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Tchouaket E, Kruglova K, Sieleunou I, Tsafack M, Tankwa JM, Takoguen G, Argiropoulos N, Robins S, Sia D. Knowledge, attitude, and practices of stakeholders involved in healthcare financing programs on economic evaluations in Cameroon. PLOS Glob Public Health 2024; 4:e0003101. [PMID: 38662686 PMCID: PMC11045103 DOI: 10.1371/journal.pgph.0003101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
There are many healthcare financing programs (HFPs) in Cameroon; however, there is a lack of information on these programs' economic effectiveness and efficiency. Involvement of local stakeholders in the economic evaluations (EEs) of HFPs is critical for ensuring contextual factors are considered prior to program implementation. We conducted a cross-sectional study to assess the need for EEs of Cameroonian HFPs. Regular staff in supervisory roles aged 18 years and above were recruited in four Cameroonian cities. Data were collected via face-to-face surveys between June 15 and August 1, 2022. Descriptive analyses summarized participants' knowledge, attitudes, and practices in relation to performing EEs of HFPs. Principal component analyses identified organizational, individual, and contextual factors that could influence participants' involvement. The total sample included 106 participants. On average, 65% of participants reported being aware of the listed HFPs; however, of these, only 28% said that they had been involved in the HFPs. Of the 106 participants, 57.5% knew about EEs; yet, almost 90% reported that the HFP in question had never been subject to an EE, and 84% had never been involved in an EE. Most participants indicated that they had intended or would like to receive EE training. Using principal component analyses, the organizational factors were classified into two components ('policy and governance' and 'planning and implementation'), the individual factors were classified into two components ('training' and 'motivation'), and the contextual factors were classified into three components ('funding,' 'political economy,' and 'public expectations'). The findings of this study highlight the need to invest in EE training to improve participation rates of Cameroonian stakeholders in the EEs of HFPs. Improved knowledge, diversified skills, and increased participation of stakeholders from all levels of the Cameroonian healthcare system are critical to the effective and efficient development, implementation, and EE of the country's HFPs.
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Affiliation(s)
- Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | | | | | | | | | - Nikolas Argiropoulos
- Department of Mathematics and Statistics, Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
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Tchouaket É, Sia D, Karemere H, Kapiteni W, Robins S. Economic analysis of a health system strengthening program in the Democratic Republic of the Congo. Sante Publique 2024; 36:135-149. [PMID: 38580462 DOI: 10.3917/spub.241.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Due to the Democratic Republic of the Congo’s (DRC) precarious health system that provides only limited access to health care, the European Union, via Memisa Belgium, implemented a program to strengthen provision of and access to health care (known as PRO DS) in the provinces of Kongo Central and Ituri. This program took a holistic approach, seeking to improve equitable access and combat malnutrition. METHODS To measure the program’s social return on investment and to estimate the cost per capita and effectiveness per euro invested (efficiency), a 61-month (1 July 2017 to 31 July 2022) cost-effectiveness evaluation with a societal perspective was carried out. The double-difference method was used to compare the results of PRO DS and non-PRO DS zones. The social return on investment was assessed via the ratio of effectiveness to costs. RESULTS Analyses revealed the program cost between 3.72 and 3.96 euros per capita per year (2022) in Kongo Central, and between 3.12 and 3.36 euros in Ituri. Importantly, it was cost-effective in the areas of reproductive health, nutrition, and the use of health and nutrition services. CONCLUSIONS The program’s strong nutritional component and overall holistic vision may explain why it was so efficient. PRO DS stands out from other programs that focus solely on one specific problem or population. Although the program has some limitations, it would be worthwhile for the government to invest in it.
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Affiliation(s)
- Éric Tchouaket
- Université du Québec en Outaouais, Sciences infirmières, Saint-Jérôme, Canada
| | - Drissa Sia
- Université du Québec en Outaouais, Sciences infirmières, Saint-Jérôme, Canada
| | - Hermès Karemere
- Catholic University of Bukavu, Regional School of Public Health, Bukavu, République démocratique du Congo
| | - Woolf Kapiteni
- University of Lubumbashi and Kirotshe Higher Institute of Medical Technique, Lubumbashi, République démocratique du Congo
| | - Stephanie Robins
- Université du Québec en Outaouais, Sciences infirmières, Saint-Jérôme, Canada
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Sawadogo PM, Sia D, Onadja Y, Beogo I, Sangli G, Sawadogo N, Gnambani A, Bassinga G, Robins S, Tchouaket Nguemeleu E. Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review. PLoS One 2023; 18:e0291486. [PMID: 37708137 PMCID: PMC10501608 DOI: 10.1371/journal.pone.0291486] [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] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Migrant, internally displaced, asylum seeking and refugee women experience ongoing risks of having their reproductive healthcare rights violated. This ever-increasing population also has limited access to sexual and reproductive health services. We conducted a scoping review to identify the barriers and facilitating factors when accessing sexual and reproductive health services for this specific population. METHODS We searched the grey literature and queried eight bibliographic databases (Embase, Medline, Cinahl, Scopus, Science Direct, Web of Science, Hinari, and Cochrane Library) to extract articles published between January, 2000, and October, 2021. The extracted data were organized in a framework adapted from Peters et al. and then categorized as facilitators or barriers. We followed the Arksey and O'Malley framework and wrote the report according to the PRISMA-Scr recommendations. RESULTS The search identified 4,722 records of which forty-two (42) met eligibility criteria and were retained for analysis. Ten (10) groups of factors facilitating and/or limiting access to sexual and reproductive health care emerged from the synthesis of the retained articles. The main barriers were lack of knowledge about services, cultural unacceptability of services, financial inaccessibility, and language barriers between patients and healthcare providers. Facilitators included mobile applications for translation and telehealth consultations, patients having a wide availability of information sources, the availability health promotion representatives, and healthcare providers being trained in cultural sensitivity, communication and person-centered care. CONCLUSION Ensuring the sexual and reproductive rights of migrant, internally displaced, asylum-seeking and refugee women requires that policymakers and health authorities develop intervention strategies based on barriers and facilitators identified in this scoping review. Therefore, considering their mental health in future studies would enable a better understanding of the barriers and facilitators of access to sexual and reproductive health services.
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Affiliation(s)
- Pengdewendé Maurice Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Drissa Sia
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Idrissa Beogo
- École des Sciences Infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Sangli
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Assé Gnambani
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Gaëtan Bassinga
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Stephanie Robins
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Eric Tchouaket Nguemeleu
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
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Tchouaket EN, Kruglova K, Beogo I, Sia D, Robins S, Bélanger E, Jubinville M, Séguin C, Kilpatrick K, Boivin S, Létourneau J. Economic evaluation of healthcare-associated infection prevention and control in long-term care: a systematic review protocol. Syst Rev 2022; 11:261. [PMID: 36463274 PMCID: PMC9719189 DOI: 10.1186/s13643-022-02128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Given the high risk of contracting a healthcare-associated infection in long-term care facilities, infection prevention and control are essential for the quality of care and safety of residents and staff. To develop more effective infection prevention and control interventions in long-term care facilities, it is important to assess the cost-effectiveness and cost-benefit of existing interventions. There are only a few reviews on this subject, but these are not recent and most do not perform an economic evaluation. Moreover, none uses a discounting approach which limits inter-study comparison. To address these gaps, we will conduct a systematic review of economic evaluations related to healthcare-associated infection prevention and control in long-term care facilities using a discounting approach. METHODS We will query MEDLINE, Embase, Web of Science, Cochrane, CINAHL, EconLit, JSTOR, and Scopus, as well as the gray literature databases CORDIS and ProQuest. We will include quantitative studies that evaluate four clinical best practices associated with infection prevention and control (hand hygiene, hygiene and sanitation, screening, basic, and additional precautions) and use at least one of five economic analyses (cost-effectiveness, cost-benefit, cost-minimization, cost-utility, cost-consequences). Primary outcomes will include net cost savings, incremental cost-effectiveness ratio, incremental cost per quality-adjusted life year, and incremental cost per disability-adjusted life year. Two co-authors will independently screen and select articles, extract data, and assess the quality of selected articles using the Scottish Intercollegiate Guidelines Network criteria, the Economic Evaluation criteria, and the Cochrane criteria for economic evaluation. Extracted data will be synthesized, and values will be adjusted to 2022 Canadian dollars using the discount rates of 3%, 5%, and 8%. DISCUSSION Information obtained through this systematic review may help researchers and policy makers make more efficient use of limited healthcare resources to ensure the safety and quality of long-term care. SYSTEMATIC REVIEW REGISTRATION Research registry ID: reviewregistry1210.
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Affiliation(s)
- Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada.
