep duration (p < 5 × 10−8; 43 loci at p < 6 × 10−9). Replication is observed for PAX8, VRK2, and FBXL12/UBL5/PIN1 loci in the CHARGE study (n = 47,180; p < 6.3 × 10−4), and 55 signals show sign-concordant effects. The 78 loci further associate with accelerometer-derived sleep duration, daytime inactivity, sleep efficiency and number of sleep bouts in secondary analysis (n = 85,499). Loci are enriched for pathways including striatum and subpallium development, mechanosensory response, dopamine binding, synaptic neurotransmission and plasticity, among others. Genetic correlation indicates shared links with anthropometric, cognitive, metabolic, and psychiatric traits and two-sample Mendelian randomization highlights a bidirectional causal link with schizophrenia. This work provides insights into the genetic basis for inter-individual variation in sleep duration implicating multiple biological pathways. Sleep is essential for homeostasis and insufficient or excessive sleep are associated with adverse outcomes. Here, the authors perform GWAS for self-reported habitual sleep duration in adults, supported by accelerometer-derived measures, and identify genetic correlation with psychiatric and metabolic traits
Collapse
Affiliation(s)
- Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.,Broad Institute, Cambridge, 02142, MA, USA
| | - Samuel E Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Jacqueline M Lane
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.,Broad Institute, Cambridge, 02142, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA
| | | | - Heming Wang
- Broad Institute, Cambridge, 02142, MA, USA.,Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, 02115, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, 02115, MA, USA
| | - Jessica A Rhodes
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.,Broad Institute, Cambridge, 02142, MA, USA
| | - Yanwei Song
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.,Northeastern University College of Science, 176 Mugar Life Sciences, 360 Huntington Avenue, Boston, MA, 02015, USA
| | - Krunal Patel
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.,Northeastern University College of Science, 176 Mugar Life Sciences, 360 Huntington Avenue, Boston, MA, 02015, USA
| | - Simon G Anderson
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - David A Bechtold
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Jack Bowden
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Brian E Cade
- Broad Institute, Cambridge, 02142, MA, USA.,Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, 02115, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, 02115, MA, USA
| | - Marta Garaulet
- Department of Physiology, University of Murcia, Murcia, 30100, Spain.,IMIB-Arrixaca, Murcia, 30120, Spain
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 7LF, UK
| | - Max A Little
- Department of Mathematics, Aston University, Birmingham, B4 7ET, UK.,Media Lab, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
| | - Andrew S Loudon
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 7LF, UK
| | - Frank A J L Scheer
- Broad Institute, Cambridge, 02142, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, 02115, MA, USA.,Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, 02115, MA, USA
| | - Kai Spiegelhalder
- Clinic for Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, 02115, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, 02115, MA, USA.,VA Boston Healthcare System, Boston, 02132, MA, USA
| | - Henning Tiemeier
- Deprtment of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, 02115, MA, USA.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, 3015, The Netherlands
| | - David W Ray
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Shaun M Purcell
- Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, 02115, Boston, MA, USA
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02115, MA, USA
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Martin K Rutter
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.,Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA. .,Broad Institute, Cambridge, 02142, MA, USA. .,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.
| |
Collapse
|
39
|
Lane JM, Jones SE, Dashti HS, Wood AR, Aragam KG, van Hees VT, Strand LB, Winsvold BS, Wang H, Bowden J, Song Y, Patel K, Anderson SG, Beaumont RN, Bechtold DA, Cade BE, Haas M, Kathiresan S, Little MA, Luik AI, Loudon AS, Purcell S, Richmond RC, Scheer FAJL, Schormair B, Tyrrell J, Winkelman JW, Winkelmann J, Hveem K, Zhao C, Nielsen JB, Willer CJ, Redline S, Spiegelhalder K, Kyle SD, Ray DW, Zwart JA, Brumpton B, Frayling TM, Lawlor DA, Rutter MK, Weedon MN, Saxena R. Biological and clinical insights from genetics of insomnia symptoms. Nat Genet 2019; 51:387-393. [PMID: 30804566 PMCID: PMC6415688 DOI: 10.1038/s41588-019-0361-7] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/25/2019] [Indexed: 11/09/2022]
Abstract
Insomnia is a common disorder linked with adverse long-term medical and psychiatric outcomes. The underlying pathophysiological processes and causal relationships of insomnia with disease are poorly understood. Here we identified 57 loci for self-reported insomnia symptoms in the UK Biobank (n = 453,379) and confirmed their effects on self-reported insomnia symptoms in the HUNT Study (n = 14,923 cases and 47,610 controls), physician-diagnosed insomnia in the Partners Biobank (n = 2,217 cases and 14,240 controls), and accelerometer-derived measures of sleep efficiency and sleep duration in the UK Biobank (n = 83,726). Our results suggest enrichment of genes involved in ubiquitin-mediated proteolysis and of genes expressed in multiple brain regions, skeletal muscle, and adrenal glands. Evidence of shared genetic factors was found between frequent insomnia symptoms and restless legs syndrome, aging, and cardiometabolic, behavioral, psychiatric, and reproductive traits. Evidence was found for a possible causal link between insomnia symptoms and coronary artery disease, depressive symptoms, and subjective well-being.
Collapse
Affiliation(s)
- Jacqueline M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Samuel E Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Krishna G Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Linn B Strand
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bendik S Winsvold
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- FORMI and Department of Neurology, Oslo University Hospital, Oslo, Norway
- Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Heming Wang
- Broad Institute, Cambridge, MA, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jack Bowden
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yanwei Song
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
- College of Science, Northeastern University, Boston, MA, USA
| | - Krunal Patel
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- College of Science, Northeastern University, Boston, MA, USA
| | - Simon G Anderson
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - David A Bechtold
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Brian E Cade
- Broad Institute, Cambridge, MA, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mary Haas
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Sekar Kathiresan
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Max A Little
- Department of Mathematics, Aston University, Birmingham, UK
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Andrew S Loudon
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaun Purcell
- Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca C Richmond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Frank A J L Scheer
- Broad Institute, Cambridge, MA, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Barbara Schormair
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Cluster for Systems Neurology (SyNergy), Munich, Germany
- Institute of Human Genetics, Technische Universität München, Munich, Germany
- Neurogenetics, Technische Universität München, Munich, Germany
| | - Kristian Hveem
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Chen Zhao
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jonas B Nielsen
- FORMI and Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Cristen J Willer
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kai Spiegelhalder
- Clinic for Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David W Ray
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX37LE/NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - John-Anker Zwart
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ben Brumpton
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Department of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Martin K Rutter
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Broad Institute, Cambridge, MA, USA.