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Catherine Séguin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Sandra Boivin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
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Létourneau J, Bélanger E, Sia D, Beogo I, Robins S, Kruglova K, Jubinville M, Tchouaket EN. Identifying performance factors of long-term care facilities in the context of the COVID-19 pandemic: a scoping review protocol. Syst Rev 2022; 11:203. [PMID: 36151556 PMCID: PMC9502645 DOI: 10.1186/s13643-022-02069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) have been severely affected by the COVID-19 pandemic with serious consequences for the residents. Some LTCFs performed better than others, experiencing lower case and death rates due to COVID-19. A comprehensive understanding of the factors that have affected the transmission of COVID-19 in LTCFs is lacking, as no published studies have applied a multidimensional conceptual framework to evaluate the performance of LTCFs during the pandemic. Much research has focused on infection prevention and control strategies or specific disease outcomes (e.g., death rates). To address these gaps, our scoping review will identify and analyze the performance factors that have influenced the management of COVID-19 in LTCFs by adopting a multidimensional conceptual framework. METHODS We will query the CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, and Web of Science databases for peer-reviewed articles written in English or French and published between January 1, 2020 and December 31, 2021. We will include articles that focus on the specified context (COVID-19), population (LTCFs), interest (facilitators and barriers to performance of LTCFs), and outcomes (dimensions of performance according to a modified version of the Ministère de la santé et des services sociaux du Québec conceptual framework). Each article will be screened by at least two co-authors independently followed by data extraction of the included articles by one co-author and a review by the principal investigator. RESULTS We will present the results both narratively and with visual aids (e.g., flowcharts, tables, conceptual maps). DISCUSSION Our scoping review will provide a comprehensive understanding of the factors that have affected the performance of LTCFs during the COVID-19 pandemic. This knowledge can help inform the development of more effective infection prevention and control measures for future pandemics and outbreaks. The results of our review may lead to improvements in the care and safety of LTCF residents and staff. SCOPING REVIEW REGISTRATION: Research Registry researchregistry7026.
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Affiliation(s)
- Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada.
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Lebel V, Argiropoulos N, Robins S, Charbonneau L, Feeley N. Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit. Acta Paediatr 2022; 111:2299-2306. [PMID: 36057447 DOI: 10.1111/apa.16538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
AIM We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). METHODS This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. RESULTS The infants were born at a mean age of 29.8 ±3.1 weeks. Greater family-centred care during early hospitalisation (p=0.01) and greater breastfeeding self-efficacy in the period before discharge (p=0.04) were significantly associated with higher readiness for discharge. The unit design was not a significantly associated with readiness for discharge. CONCLUSION The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.
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Affiliation(s)
- Valérie Lebel
- Nursing Department, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Nikolas Argiropoulos
- Centre for Nursing Research & Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Stephanie Robins
- Nursing Department, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Lyne Charbonneau
- Department of Nursing, Jewish General Hospital, Montreal, Québec, Canada
| | - Nancy Feeley
- Centre for Nursing Research & Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada.,Ingram School of Nursing, McGill University, Montreal, Québec, Canada
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Lebel V, Feeley N, Robins S, Stremler R. Factors Influencing Mothers' Quality of Sleep during Their Infants' NICU Hospitalization. Behav Sleep Med 2022; 20:610-621. [PMID: 34472406 DOI: 10.1080/15402002.2021.1971985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVES The purpose of this study is to identify factors associated with Neonatal Intensive Care Unit (NICU) mothers' quality of sleep as measured with the General Sleep Disturbance Scale (GSDS). METHODS Recruitment took place in a level 3 NICU. At enrollment, mothers completed a socio-demographic questionnaire, described their presence in the unit and their breast milk expression behavior. They also completed online or paper questionnaires about NICU-related stress, symptoms of postpartum depression, family-centered care, perception of noise and light in the unit, and sleep disturbances. Data regarding the infant's clinical condition were collected from their medical file. Pearson correlations were performed to identify associations between mothers' quality of sleep and other study variables. Subsequently, to compare mothers with a clinically significant GSDS score to mothers with a non-significant score, a binary logistic regression model was conducted. RESULTS 132 mothers participated. Sleep disturbances of mothers with an infant hospitalized in the NICU was positively correlated with stress (r = 0.40; p = .00), depressive symptoms (r = 0.51; p = .00), and breast milk expression (r = 0.23; p = .01). In addition, for mothers with significant levels of depressive symptoms (OR = 1.19; p = .00), with greater presence in the unit (OR = 1.36; p = .04), or with other children at home (OR = 3.12; p = .04), the likelihood of clinically significant sleep disturbances was increased. CONCLUSIONS These results improve our understanding of the factors influencing the quality of sleep of mothers whose premature infant is hospitalized for 2 weeks or more in the NICU. In addition, these results allow the identification of mothers having a higher possibility for sleep disturbance, which enables the implementation of targeted interventions to promote adequate sleep.
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Affiliation(s)
- Valérie Lebel
- Department of Nursing Science, University of Turku, Turku, Finland.,Université Du Québec En Outaouais, Québec, Canada
| | - Nancy Feeley
- McGill University, Ingram School of NursingMontreal,QCCanada
| | | | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoToronto, ON, Canada
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Mignault A, Tchouaket Nguemeleu É, Robins S, Maillet É, Matetsa E, Dupuis S. Correction: Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers’ Worries. JMIR Perioper Med 2022; 5:e41052. [PMID: 35839465 PMCID: PMC9338422 DOI: 10.2196/41052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandre Mignault
- Bloc OpératoireCentre hospitalier de l’Université de MontréalMontréal, QCCanada
| | | | - Stephanie Robins
- Département des sciences infirmièresUniversité du Québec en OutaouaisSt-Jérome, QCCanada
| | - Éric Maillet
- École des sciences infirmièresFaculté de médecine et des sciences de la santéUniversité de SherbrookeSherbrooke, QCCanada
| | - Edwige Matetsa
- Bloc OpératoireCentre hospitalier de l’Université de MontréalMontréal, QCCanada
| | - Stéphane Dupuis
- Bloc OpératoireCentre hospitalier de l’Université de MontréalMontréal, QCCanada
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Mignault A, Tchouaket Nguemeleu É, Robins S, Maillet É, Matetsa E, Dupuis S. Automated intra-operative SMS message updates: a quality improvement initiative to relieve caregivers’ worries (Preprint). JMIR Perioper Med 2022; 5:e36208. [PMID: 35436760 PMCID: PMC9084444 DOI: 10.2196/36208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 04/14/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Alexandre Mignault
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Stephanie Robins
- Département des sciences infirmières, Université du Québec en Outaouais, St-Jérome, QC, Canada
| | - Éric Maillet
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Edwige Matetsa
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stéphane Dupuis
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Sawadogo PM, Sia D, Nguemeleu ET, Kobiane JF, Onadja Y, Robins S. Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review. Pan Afr Med J 2022; 43:45. [DOI: 10.11604/pamj.2022.43.45.32820] [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] [Received: 12/15/2021] [Accepted: 09/11/2022] [Indexed: 11/11/2022] Open
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Miner SA, Gelgoot EN, Lahuec A, Wunderlich S, Safo D, Brochu F, Dawadi S, Robins S, Bernadette S, O’Connell L, Chan P, Ells C, Holzer H, Lo K, Mahutte N, Ouhilal S, Rosberger Z, Tulandi T, Zelkowitz P. “Who needs an app? Fertility patients’ use of a novel mobile health app”. Digit Health 2022; 8:20552076221102248. [PMID: 35646384 PMCID: PMC9131380 DOI: 10.1177/20552076221102248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The number of couples experiencing infertility treatment has increased, as has the number of women and men experiencing infertility treatment-related stress and anxiety. Therefore, there is a need to provide information and support to both men and women facing fertility concerns. To achieve this goal, we designed a mhealth app, Infotility, that provided men and women with tailored medical, psychosocial, lifestyle, and legal information. Methods This study specifically examined how fertility factors (e.g. time in infertility treatment, parity), socio-demographic characteristics (e.g. gender, education, immigrant status), and mental health characteristics (e.g. stress, depression, anxiety, fertility-related quality of life) were related to male and female fertility patients’ patterns of use of the Infotility app. Results Overall, the lifestyle section of the app was the most highly used section by both men and women. In addition, women without children and highly educated women were more likely to use Infotility. No demographic, mental health or fertility characteristics were significantly associated with app use for men. Conclusion This study shows the feasibility of a mhealth app to address the psychosocial and informational needs of fertility patients.