| |
Collapse
|
40
|
Blackman DJ, Saraf S, MacCarthy PA, Myat A, Anderson SG, Malkin CJ, Cunnington MS, Somers K, Brennan P, Manoharan G, Parker J, Aldalati O, Brecker SJ, Dowling C, Hoole SP, Dorman S, Mullen M, Kennon S, Jerrum M, Chandrala P, Roberts DH, Tay J, Doshi SN, Ludman PF, Fairbairn TA, Crowe J, Levy RD, Banning AP, Ruparelia N, Spence MS, Hildick-Smith D. Long-Term Durability of Transcatheter Aortic Valve Prostheses. J Am Coll Cardiol 2019; 73:537-545. [DOI: 10.1016/j.jacc.2018.10.078] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
|
41
|
Heald AH, Livingston M, Fryer A, Cortes G, Anderson SG, Gadsby R, Laing I, Lunt M, Young RJ, Stedman M. Real-world practice level data analysis confirms link between variability within Blood Glucose Monitoring Strip (BGMS) and glycosylated haemoglobin (HbA1c) in Type 1 Diabetes. Int J Clin Pract 2018; 72:e13252. [PMID: 30168887 PMCID: PMC6766879 DOI: 10.1111/ijcp.13252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 01/06/2023] Open
Abstract
AIMS/HYPOTHESIS Our aim was to quantify the impact of Blood Glucose Monitoring Strips variability (BGMSV) at GP practice level on the variability of reported glycated haemoglobin (HbA1cV) levels. METHODS Overall GP Practice BGMSV and HbA1cV were calculated from the quantity of main types of BGMS being prescribed combined with the published accuracy, as % results within ±% bands from reference value for the selected strip type. The regression coefficient between the BGMSV and HbA1cV was calculated. To allow for the aggregation of estimated three tests/day over 13 weeks (ie, 300 samples) of actual Blood Glucose (BG) values up to the HbA1c, we multiplied HbA1cV coefficient by √300 to estimate an empirical value for impact of BGMSV on BGV. RESULTS Four thousand five hundred and twenty-four practice years with 159 700 T1DM patient years where accuracy data were available for more than 80% of strips prescribed were included, with overall BGMSV 6.5% and HbA1c mean of 66.9 mmol/mol (8.3%) with variability of 13 mmol/mol equal to 19% of the mean. At a GP practice level, BGMSV and HbA1cV as % of mean HbA1c (in other words, the spread of HbA1c) were closely related with a regression coefficient of 0.176, P < 0.001. Thus, greater variability in the BGMS at a GP practice level resulted in a greater spread of HbA1C readings in T1DM patients. Applying this factor for BGMS to the national ISO accepted standard where 95% results must be ≤±15% from reference, revealed that for BG, 95% results would be ≤±45% from the reference value. Thus, the variation in BG is three times that of the BGMS. For a patient with BG target @10 mmol/L using the worst performing ISO standard strips, on 1/20 occasions (average 1/week) actual blood glucose value could be >±4.5 mmol/L from target, compared with the best performing BGMS with BG >±2.2 mmol/L from reference on 1/20 occasions. CONCLUSION Use of more variable/less accurate BGMS is associated both theoretically and in practice with a larger variability in measured BG and HbA1c, with implications for patient confidence in their day-to-day monitoring experience.
Collapse
Affiliation(s)
- Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
| | | | - Anthony Fryer
- Institute for Applied Clinical SciencesKeele UniversityKeeleUK
| | - Gabriela Cortes
- Head of Medical DepartmentHigh Speciality Regional Hospital of IxtapalucaMexico CityMexico
| | - Simon G. Anderson
- Institute of Cardiovascular SciencesUniversity of ManchesterManchesterUK
| | - Roger Gadsby
- Warwick Medical SchoolUniversity of WarwickWiltshireUK
| | - Ian Laing
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
| | - Mark Lunt
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | | | | |
Collapse
|
42
|
Anderson SG, Contractor H, Saluja S, Sarma J, Garg S. 6130Next generation P2Y12 inhibitors improve survival in ACS: An analysis from the British Cardiovascular Intervention Society database. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6130] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- S G Anderson
- University of Manchester, Institute of Cardiovascular Sciences, Manchester, United Kingdom
| | - H Contractor
- University Hospital of South Manchester NHS Foundation Trust, North West Heart Centre, Manchester, United Kingdom
| | - S Saluja
- University of Manchester, Institute of Cardiovascular Sciences, Manchester, United Kingdom
| | - J Sarma
- University Hospital of South Manchester NHS Foundation Trust, North West Heart Centre, Manchester, United Kingdom
| | - S Garg
- Royal Blackburn Hospital, Blackburn, United Kingdom
| |
Collapse
|
43
|
Anderson SG, Shoaib A, Myint P, Cleland J, Hardman SM, McDonagh T, Keavney B, Garratt CJ, Mamas M. P6545Does rhythm matter in acute heart failure? An insight into clinical outcomes from the British Society for Heart Failure national audit. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6545] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- S G Anderson
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
| | - A Shoaib
- University of Keele, Keele Cardiovascular Research Group, Keele, United Kingdom
| | - P Myint
- University of Aberdeen, Institute of Applied Health Sciences, Aberdeen, United Kingdom
| | - J Cleland
- University of Glasgow, Robertson Centre for Biostatistics and Clinical Trials, Glasgow, United Kingdom
| | - S M Hardman
- Whittington Hospital, Clinical & Academic Department of Cardiovascular Medicine, London, United Kingdom
| | - T McDonagh
- King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - B Keavney
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
| | - C J Garratt
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
| | - M Mamas
- University of Keele, Keele Cardiovascular Research Group, Keele, United Kingdom
| |
Collapse
|
44
|
Heald AH, Fryer AA, Anderson SG, Livingston M, Lunt M, Davies M, Moreno GYC, Gadsby R, Young RJ, Stedman M. Sodium-glucose co-transporter-2 inhibitors, the latest residents on the block: Impact on glycaemic control at a general practice level in England. Diabetes Obes Metab 2018. [PMID: 29516618 DOI: 10.1111/dom.13281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine, using published general practice-level data, how differences in Type 2 diabetes mellitus (T2DM) prescribing patterns relate to glycaemic target achievement levels. METHODS Multiple linear regression modelling was used to link practice characteristics and defined daily dose (DDD) of different classes of medication in 2015/2016 and changes between that year and the year 2014/2015 in medication to proportion of patients achieving target glycaemic control (glycated haemoglobin A1c [HbA1c] ≤58 mmol/mol [7.5%]) and proportion of patients at high glycaemic risk (HbA1c >86 mmol/mol [10.0%]) for practices in the National Diabetes Audit with >100 people with T2DM on their register. RESULTS Overall, HbA1c outcomes were not different between the years studied. Although, in percentage terms, most practices increased their use of sodium-glucose co-transporter-2 (SGLT2) inhibitors (96%), dipeptidyl peptidase-4 (DPP-4) inhibitors (76%) and glucagon-like peptide 1 (GLP-1) analogues (53%), there was wide variation in the use of older and newer therapies. For example, 12% of practices used >200% of the national average for some newer agents. In cross-sectional analysis, greater prescribing of metformin and analogue insulin were associated with a higher proportion of patients achieving HbA1c ≤58 mmol/mol; the use of SGLT2 inhibitors and metformin was associated with a reduced proportion of patients with HbA1c >86 mol/mol; otherwise associations for sulphonylureas, GLP-1 analogues, SGLT2 inhibitors and DPP-4 inhibitors were neutral or negative. In year-on-year analysis there was ongoing deterioration in glycaemic control, which was offset to some extent by increased use of SGLT2 inhibitors and GLP-1 analogues, which were associated with a greater proportion of patients achieving HbA1c levels ≤58 mmol/mol and a smaller proportion of patients with HbA1c levels >86 mmol/mol. SGLT2 inhibitor prescribing was associated with significantly greater improvements than those found for GLP-1 analogues. CONCLUSION Greater use of newer agents was associated with improvement in glycaemic outcomes but was not sufficient to compensate for the prevailing decline. This may reflect wide variability in the prescribing of newer agents. We found that SGLT inhibitors may be superior to other oral agents in relation to HbA1c outcome. Serious consideration should be given to their use.