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Affiliation(s)
- Skye A Miner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Sociology, McGill University, Montreal, Canada
| | - Eden N Gelgoot
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Alix Lahuec
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Samantha Wunderlich
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Darryl Safo
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Felicia Brochu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Shrinkhala Dawadi
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Stephanie Robins
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | | | - Laura O’Connell
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Peter Chan
- McGill University Health Center, Montreal, Canada
| | - Carolyn Ells
- Department of Medicine McGill University, Montreal, Canada
| | - Hananel Holzer
- Department of Medicine McGill University, Montreal, Canada
| | - Kirk Lo
- Mount Sinai Hospital University of Toronto, Toronto, Canada
| | | | | | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Togas Tulandi
- Department of Medicine McGill University, Montreal, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
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12
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Hussain S, Robins S, Landon C. 280: Development of a pancreatic enzyme replacement therapy smart pill holder. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Kruglova K, Gelgoot EN, Chan P, Lo K, Rosberger Z, Bélanger E, Kazdan J, Robins S, Zelkowitz P. Risky Business: Increasing Fertility Knowledge of Men in the General Public Using the Mobile Health Application Infotility XY. Am J Mens Health 2021; 15:15579883211049027. [PMID: 34697968 PMCID: PMC8552396 DOI: 10.1177/15579883211049027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Male infertility presents a public health concern. As most men wish to become fathers, it is important to increase men’s awareness of infertility risk factors. We developed a mobile health application (mHealth app), Infotility XY, to promote men’s reproductive health. This study evaluates whether use of the app led to increased knowledge of infertility risk factors, and whether knowledge change was associated with participants’ sociodemographic characteristics and/or app usage. Participants were recruited between August and October 2020. Eligibility criteria included: identified as male; 18–45 years old; childless; no infertility history; able to read and write in English/French; had internet access. We assessed participants’ fertility knowledge before and after app use. App usage data were captured during the 2-week intervention period. Our sample included 49 men aged 18–45. Seventy-eight percent of participants had not previously sought fertility information. Participants viewed on average 75% of the app’s articles, and 96% of participants said the app increased their fertility knowledge. Before app use, 55% of men said they were aware of infertility risk factors, compared to 96% after app use. Men correctly identified more risk factors after app use compared to before, t(48) = 8.28, p < .001. Participants’ sociodemographic characteristics and amount of app usage were not associated with knowledge change. This study provides evidence of the feasibility of an mHealth app to improve men’s awareness of infertility risk factors. Given the positive relationship between male reproductive health and overall health, increased awareness of infertility risk factors may lead to men’s improved overall health.
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Affiliation(s)
- Katya Kruglova
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Eden Noah Gelgoot
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Peter Chan
- McGill University Health Centre, Montréal, QC, Canada.,Department of Surgery, McGill University, Montréal, QC, Canada
| | - Kirk Lo
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada.,Department of Psychology, McGill University, Montréal, QC, Canada.,Department of Oncology, McGill University, Montréal, QC, Canada
| | - Emilie Bélanger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Jordana Kazdan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Stephanie Robins
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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14
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Tchouaket Nguemeleu E, Robins S, Boivin S, Sia D, Kilpatrick K, Dubreuil B, Larouche C, Parisien N, Letourneau J. A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec. Antimicrob Resist Infect Control 2021; 10:150. [PMID: 34674758 PMCID: PMC8529371 DOI: 10.1186/s13756-021-01000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost–benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. Conclusions The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01000-y.
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Affiliation(s)
- Eric Tchouaket Nguemeleu
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada.
| | - Stephanie Robins
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada
| | - Sandra Boivin
- Centre Intégré de Santé et de Services Sociaux Des Laurentides, Direction de la Santé Publique, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - Bruno Dubreuil
- Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada
| | - Catherine Larouche
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Laval, Canada
| | - Natasha Parisien
- Institut National de Santé Publique du Québec, Quebec City, Québec, Canada
| | - Josiane Letourneau
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada
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15
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Kruglova K, O'Connell SBL, Dawadi S, Gelgoot EN, Miner SA, Robins S, Schinazi J, Zelkowitz P. An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study. JMIR Form Res 2021; 5:e28136. [PMID: 34636741 PMCID: PMC8548975 DOI: 10.2196/28136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 01/25/2023] Open
Abstract
Background The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public. Results This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps.
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Affiliation(s)
- Katya Kruglova
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Siobhan Bernadette Laura O'Connell
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Shrinkhala Dawadi
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Eden Noah Gelgoot
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Skye A Miner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Stephanie Robins
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Joy Schinazi
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Tchouaket Nguemeleu E, Boivin S, Robins S, Sia D, Kilpatrick K, Brousseau S, Dubreuil B, Larouche C, Parisien N. Development and validation of a time and motion guide to assess the costs of prevention and control interventions for nosocomial infections: A Delphi method among experts. PLoS One 2020; 15:e0242212. [PMID: 33180833 PMCID: PMC7660509 DOI: 10.1371/journal.pone.0242212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. OBJECTIVE To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. METHODS An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. RESULTS Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. DISCUSSION/CONCLUSION This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.
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Affiliation(s)
| | - Sandra Boivin
- Centre Intégré de Santé et de Services de Sociaux des Laurentides, Direction de la Santé Publique, Saint-Jérôme, Québec, Canada
| | - Stephanie Robins
- Université du Québec en Outaouais, Department of Nursing Research, Saint-Jérôme, QC, Canada
| | - Drissa Sia
- Université du Québec en Outaouais, Department of Nursing Research, Saint-Jérôme, QC, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Sylvain Brousseau
- Université du Québec en Outaouais, Department of Nursing Research, Saint-Jérôme, QC, Canada
| | - Bruno Dubreuil
- Institut de Cardiologie, Montreal Heart Institute, Montréal, Québec, Canada
| | - Catherine Larouche
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay, Lac-Saint-Jean, Québec, Canada
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Gelgoot EN, Kelly-Hedrick M, Miner SA, Robins S, Chan P, Ells C, Holzer H, Lo K, Mahutte N, Ouhilal S, Tulandi T, Zelkowitz P. Predictors of infertility-related concerns in a Canadian survey of men and women seeking fertility treatment. Patient Educ Couns 2020; 103:1812-1820. [PMID: 32273146 DOI: 10.1016/j.pec.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine if and how factors associated with infertility-related concerns and opportunity to discuss concerns differ between male and female fertility patients. METHODS A cross-sectional survey of 313 female and 254 male patients recruited from Canadian fertility clinics. An online survey asked about sociodemographic characteristics, psychological distress, the severity of psychosocial concerns on a scale of 0 (not concerned) to 5 (very concerned) related to fertility treatment, and their opportunity and desire to discuss concerns with healthcare providers (HCPs). RESULTS For women, higher stress, educational attainment and being childless were associated with higher concern (F(6, 287) = 14.73, p < .001). For men, higher stress, being religious and longer treatment duration were associated with higher concern (F(8, 222) = 9.87, p < .001). No significant difference existed between men's and women's average concern scores (t(558) = -1.62, p = .11) or opportunity to discuss concerns (t(149) = 0.28, p = .78). CONCLUSION Our results indicate an unmet need and desire for support among subgroups of patients who were concerned about psychosocial issues related to infertility, but did not have the opportunity to discuss these issues with HCPs. PRACTICE IMPLICATIONS There is a need to tailor resources to address the concerns of male and female fertility patients from diverse sociodemographic backgrounds and with different fertility histories.
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Affiliation(s)
- Eden Noah Gelgoot
- Department of Psychiatry, McGill University, Montréal, Canada; Department of Psychiatry, Jewish General Hospital, Montréal, Canada
| | - Margot Kelly-Hedrick
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Skye A Miner
- Department of Psychiatry, Jewish General Hospital, Montréal, Canada; Department of Sociology, McGill University, Montréal, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montréal, Canada; Lady Davis Institute for Medical Research, Montréal, Canada
| | - Peter Chan
- McGill University Health Centre, Montréal, Canada; Department of Surgery, McGill University, Montréal, Canada
| | - Carolyn Ells
- Lady Davis Institute for Medical Research, Montréal, Canada; Department of Medicine, Biomedical Ethics Unit, McGill University, Montréal, Canada
| | - Hananel Holzer
- McGill University Health Centre, Montréal, Canada; Department of Medicine, Biomedical Ethics Unit, McGill University, Montréal, Canada; Department of Obstetrics and Gynecology, McGill University, Montréal, Canada; Hebrew University School of Medicine, Jerusalem, Israel; Fertility Department, Obstetrics & Gynecology Division, Hadassah University Hospitals, Jerusalem, Israel
| | - Kirk Lo
- Department of Surgery, Mount Sinai Hospital, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | | | | | - Togas Tulandi
- McGill University Health Centre, Montréal, Canada; Department of Obstetrics and Gynecology, McGill University, Montréal, Canada; Department of Obstetrics and Gynecology, Jewish General Hospital, Montréal, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, McGill University, Montréal, Canada; Department of Psychiatry, Jewish General Hospital, Montréal, Canada; Lady Davis Institute for Medical Research, Montréal, Canada.