Collapse
Affiliation(s)
- Adrian H Heald
- School of Medicine Sciences and Manchester, Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | | | - Simon G Anderson
- School of Medicine Sciences and Manchester, Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Mark Lunt
- School of Medicine Sciences and Manchester, Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Gabriela Y C Moreno
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
- High Specialty Regional Hospital of Ixtapaluca, Mexico City, Mexico
| | - Roger Gadsby
- Warwick Medical School, University of Warwick, Warwick, UK
- National Diabetes Audit, London, UK
| | | | | |
Collapse
|
45
|
Emdin CA, Anderson SG, Salimi-Khorshidi G, Woodward M, MacMahon S, Dwyer T, Rahimi K. Usual blood pressure, atrial fibrillation and vascular risk: evidence from 4.3 million adults. Int J Epidemiol 2018; 46:162-172. [PMID: 27143136 PMCID: PMC5407172 DOI: 10.1093/ije/dyw053] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Although elevated blood pressure is associated with an increased risk of atrial fibrillation (AF), it is unclear if this association varies by individual characteristics. Furthermore, the associations between AF and a range of different vascular events are yet to be reliably quantified. Methods: Using linked electronic health records, we examined the time to first diagnosis of AF and time to first diagnosis of nine vascular events in a cohort of 4.3 million adults, aged 30 to 90 years, in the UK. Results: A 20-mmHg higher usual systolic blood pressure was associated with a higher risk of AF [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.19, 1.22]. The strength of the association declined with increasing age, from an HR of 1.91 (CI 1.75, 2.09) at age 30-40 to an HR of 1.01 (CI 0.97, 1.04) at age 80-90 years. AF without antithrombotic use at baseline was associated with a greater risk of any vascular event than AF with antithrombotic usage (P interaction < 0.0001). AF without baseline antithrombotic usage was associated with an increased risk of ischaemic heart disease (HR 2.52, CI 2.23, 2.84), heart failure (HR 3.80, CI 3.50, 4.12), ischaemic stroke (HR 2.72, CI 2.19, 3.38), unspecified stroke (HR 2.59, CI 2.25, 2.99), haemorrhagic stroke, chronic kidney disease, peripheral arterial disease and vascular dementia, but not aortic aneurysm. Conclusions: The association between elevated blood pressure and AF attenuates with increasing age. AF without antithrombotic usage is associated with an increased risk of eight vascular events.
Collapse
Affiliation(s)
- Connor A Emdin
- George Institute for Global Health, University of Oxford, Oxford, UK
| | - Simon G Anderson
- George Institute for Global Health, University of Oxford, Oxford, UK.,Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, NH, USA
| | | | - Mark Woodward
- George Institute for Global Health, University of Oxford, Oxford, UK.,George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore,MD, USA
| | - Stephen MacMahon
- George Institute for Global Health, University of Oxford, Oxford, UK.,George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Terrence Dwyer
- George Institute for Global Health, University of Oxford, Oxford, UK
| | - Kazem Rahimi
- George Institute for Global Health, University of Oxford, Oxford, UK.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
46
|
Vetter C, Dashti HS, Lane JM, Anderson SG, Schernhammer ES, Rutter MK, Saxena R, Scheer FAJL. Night Shift Work, Genetic Risk, and Type 2 Diabetes in the UK Biobank. Diabetes Care 2018; 41:762-769. [PMID: 29440150 PMCID: PMC5860836 DOI: 10.2337/dc17-1933] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/02/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the effects of past and current night shift work and genetic type 2 diabetes vulnerability on type 2 diabetes odds. RESEARCH DESIGN AND METHODS In the UK Biobank, we examined associations of current (N = 272,214) and lifetime (N = 70,480) night shift work exposure with type 2 diabetes risk (6,770 and 1,191 prevalent cases, respectively). For 180,704 and 44,141 unrelated participants of European ancestry (4,002 and 726 cases, respectively) with genetic data, we assessed whether shift work exposure modified the relationship between a genetic risk score (comprising 110 single-nucleotide polymorphisms) for type 2 diabetes and prevalent diabetes. RESULTS Compared with day workers, all current night shift workers were at higher multivariable-adjusted odds for type 2 diabetes (none or rare night shifts: odds ratio [OR] 1.15 [95% CI 1.05-1.26]; some nights: OR 1.18 [95% CI 1.05-1.32]; and usual nights: OR 1.44 [95% CI 1.19-1.73]), except current permanent night shift workers (OR 1.09 [95% CI 0.93-1.27]). Considering a person's lifetime work schedule and compared with never shift workers, working more night shifts per month was associated with higher type 2 diabetes odds (<3/month: OR 1.24 [95% CI 0.90-1.68]; 3-8/month: OR 1.11 [95% CI 0.90-1.37]; and >8/month: OR 1.36 [95% CI 1.14-1.62]; Ptrend = 0.001). The association between genetic type 2 diabetes predisposition and type 2 diabetes odds was not modified by shift work exposure. CONCLUSIONS Our findings show that night shift work, especially rotating shift work including night shifts, is associated with higher type 2 diabetes odds and that the number of night shifts worked per month appears most relevant for type 2 diabetes odds. Also, shift work exposure does not modify genetic risk for type 2 diabetes, a novel finding that warrants replication.