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18
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Solomonova E, MacKinnon AL, Gold I, Robins S, Wunderlich S, Feeley N, Hayton B, Libman E, Zelkowitz P. Disordered sleep is related to delusional ideation and depression during the perinatal period. Sleep Health 2020; 6:179-184. [DOI: 10.1016/j.sleh.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
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Feeley N, Robins S, Genest C, Stremler R, Zelkowitz P, Charbonneau L. A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design. BMC Pediatr 2020; 20:38. [PMID: 31996178 PMCID: PMC6988355 DOI: 10.1186/s12887-020-1929-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/23/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023] Open
Abstract
Background The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants. Purpose To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs. Methods A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge. Results Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy. At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education. Conclusions Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.
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Affiliation(s)
- Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, B- 621, Montréal, Québec, H3T 1E2, Canada. .,Ingram School of Nursing, McGill University, Montréal, Canada.
| | - Stephanie Robins
- Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte Ste-Catherine Road, Montreal, Quebec, H3T 1E4, Canada
| | - Christine Genest
- Faculty of Nursing, University of Montreal, 2375 Côte Ste-Catherine Road, Montréal, Québec, H3T 1A8, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital Senior Investigator, Lady Davis Institute for Medical Research, 4333 Côte Ste-Catherine Road, Montréal, Québec, H3T 1E4, Canada
| | - Lyne Charbonneau
- Neonatology, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, Montréal, Québec, H3T 1E2, Canada
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Lecompte V, Robins S, King L, Solomonova E, Khan N, Moss E, Nagy C, Feeley N, Gold I, Hayton B, Turecki G, Zelkowitz P. Examining the role of mother-child interactions and DNA methylation of the oxytocin receptor gene in understanding child controlling attachment behaviors. Attach Hum Dev 2020; 23:37-55. [DOI: 10.1080/14616734.2019.1708422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- V. Lecompte
- Institut Universitaire Jeunes en Difficulté, CIUSSS Centre-Sud-de-l’île-de-Montréal , Montreal, Canada
| | - S. Robins
- Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal, Canada
- Department of Psychiatry, Jewish General Hospital , Montreal, Canada
| | - L. King
- Department of Psychiatry, McGill University , Montreal, Canada
| | - E. Solomonova
- Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal, Canada
- Department of Psychiatry, Jewish General Hospital , Montreal, Canada
- Department of Psychiatry, McGill University , Montreal, Canada
| | - N. Khan
- Department of Medicine, McGill University , Montreal, Canada
| | - E. Moss
- Department of Psychology, Université du Québec à Montréal , Montréal, Canada
| | - C. Nagy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute , Montreal, Canada
| | - N. Feeley
- Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal, Canada
- Center for Nursing Research, Jewish General Hospital , Montreal, Canada
- Ingram School of Nursing, McGill University , Montreal, Canada
| | - I. Gold
- Department of Psychiatry, McGill University , Montreal, Canada
- Department of Philosophy, McGill University , Montreal, Canada
| | - B. Hayton
- Department of Psychiatry, Jewish General Hospital , Montreal, Canada
- Department of Psychiatry, McGill University , Montreal, Canada
| | - G. Turecki
- Department of Psychiatry, McGill University , Montreal, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute , Montreal, Canada
| | - P. Zelkowitz
- Lady Davis Institute for Medical Research, Jewish General Hospital , Montreal, Canada
- Department of Psychiatry, Jewish General Hospital , Montreal, Canada
- Department of Psychiatry, McGill University , Montreal, Canada
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21
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Brochu F, Robins S, Miner SA, Grunberg PH, Chan P, Lo K, Holzer HEG, Mahutte N, Ouhilal S, Tulandi T, Zelkowitz P. Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences. J Med Internet Res 2019; 21:e15132. [PMID: 31829963 PMCID: PMC6933516 DOI: 10.2196/15132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 01/30/2023] Open
Abstract
Background Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs. Objective The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients. Methods Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology. Results A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03). Conclusions This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients’ needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet.
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Affiliation(s)
- Felicia Brochu
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Skye A Miner
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Department of Sociology, McGill University, Montreal, QC, Canada
| | - Paul H Grunberg
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Peter Chan
- McGill University Health Center, Montreal, QC, Canada
| | - Kirk Lo
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Hananel E G Holzer
- McGill University Health Center, Montreal, QC, Canada.,Hadassah University Hospitals, Jerusalem, Israel.,Hebrew University, Jerusalem, Israel
| | | | | | - Togas Tulandi
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,McGill University Health Center, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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Solomonova E, MacKinnon A, Gold I, Robins S, Wunderlich S, Feeley N, Hayton B, Libman E, Zelkowitz P. Disordered sleep is associated with delusional ideation and depression during pregnancy and postpartum. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zelkowitz P, Miner S, O'Connell S, Robins S. An mHealth App Designed for Fertility Patients: From Conception to Pilot Testing. ACTA ACUST UNITED AC 2019. [DOI: 10.2196/15236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background
Infertility is a distressing chronic condition affecting one in six couples; many of them seek to achieve a pregnancy via assisted reproductive technologies. Online resources for information and support are a mainstay of the self-help strategies of fertility patients. Patients seek explanations online about their diagnoses and treatment options, and hope to connect with others who have lived through a diagnosis of infertility. However, medical information found online is often inaccurate or hard to understand. Importantly, online forums that might provide social support are seldom monitored, allowing for the dissemination of potentially misleading information. In this study we describe the development of an mHealth app, Infotility, designed to provide evidence-based reproductive health information and a monitored message board to provide social support to users.
Objective
The objective was to describe the steps involved in the production of an mHealth app created specifically for fertility patients.
Methods
Our team followed guidelines established for the development of complex health interventions. To evaluate the existing online information sources, we assessed web-based information on infertility using standardized tools for readability, suitability and quality. To determine our stakeholders’ perspectives on what content to include in the app, a needs assessment survey was conducted in a sample of 289 male and 370 female fertility patients and 127 health care providers at clinics in Montreal and Toronto. A comprehensive review of the literature on the medical and psychosocial aspects of infertility was undertaken; summaries were then reviewed for accuracy and pertinence by patients, clinicians, researchers and professionals in the field of fertility. A technology partner was hired to create a user-friendly mobile app that contained the informational summaries, with separate portals for men and women, leading to content specifically curated for the user’s interests. There was also a closed discussion platform, “Connect”, monitored by 18 previous or current fertility patients. Peer monitors underwent one-on-one training and received an instructional manual created to assist with responding to forum messages from participants. Between November 2018 and April 2019, the app was pilot tested in a sample of 72 male and 187 female fertility patients to assess feasibility of recruitment, acceptability, and user satisfaction.
Results
Initial results show that men and women appreciated Infotility. The most popular sections included information on modifiable lifestyle risks (eg, diet, exercise, environment), and medical and psychosocial information. Men preferentially visited pages about lifestyle factors whereas the most common pages visited by women related to medical information. Importantly, the “Connect” social network logged 39 open forum conversations with 258 total posts, as well as 14 private messages. Both men and women lurked and posted on the board; women posted more often than men.
Conclusions
The design of a mobile health app for fertility patients should consider user experience and design along with the quality and accessibility of information. A fertility mHealth app should provide access to monitored social support through the interface and consider how to effectively tailor information to men and women.
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Solomonova E, Lee YEA, Robins S, King L, Feeley N, Gold I, Hayton B, Libman E, Nagy C, Turecki G, Zelkowitz P. Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress. Psychoneuroendocrinology 2019; 107:160-168. [PMID: 31132568 DOI: 10.1016/j.psyneuen.2019.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/06/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women. METHODS A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ. RESULTS Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (rs=-.390, p = .001), PN3 (rs=-.384, p = .002) and at PP (rs= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R2 = .105), PN2 (p < .001, adjusted R2 = .088) and PP (p = .003, adjusted R2 = .064). CONCLUSIONS Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.
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Affiliation(s)
- E Solomonova
- Department of Psychiatry, McGill University, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Canada; Department of Psychiatry, Jewish General Hospital, Canada
| | - Y E A Lee
- Lady Davis Institute for Medical Research, Jewish General Hospital, Canada
| | - S Robins
- Lady Davis Institute for Medical Research, Jewish General Hospital, Canada; Department of Psychiatry, Jewish General Hospital, Canada
| | - L King
- Department of Psychiatry, McGill University, Canada; Department of Psychiatry, Jewish General Hospital, Canada
| | - N Feeley
- Lady Davis Institute for Medical Research, Jewish General Hospital, Canada; Center for Nursing Research, Jewish General Hospital, Canada; Ingram School of Nursing, McGill University, Canada
| | - I Gold
- Department of Psychiatry, McGill University, Canada; Department of Philosophy, McGill University, Canada
| | - B Hayton
- Department of Psychiatry, McGill University, Canada; Department of Psychiatry, Jewish General Hospital, Canada
| | - E Libman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Canada; Department of Psychiatry, Jewish General Hospital, Canada
| | - C Nagy
- Department of Neurology and Neurosurgery, McGill University, Canada; McGill Group for Suicide Studies, Canada; Douglas Mental Health University Institute, Canada
| | - G Turecki
- Department of Psychiatry, McGill University, Canada; McGill Group for Suicide Studies, Canada; Douglas Mental Health University Institute, Canada
| | - P Zelkowitz
- Department of Psychiatry, McGill University, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Canada; Department of Psychiatry, Jewish General Hospital, Canada.
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MacKinnon AL, Houazene S, Robins S, Feeley N, Zelkowitz P. Maternal Attachment Style, Interpersonal Trauma History, and Childbirth-Related Post-traumatic Stress. Front Psychol 2018; 9:2379. [PMID: 30618902 PMCID: PMC6279867 DOI: 10.3389/fpsyg.2018.02379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022] Open
Abstract
Childbirth-related post-traumatic stress has potentially negative and enduring consequences for the well-being of women and their families. Although research to date has identified attachment style and trauma history as individual risk factors, they have yet to be examined as integrative processes in the development and maintenance of childbirth-related post-traumatic stress. The current investigation aimed to examine whether attachment style may moderate the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology across the first 6 months of the postpartum period. A large community sample of women were recruited from two Canadian urban hospitals. Childbirth-related post-traumatic stress symptoms were assessed longitudinally at 5 weeks, 2 months, and 6 months postpartum. Latent growth curve modeling (n = 251) revealed that attachment style moderated the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology, while controlling for other well-established psychosocial (e.g., trait anxiety, previous psychopathology, lack of perceived support) and childbirth-related (e.g., mode of birth, labor pain, subjective experience) risk factors. More secure attachment conferred resiliency and more fearful attachment conferred vulnerability among women without a history of interpersonal trauma, while more preoccupied and more dismissing attachment conferred resiliency among women with a history of interpersonal trauma. These findings highlight the importance of understanding the integrative processes among risk and protective factors underlying the development of and ability to cope with childbirth-related post-traumatic stress. Attachment style and trauma history, which can be quickly measured, should be considered as targets in antenatal screening.
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Affiliation(s)
- Anna L. MacKinnon
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Sarah Houazene
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Nancy Feeley
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Centre for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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26
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Miner SA, Robins S, Zhu YJ, Keeren K, Gu V, Read SC, Zelkowitz P. Evidence for the use of complementary and alternative medicines during fertility treatment: a scoping review. BMC Complement Altern Med 2018; 18:158. [PMID: 29764413 PMCID: PMC5952848 DOI: 10.1186/s12906-018-2224-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/30/2018] [Indexed: 03/26/2024]
Abstract
BACKGROUND Complementary and alternative medicines (CAM) are sometimes used by individuals who desire to improve the outcomes of their fertility treatment and/or mental health during fertility treatment. However, there is little comprehensive information available that analyzes various CAM methods across treatment outcomes and includes information that is published in languages other than English. METHOD This scoping review examines the evidence for 12 different CAM methods used to improve female and male fertility outcomes as well as their association with improving mental health outcomes during fertility treatment. Using predefined key words, online medical databases were searched for articles (n = 270). After exclusion criteria were applied, 148 articles were analyzed in terms of their level of evidence and the potential for methodological and author bias. RESULTS Surveying the literature on a range of techniques, this scoping review finds a lack of high quality evidence that complementary and alternative medicine (CAM) improves fertility or mental health outcomes for men or women. Acupuncture has the highest level of evidence for its use in improving male and female fertility outcomes although this evidence is inconclusive. CONCLUSION Overall, the quality of the evidence across CAM methods was poor not only because of the use of research designs that do not yield conclusive results, but also because results were contradictory. There is a need for more research using strong methods such as randomized controlled trials to determine the effectiveness of CAM in relation to fertility treatment, and to help physicians and patients make evidence-based decisions about CAM use during fertility treatment.
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Affiliation(s)
- Skye A. Miner
- Department of Sociology, McGill University, Room 712, Leacock Building, 855 Sherbrooke Street West, Montreal, QC H3A 2T7 Canada
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
| | - Yu Jia Zhu
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
- Department of Dentistry, McGill University, 2001 McGill College Ave, Montreal, QC H3A 1G1 Canada
| | - Kathelijne Keeren
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
| | - Vivian Gu
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
- Department of Medicine, University of British Columbia Medical School, 2275 Laurel Street, 10th Floor, British Columbia, BC V5Z 1M9 Canada
| | - Suzanne C. Read
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, 4333 Chemin de la Cote-Ste-Catherine, Room 223, Montreal, QC H3T 1E4 Canada
- Lady Davis Institute, 3755 Chemin de la Cote-Ste-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Psychiatry, McGill University, Ludmer Research and Training Building, 1033 Pine Ave. West., Montreal, QC H3A 1A1 Canada
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King L, Robins S, Chen G, Yerko V, Zhou Y, Nagy C, Feeley N, Gold I, Hayton B, Turecki G, Zelkowitz P. Perinatal depression and DNA methylation of oxytocin-related genes: a study of mothers and their children. Horm Behav 2017; 96:84-94. [PMID: 28918249 DOI: 10.1016/j.yhbeh.2017.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 03/20/2017] [Revised: 08/08/2017] [Accepted: 09/12/2017] [Indexed: 12/31/2022]
Abstract
The present study investigated the association of perinatal depression (PD) with differential methylation of 3 genomic regions among mother and child dyads: exon 3 within the oxytocin receptor (OXTR) gene and 2 intergenic regions (IGR) between the oxytocin (OXT) and vasopressin (AVP) genes. Maternal PD was assessed at 5 time-points during pregnancy and postpartum. Four groups were established based on Edinburgh Postnatal Depression Scale (EPDS) cut-off scores: no PD, prenatal or postpartum depressive symptoms only and persistent PD (depressive symptoms both prenatally and postpartum). Salivary DNA was collected from mothers and children at the final time-point, 2.9years postpartum. Mothers with persistent PD had significantly higher overall OXTR methylation than the other groups and this pattern extended to 16/22 individual CpG sites. For the IGR, only the region closer to the AVP gene (AVP IGR) showed significant differential methylation, with the persistent PD group displaying the lowest levels of methylation overall, but not for individual CpG sites. These results suggest that transient episodes of depression may not be associated with OXTR hypermethylation. Validation studies need to confirm the downstream biological effects of AVP IGR hypomethylation as it relates to persistent PD. Differential methylation of the OXTR and IGR regions was not observed among children exposed to maternal PD. The consequences of OXTR hypermethylation and AVP IGR hypomethylation found in mothers with persistent PDS may not only impact the OXT system, but may also compromise maternal behavior, potentially resulting in negative outcomes for the developing child.
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Affiliation(s)
- Leonora King
- Jewish General Hospital, Lady Davis Institute for Medical Research & McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Stephanie Robins
- Jewish General Hospital & Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Gang Chen
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Volodymyr Yerko
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Yi Zhou
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Corina Nagy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Ian Gold
- Department of Philosophy & Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Barbara Hayton
- Jewish General Hospital & McGill University, Department of Psychiatry & Family Medicine, Montreal, Quebec, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & McGill University, Department of Psychiatry, Montreal, Quebec, Canada.
| | - Phyllis Zelkowitz
- Jewish General Hospital, Lady Davis Institute for Medical Research & McGill University, Department of Psychiatry, Montreal, Quebec, Canada.
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MacKinnon AL, Naguib M, Barr HJ, Levinsson A, Robins S, Feeley N, Hayton B, Zelkowitz P, Gold I. Delusional ideation during the perinatal period in a community sample. Schizophr Res 2017; 179:17-22. [PMID: 27670238 DOI: 10.1016/j.schres.2016.09.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite the prevalence of mental health problems during the perinatal period, little research has examined psychotic symptoms in a community sample across pregnancy and the postpartum. Exposure to environmental risk factors, and immigration in particular, are associated with increased risk for psychotic disorders. The current investigation examined whether psychosocial risk and immigrant status would predict levels of delusional ideation across the perinatal period when controlling for depression, anxiety, and demographic factors. METHODS A community sample of 316 pregnant women was assessed at 12-14 and 32-34weeks gestation during routine clinic visits, and at 7-9weeks postpartum during a home visit. Measures included self-report ratings of psychosocial risk (e.g., history of mental health problems or abuse, stressful life events, lack of social support), pregnancy-related anxiety, depressive symptomatology, and delusional ideation. RESULTS There was less delusional ideation during the postpartum period than during early pregnancy. Across all time points, levels of delusional ideation were lower than in the general population. Analyses using multilevel modeling indicated significant fixed-effects for the variables time, age, partnership, being religious and prenatal anxiety, but not depressive symptomatology, on delusional ideation. Immigrant status moderated the effect of psychosocial risk such that greater psychosocial risk predicted more symptoms of delusional ideation among immigrants, but not non-immigrants. CONCLUSION Psychosocial risk factors place immigrant women at an increased likelihood for experiencing delusional ideation during the perinatal period.