Collapse
Affiliation(s)
- Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO .,Broad Institute of MIT and Harvard, Cambridge, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston and Harvard Medical School, Boston, MA
| | - Hassan S Dashti
- Broad Institute of MIT and Harvard, Cambridge, MA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Jacqueline M Lane
- Broad Institute of MIT and Harvard, Cambridge, MA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Simon G Anderson
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, U.K.,Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston and Harvard Medical School, Boston, MA.,Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Martin K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, U.K.,Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Richa Saxena
- Broad Institute of MIT and Harvard, Cambridge, MA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Frank A J L Scheer
- Broad Institute of MIT and Harvard, Cambridge, MA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
47
|
Anderson SG, Shoo H, Saluja S, Anderson CD, Khan A, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort. Diabetologia 2018; 61:959-967. [PMID: 29264632 PMCID: PMC6448990 DOI: 10.1007/s00125-017-4522-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. METHODS This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. RESULTS The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age- and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR 1.72 [95% CI 1.56, 1.90], p < 0.001) increased risk of mortality in those with type 2 diabetes. Risk of death increased by 14% per quintile of deprivation in a univariable analysis (HR 1.14 [95% CI 1.10, 1.17]). In multivariable Cox regression analyses, there was a 48% increased risk of mortality in individuals with a foot ulcer (HR 1.48 [95% CI 1.33, 1.66]) independent of the Townsend index score (HR 1.13 [95% CI 1.10, 1.17], per quintile), baseline age, sex, diabetes type, smoking status, hypertension, statin use, β-blocker use, metformin use, HbA1c levels and insulin use. CONCLUSIONS/INTERPRETATION This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.
Collapse
Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | - Haika Shoo
- Diabetes and Endocrine Department, East Cheshire NHS Trust, Macclesfield, UK
| | - Sushant Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Endocrinology and Diabetes, Leighton Hospital, Crewe, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Edward B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - George Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - Adrian H Heald
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Stott Lane, Salford, UK.
- School of Medical Sciences, Faculty of Biology, Medicine, and Health, and Manchester Academic Health Science Centre (MAHSC), The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
| |
Collapse
|
48
|
Kyle SD, Sexton CE, Feige B, Luik AI, Lane J, Saxena R, Anderson SG, Bechtold DA, Dixon W, Little MA, Ray D, Riemann D, Espie CA, Rutter MK, Spiegelhalder K. Sleep and cognitive performance: cross-sectional associations in the UK Biobank. Sleep Med 2017; 38:85-91. [PMID: 29031762 DOI: 10.1016/j.sleep.2017.07.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The relationship between insomnia symptoms and cognitive performance is unclear, particularly at the population level. We conducted the largest examination of this association to date through analysis of the UK Biobank, a large population-based sample of adults aged 40-69 years. We also sought to determine associations between cognitive performance and self-reported chronotype, sleep medication use and sleep duration. METHODS This cross-sectional, population-based study involved 477,529 participants, comprising 133,314 patients with frequent insomnia symptoms (age: 57.4 ± 7.7 years; 62.1% female) and 344,215 controls without insomnia symptoms (age: 56.1 ± 8.2 years; 52.0% female). Cognitive performance was assessed by a touchscreen test battery probing reasoning, basic reaction time, numeric memory, visual memory, and prospective memory. Adjusted models included relevant demographic, clinical, and sleep variables. RESULTS Frequent insomnia symptoms were associated with cognitive impairment in unadjusted models; however, these effects were reversed after full adjustment, leaving those with frequent insomnia symptoms showing statistically better cognitive performance over those without. Relative to intermediate chronotype, evening chronotype was associated with superior task performance, while morning chronotype was associated with the poorest performance. Sleep medication use and both long (>9 h) and short (<7 h) sleep durations were associated with impaired performance. CONCLUSIONS Our results suggest that after adjustment for potential confounding variables, frequent insomnia symptoms may be associated with a small statistical advantage, which is unlikely to be clinically meaningful, on simple neurocognitive tasks. Further work is required to examine the mechanistic underpinnings of an apparent evening chronotype advantage in cognitive performance and the impairment associated with morning chronotype, sleep medication use, and sleep duration extremes.