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Affiliation(s)
- Anna L MacKinnon
- Department of Psychology, McGill University, Montreal, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
| | - Mariam Naguib
- Interfaculty of Cognitive Science, McGill University, Montreal, Canada
| | - Helena J Barr
- Department of Psychology, McGill University, Montreal, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Anna Levinsson
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada; Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Barbara Hayton
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ian Gold
- Department of Psychiatry, McGill University, Montreal, Canada
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Robins S, Barr HJ, Idelson R, Lambert S, Zelkowitz P. Online Health Information Regarding Male Infertility: An Evaluation of Readability, Suitability, and Quality. Interact J Med Res 2016; 5:e25. [PMID: 27769954 PMCID: PMC5097174 DOI: 10.2196/ijmr.6440] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 08/03/2016] [Revised: 09/23/2016] [Accepted: 09/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Many men lack knowledge about male infertility, and this may have consequences for their reproductive and general health. Men may prefer to seek health information online, but these sources of information vary in quality. OBJECTIVE The objective of this study is to determine if online sources of information regarding male infertility are readable, suitable, and of appropriate quality for Internet users in the general population. METHODS This study used a cross-sectional design to evaluate online sources resulting from search engine queries. The following categories of websites were considered: (1) Canadian fertility clinics, (2) North American organizations related to fertility, and (3) the first 20 results of Google searches using the terms "male infertility" and "male fertility preservation" set to the search locations worldwide, English Canada, and French Canada. Websites that met inclusion criteria (N=85) were assessed using readability indices, the Suitability Assessment of Materials (SAM), and the DISCERN tool. The associations between website affiliation (government, university/medical, non-profit organization, commercial/corporate, private practice) and Google placement to readability, suitability, and quality were also examined. RESULTS None of the sampled websites met recommended levels of readability. Across all websites, the mean SAM score for suitability was 45.37% (SD 11.21), or "adequate", while the DISCERN mean score for quality was 43.19 (SD 10.46) or "fair". Websites that placed higher in Google obtained a higher overall score for quality with an r (58) value of -.328 and a P value of .012, but this position was not related to readability or suitability. In addition, 20% of fertility clinic websites did not include fertility information for men. CONCLUSIONS There is a lack of high quality online sources of information on male fertility. Many websites target their information to women, or fail to meet established readability criteria for the general population. Since men may prefer to seek health information online, it is important that health care professionals develop high quality sources of information on male fertility for the general population.
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Affiliation(s)
- Stephanie Robins
- Jewish General Hospital, Department of Psychiatry, Montreal, QC, Canada
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Ballantyne C, Cushman M, Psaty B, Furberg C, Khaw KT, Sandhu M, Oldgren J, Rossi GP, Maiolino G, Cesari M, Lenzini L, James SK, Rimm E, Collins R, Anderson J, Koenig W, Brenner H, Rothenbacher D, Berglund G, Persson M, Berger P, Brilakis E, McConnell JP, Koenig W, Sacco R, Elkind M, Talmud P, Rimm E, Cannon CP, Packard C, Barrett-Connor E, Hofman A, Kardys I, Witteman JCM, Criqui M, Corsetti JP, Rainwater DL, Moss AJ, Robins S, Bloomfield H, Collins D, Packard C, Wassertheil-Smoller S, Ridker P, Ballantyne C, Cannon CP, Cushman M, Danesh J, Gu D, Hofman A, Nelson JJ, Thompson S, Zalewski A, Zariffa N, Di Angelantonio E, Kaptoge S, Thompson A, Thompson S, Walker M, Watson S, Wood A. Collaborative meta-analysis of individual participant data from observational studies of Lp-PLA2 and cardiovascular diseases. ACTA ACUST UNITED AC 2016; 14:3-11. [PMID: 17301621 DOI: 10.1097/01.hjr.0000239464.18509.f1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A large number of observational epidemiological studies have reported generally positive associations between circulating mass and activity levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular diseases. Few studies have been large enough to provide reliable estimates in different circumstances, such as in different subgroups (e.g., by age group, sex, or smoking status) or at different Lp-PLA2 levels. Moreover, most published studies have related disease risk only to baseline values of Lp-PLA2 markers (which can lead to substantial underestimation of any risk relationships because of within-person variability over time) and have used different approaches to adjustment for possible confounding factors. OBJECTIVES By combination of data from individual participants from all relevant observational studies in a systematic 'meta-analysis', with correction for regression dilution (using available data on serial measurements of Lp-PLA2), the Lp-PLA2 Studies Collaboration will aim to characterize more precisely than has previously been possible the strength and shape of the age and sex-specific associations of plasma Lp-PLA2 with coronary heart disease (and, where data are sufficient, with other vascular diseases, such as ischaemic stroke). It will also help to determine to what extent such associations are independent of possible confounding factors and to explore potential sources of heterogeneity among studies, such as those related to assay methods and study design. It is anticipated that the present collaboration will serve as a framework to investigate related questions on Lp-PLA2 and cardiovascular outcomes. METHODS A central database is being established containing data on circulating Lp-PLA2 values, sex and other potential confounding factors, age at baseline Lp-PLA2 measurement, age at event or at last follow-up, major vascular morbidity and cause-specific mortality. Information about any repeat measurements of Lp-PLA2 and potential confounding factors has been sought to allow adjustment for possible confounding and correction for regression dilution. The analyses will involve age-specific regression models. Synthesis of the available observational studies of Lp-PLA2 will yield information on a total of about 15 000 cardiovascular disease endpoints.
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Gu V, Feeley N, Gold I, Hayton B, Robins S, Mackinnon A, Samuel S, Carter CS, Zelkowitz P. Intrapartum Synthetic Oxytocin and Its Effects on Maternal Well-Being at 2 Months Postpartum. Birth 2016; 43:28-35. [PMID: 26554749 DOI: 10.1111/birt.12198] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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] [Accepted: 08/24/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Synthetic oxytocin (synOT) is commonly used in labor management to induce and augment labor, and to prevent postpartum hemorrhage. However, its long-term consequences for maternal health and behavior are largely understudied. We examined the relationship between synOT and maternal oxytocin levels, breastfeeding, and maternal mental health at 2 months postpartum. METHODS Women were recruited during pregnancy or within 48 hours of giving birth through obstetric practices and hospitals. A total of 386 women were visited in their homes at 2 months postpartum, where they completed questionnaires assessing breastfeeding, depression, anxiety, posttraumatic stress, and somatization. Oxytocin levels were obtained from blood samples and synOT dosage information was gathered from hospital charts. RESULTS Intrapartum synOT dose was positively correlated with endogenous oxytocin levels at 2 months postpartum. Women who were exclusively breastfeeding at 2 months postpartum had received significantly less synOT compared with their nonexclusively breastfeeding counterparts. Higher synOT dose was associated with greater depressive, anxious, and somatization symptoms. SynOT dose was not associated with perinatal posttraumatic stress. CONCLUSIONS The widespread use of synOT in managed labor warrants caution, as the influence of synOT on a new mother's well-being is evident at 2 months postpartum.