Collapse
Affiliation(s)
- Simon D Kyle
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
| | - Claire E Sexton
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - Bernd Feige
- Clinic for Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Jacqueline Lane
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Richa Saxena
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA; Department of Anesthesia, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Simon G Anderson
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - David A Bechtold
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - William Dixon
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - Max A Little
- Engineering and Applied Science, Aston University, Birmingham, UK; Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David Ray
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, UK
| | - Dieter Riemann
- Clinic for Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Martin K Rutter
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, UK; Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kai Spiegelhalder
- Clinic for Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
49
|
Vetter C, Dashti HS, Lane JM, Anderson SG, Schernhammer ES, Rutter MK, Saxena R, Scheer FA. 1013 SHIFT WORK, CHRONOTYPE, AND TYPE 2 DIABETES IN THE UK BIOBANK AND TYPE 2 DIABETES IN THE UK BIOBANK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1012] [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: 11/14/2022] Open
|
50
|
Heald AH, Anderson SG, Scargill JJ, Short A, Holland D, Khan A, Fryer AA, Donn RP, Livingston M. Social Disadvantage Is Associated With Lower Vitamin D Levels in Older People and There Is No Surrogate for Its Measurement. Gerontol Geriatr Med 2017; 3:2333721417697843. [PMID: 28491910 PMCID: PMC5406141 DOI: 10.1177/2333721417697843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/15/2016] [Accepted: 01/16/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction: There is increasing evidence concerning adverse health consequences of low vitamin D levels. We determined whether there is any surrogate for measuring vitamin D in people older than 70 years and the relation between index of multiple deprivation (IMD) and vitamin D levels. Methods: Blood samples from 241 patients were included in this analysis. Concurrent measurements for 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and bone profile are reported. Results: The prevalence of total vitamin D insufficiency/deficiency (defined as total vitamin D <50 nmol/L) was 57.5% overall. Even for patients with vitamin D deficiency, a significant proportion had PTH, normal calcium, phosphate, and alkaline phosphatase levels. For patients with vitamin D <25 nmol/L, 62.7% had a PTH within reference range, 83.1% had normal serum-adjusted calcium, 80.6% had normal phosphate, and 85.1% had a normal serum alkaline phosphatase. With increasing quintiles of IMD, there was a 22% increased risk of vitamin D deficiency/insufficiency from quintiles 1 to 5, in age- and sex-adjusted logistic regression models (odds ratio [OR] = 1.22, 95% confidence interval [1.01, 1.47]; p = .034). Conclusion: No other parameter is currently adequate for screening for vitamin D deficiency in older people. A higher IMD is associated with lower vitamin D levels in older people.
Collapse
Affiliation(s)
- Adrian H Heald
- The University of Manchester, UK.,Leighton Hospital, Crewe, UK.,Salford Royal NHS Foundation Trust, UK
| | | | | | | | | | | | | | | | | |
Collapse
|