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Affiliation(s)
- Vivian Gu
- Department of Psychology, McGill University, Montreal, Canada
| | - Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital, Montreal, Canada
| | - Ian Gold
- Department of Philosophy, McGill University, Montreal, Canada
| | - Barbara Hayton
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Anna Mackinnon
- Department of Psychology, McGill University, Montreal, Canada
| | - Simcha Samuel
- Department of Psychology, McGill University, Montreal, Canada
| | - C Sue Carter
- Kinsey Institute, University of Indiana, Bloomington, IN, USA
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Wilson A, Prokop NH, Robins S. Addressing All Heads of the Hydra: Reframing Safeguards for Mentally Impaired Detainees in Immigration Removal Proceedings. Rev Law Soc Change 2015; 39:313-368. [PMID: 26793824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article concerns the constitutional rights of detained, mentally impaired non-citizens in defending against deportation. Due process requires that such detainees receive a full and fair hearing. However, until recently, they were not provided an attorney to assist them in navigating our extremely complicated immigration system. Mentally impaired detainees were expected to proceed alone in proving the elements of their claims against skilled government attorneys--a daunting task even for those unencumbered by a mental disorder. On December 31, 2013, the Department of Justice ("DOJ") released guidelines detailing new procedures for how immigration courts should handle these cases, including the provision of counsel upon a finding of mental incompetence. The guidelines were issued as a direct response to Franco-Gonzales v. Holder, a class action lawsuit brought by the American Civil Liberties Union in federal district court in California seeking appointed counsel for detained, unrepresented, mentally impaired non-citizens. The guidelines created a three-stage process for assessing competency. Only at the end of this process--and after an individual is declared incompetent--is counsel appointed. This article argues that the DOJ guidelines fall far short of Franco's promise of due process for this particularly vulnerable population. It proposes an alternative model wherein counsel is appointed the moment the court is presented with "indicia" of incompetence, rather than after an adjudication of incompetence. "Indicia" should create a presumption of incompetency that can be rebutted only after a forensic evaluation is conducted and the court holds a robust hearing into the matter. This article reveals, through empirical evidence, the critical role that counsel plays in the investigation of a respondent's ability to participate in the proceedings, and how an attorney is often the only party positioned to marshal all the evidence relevant to the question of competency. Additionally, where a lack of competence is found, the court should appoint a guardian ad litem ("GAL") to assist the attorney in the individual's defense. Counsel and the GAL should work in tandem to achieve the outcome most favorable to the individual, which could be termination, the pursuit of relief, or even deportation in some instances. The expanded use of existing "Deferred Action" categories offers an additional remedy when none of the above proposed options are adequate. The article concludes that the DOJ guidance must be amended in accordance with these recommendations. This proposal best ensures vigorous and informed examination of an individual's competency, while safeguarding the individual against the inherent limits of immigration courts, conflicts of interest, and undue harm.
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Affiliation(s)
- Amelia Wilson
- Immigrant Rights Program of the American Friends Service Committee, Newark, New Jersey, and Rutgers School of Law-Newark, and Seton Hall University School of Law
| | - Natalie H Prokop
- Immigrant Rights Program of the American Friends Service Committee, Newark, New Jersey
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Lupu C, Robins S. Determination of a safe and effective ultraviolet B radiant dose in budgerigars (Melopsittacus undulatus): a pilot study. J Avian Med Surg 2014; 27:269-79. [PMID: 24640928 DOI: 10.1647/2011-0291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The object of this study was to establish a minimum dose of ultraviolet B (UVB) radiation capable of producing an erythemal reaction in budgerigars (Melopsittacus undulatus), to determine a threshold dose of UVB for vitamin D photoconversion, and to investigate the use of safer UVB wavelengths. In each of 5 experiments of this study, 20 birds were divided into a control group (n = 10) and a UVB irradiated group (n = 10). Light sources that provide broadband UVB wavelengths (280-315 nm) and narrowband UVB (310-320 nm) were used. Varied doses of UVB radiation were administered to budgerigars by altering exposure time and irradiance. Safety was determined by observing body weight and incidence of photokeratitis and photodermatitis. Efficacy was evaluated by measuring changes in serum 25-hydroxycholecalciferol levels. Serum corticosterone was measured in 1 experiment to monitor stress levels. The results demonstrated that exposure to 180 mJ/cm2 broadband UVB induced vitamin D photoconversion, decreased body weights, and increased serum corticosterone levels. At these wavelengths, UVB-induced lesions were observed. A broadband UVB of 150 to 300 mJ/cm2 was determined as the minimum erythema dose, and the threshold dose for vitamin D photoconversion was calculated to be in the range of 113-225 mJ/cm2. No erythemal lesions or vitamin D photoconversion took place after exposure to up to 1730 mJ/cm2 narrowband UVB radiation. A minimum erythema dose and a threshold dose for vitamin D conversion need to be determined for each species if phototherapy is to be considered as a safe and effective therapeutic or husbandry tool.
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Paschalis E, Tatakis D, Robins S, Fratzl P, Manjubala I, Zoehrer R, Gamsjaeger S, Buchinger B, Roschger A, Phipps R, Boskey A, Dall'Ara E, Varga P, Zysset P, Klaushofer K, Roschger P. Lathyrism-induced alterations in collagen cross-links influence the mechanical properties of bone material without affecting the mineral. Bone 2011; 49:1232-41. [PMID: 21920485 PMCID: PMC3229977 DOI: 10.1016/j.bone.2011.08.027] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 12/17/2022]
Abstract
In the present study a rat animal model of lathyrism was employed to decipher whether anatomically confined alterations in collagen cross-links are sufficient to influence the mechanical properties of whole bone. Animal experiments were performed under an ethics committee approved protocol. Sixty-four female (47 day old) rats of equivalent weights were divided into four groups (16 per group): Controls were fed a semi-synthetic diet containing 0.6% calcium and 0.6% phosphorus for 2 or 4 weeks and β-APN treated animals were fed additionally with β-aminopropionitrile (0.1% dry weight). At the end of this period the rats in the four groups were sacrificed, and L2-L6 vertebra were collected. Collagen cross-links were determined by both biochemical and spectroscopic (Fourier transform infrared imaging (FTIRI)) analyses. Mineral content and distribution (BMDD) were determined by quantitative backscattered electron imaging (qBEI), and mineral maturity/crystallinity by FTIRI techniques. Micro-CT was used to describe the architectural properties. Mechanical performance of whole bone as well as of bone matrix material was tested by vertebral compression tests and by nano-indentation, respectively. The data of the present study indicate that β-APN treatment changed whole vertebra properties compared to non-treated rats, including collagen cross-links pattern, trabecular bone volume to tissue ratio and trabecular thickness, which were all decreased (p<0.05). Further, compression tests revealed a significant negative impact of β-APN treatment on maximal force to failure and energy to failure, while stiffness was not influenced. Bone mineral density distribution (BMDD) was not altered either. At the material level, β-APN treated rats exhibited increased Pyd/Divalent cross-link ratios in areas confined to a newly formed bone. Moreover, nano-indentation experiments showed that the E-modulus and hardness were reduced only in newly formed bone areas under the influence of β-APN, despite a similar mineral content. In conclusion the results emphasize the pivotal role of collagen cross-links in the determination of bone quality and mechanical integrity. However, in this rat animal model of lathyrism, the coupled alterations of tissue structural properties make it difficult to weigh the contribution of the anatomically confined material changes to the overall mechanical performance of whole bone. Interestingly, the collagen cross-link ratio in bone forming areas had the same profile as seen in actively bone forming trabecular surfaces in human iliac crest biopsies of osteoporotic patients.
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Affiliation(s)
- E.P. Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
- Corresponding author at: Ludwig Boltzmann Institute of Osteology, Hanusch Krankenhaus, Heinrich Collin Str. 30, A-1140 Vienna, Austria.
| | - D.N. Tatakis
- Division of Periodontology, The Ohio State University, Columbus, OH, USA
- Visiting Professor, King Saud University, Riyadh, Saudi Arabia
| | - S. Robins
- Matrix Biochemistry, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, UK
| | - P. Fratzl
- Max Planck Institute of Colloids and Interfaces, Department of Biomaterials, Research Campus Golm, Potsdam, Germany
| | - I. Manjubala
- Max Planck Institute of Colloids and Interfaces, Department of Biomaterials, Research Campus Golm, Potsdam, Germany
| | - R. Zoehrer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
| | - S. Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
| | - B. Buchinger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
| | - A. Roschger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
| | - R. Phipps
- Dept. of Pharmacology, Husson University, ME, USA
| | - A.L. Boskey
- Hospital for Special Surgery, New York, NY, USA
| | - E. Dall'Ara
- Institut für Leichtbau und Struktur-Biomechanik, TU Wien, Vienna, Austria
| | - P. Varga
- Institut für Leichtbau und Struktur-Biomechanik, TU Wien, Vienna, Austria
| | - P. Zysset
- Institut für Leichtbau und Struktur-Biomechanik, TU Wien, Vienna, Austria
| | - K. Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
| | - P. Roschger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
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Roussel L, Robins S, Schachter A, Bérubé J, Hamid Q, Rousseau S. Steroids and extracellular signal-regulated kinase 1/2 activity suppress activating transcription factor 3 expression in patients with severe asthma. J Allergy Clin Immunol 2011; 127:1632-4. [PMID: 21514952 DOI: 10.1016/j.jaci.2011.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/18/2022]
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Robins S, Roussel L, Schachter A, Risse PA, Mogas AK, Olivenstein R, Martin JG, Hamid Q, Rousseau S. Steroid-insensitive ERK1/2 activity drives CXCL8 synthesis and neutrophilia by airway smooth muscle. Am J Respir Cell Mol Biol 2011; 45:984-90. [PMID: 21493783 DOI: 10.1165/rcmb.2010-0450oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe or refractory asthma affects 5 to 15% of all patients with asthma, but is responsible for more than half of the health burden associated with the disease. Severe asthma is characterized by a dramatic increase in smooth muscle and airway inflammation. Although glucocorticoids are the mainstay of treatment in asthma, they are unable to fully control the disease in individuals with severe asthma. We found that airway smooth muscle cells (ASMCs) from individuals with severe asthma showed elevated activities of the ERK1/ERK2 and p38 MAPK pathways despite treatment with oral and inhaled glucocorticoids, which increased the expression of DUSP1, a phosphatase shown to limit p38 MAPK activity. In ex vivo ASMCs, TNF-α but not IL-17A induced expression of the neutrophil chemoattractant CXCL8. Moreover, TNF-α led to up-regulation of the ERK1/ERK2 and p38 MAPKs pathways, with only the latter being sensitive to pretreatment with the glucocorticoid dexamethasone. In contrast to epithelial and endothelial cells, TNF-α-stimulated CXCL8 synthesis was dependent on ERK1/ERK2 but not on p38 MAPK. Moreover, suppressing ERK1/ERK2 activation prevented neutrophil recruitment by ASMCs, whereas suppressing p38 MAPK activity had no impact. Taken together, these results highlight the ERK1/ERK2 MAPK cascade as a novel and attractive target in severe asthma because the activation of this pathway is insensitive to the action of glucocorticoids and is involved in neutrophil recruitment, contributing the to inflammation seen in the disease.
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Affiliation(s)
- Stephanie Robins
- Meakins-Christie Laboratories, McGill University Heath Centre Research Institute, Montréal, Canada.
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Lupu C, Robins S. Comparison of treatment protocols for removing metallic foreign objects from the ventriculus of budgerigars (Melopsittacus undulatus). J Avian Med Surg 2009; 23:186-93. [PMID: 19999761 DOI: 10.1647/2007-018.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To compare the efficacy of treatment protocols recommended to aid passage of metallic foreign objects from the ventriculus of birds, a 1-mm metal sphere, made from solder wire, was placed into the crop of each of 44 budgerigars (Melopsittacus undulatus). After survey radiographs confirmed the spheres were lodged in the ventriculus, birds were divided into 6 groups. Each group received 1 of 6 different treatment protocols: psyllium with grit, acidic drinking water, fine grit, coarse grit, cathartic emollients (peanut butter and mineral oil), and a control group. All birds were treated simultaneously with a chelating agent, dimercaptosuccinic acid (DMSA), to prevent heavy-metal toxicosis. Successive survey radiographs were used to monitor elimination of the spheres from the digestive tract. Of all protocols tested, birds treated with either fine or large grit had the shortest mean elimination time of the metal spheres. These results indicate that administration of grit particles, either fine or coarse, appears to be effective in hastening the passage of metallic foreign objects from the ventriculus of budgerigars.
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Affiliation(s)
- Corina Lupu
- Montreal Bird and Exotic Veterinary Hospital, 6090 Sherbrooke St W, Montreal, QC H4A 1Y1, Canada
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Chekanov S, Derrick M, Krakauer D, Loizides JH, Magill S, Miglioranzi S, Musgrave B, Repond J, Yoshida R, Mattingly MCK, Antonioli P, Bari G, Basile M, Bellagamba L, Boscherini D, Bruni A, Bruni G, Cara Romeo G, Cifarelli L, Cindolo F, Contin A, Corradi M, De Pasquale S, Giusti P, Iacobucci G, Margiotti A, Montanari A, Nania R, Palmonari F, Pesci A, Sartorelli G, Zichichi A, Aghuzumtsyan G, Bartsch D, Brock I, Goers S, Hartmann H, Hilger E, Irrgang P, Jakob HP, Kind O, Meyer U, Paul E, Rautenberg J, Renner R, Stifutkin A, Tandler J, Voss KC, Wang M, Weber A, Bailey DS, Brook NH, Cole JE, Heath GP, Namsoo T, Robins S, Wing M, Capua M, Mastroberardino A, Schioppa M, Susinno G, Kim JY, Kim YK, Lee JH, Lim IT, Pac MY, Caldwell A, Helbich M, Liu X, Mellado B, Ning Y, Paganis S, Ren Z, Schmidke WB, Sciulli F, Chwastowski J, Eskreys A, Figiel J, Galas A, Olkiewicz K, Stopa P, Zawiejski L, Adamczyk L, Bołd T, Grabowska-Bołd I, Kisielewska D, Kowal AM, Kowal M, Kowalski T, Przybycień M, Suszycki L, Szuba D, Szuba J, Kotański A, Słomiński W, Adler V, Behrens U, Bloch I, Borras K, Chiochia V, Dannheim D, Drews G, Fourletova J, Fricke U, Geiser A, Göttlicher P, Gutsche O, Haas T, Hain W, Hillert S, Kahle B, Kötz U, Kowalski H, Kramberger G, Labes H, Lelas D, Lim H, Löhr B, Mankel R, Melzer-Pellmann IA, Nguyen CN, Notz D, Nucio-Quiroz AE, Polini A, Raval A, Rurua L, Schneekloth U, Stösslein U, Wolf G, Youngman C, Zeuner W, Schlenstedt S, Barbagli G, Gallo E, Genta C, Pelfer PG, Bamberger A, Benen A, Karstens F, Dobur D, Vlasov NN, Bell M, Bussey PJ, Doyle AT, Ferrando J, Hamilton J, Hanlon S, Saxon DH, Skillicorn IO, Gialas I, Carli T, Gosau T, Holm U, Krumnack N, Lohrmann E, Milite M, Salehi H, Schleper P, Stonjek S, Wichmann K, Wick K, Ziegler A, Ziegler A, Collins-Tooth C, Foudas C, Gonçalo R, Long KR, Tapper AD, Cloth P, Filges D, Kataoka M, Nagano K, Tokushuku K, Yamada S, Yamazaki Y, Barakbaev AN, Boos EG, Pokrovskiy NS, Zhautykov BO, Son D, Piotrzkowski K, Barreiro F, Glasman C, González O, Labarga L, del Peso J, Tassi E, Terrón J, Vázquez M, Zambrana M, Barbi M, Corriveau F, Gliga S, Lainesse J, Padhi S, Stairs DG, Walsh R, Tsurugai T, Antonov A, Danilov P, Dolgoshein BA, Gladkov D, Sosnovtsev V, Suchkov S, Dementiev RK, Ermolov PF, Golubkov YA, Katkov II, Khein LA, Korzhavina IA, Kuzmin VA, Levchenko BB, Lukina OY, Proskuryakov AS, Shcheglova LM, Zotkin SA, Coppola N, Grijpink S, Koffeman E, Kooijman P, Maddox E, Pellegrino A, Schagen S, Tiecke H, Velthuis JJ, Wiggers L, de Wolf E, Brümmer N, Bylsma B, Durkin LS, Ling TY, Cooper-Sarkar AM, Cottrell A, Devenish RCE, Foster B, Grzelak G, Gwenlan C, Patel S, Straub PB, Walczak R, Bertolin A, Brugnera R, Carlin R, Dal Corso F, Dusini S, Garfagnini A, Limentani S, Longhin A, Parenti A, Posocco M, Stanco L, Turcato M, Heaphy EA, Metlica F, Oh BY, Whitmore JJ, Iga Y, D’Agostini G, Marini G, Nigro A, Cormack C, Hart JC, McCubbin NA, Heusch C, Park IH, Pavel N, Abramowicz H, Gabareen A, Kananov S, Kreisel A, Levy A, Kuze M, Fusayasu T, Kagawa S, Kohno T, Tawara T, Yamashita T, Hamatsu R, Hirose T, Inuzuka M, Kaji H, Kitamura S, Matsuzawa K, Ferrero MI, Monaco V, Sacchi R, Solano A, Arneodo M, Ruspa M, Koop T, Martin JF, Mirea A, Butterworth JM, Hall-Wilton R, Jones TW, Lightwood MS, Sutton MR, Targett-Adams C, Ciborowski J, Ciesielski R, Łużniak P, Nowak RJ, Pawlak JM, Sztuk J, Tymieniecka T, Ukleja A, Ukleja J, Żarnecki AF, Adamus M, Plucinski P, Eisenberg Y, Gladilin LK, Hochman D, Karshon U, Riveline M, Kçira D, Lammers S, Li L, Reeder DD, Rosin M, Savin AA, Smith WH, Deshpande A, Dhawan S, Bhadra S, Catterall CD, Fourletov S, Hartner G, Menary S, Soares M, Standage J. Erratum: Bottom photoproduction measured using decays into muons in dijet events inepcollisions ats=318 GeV[Phys. Rev. D70, 012008 (2004)]. Int J Clin Exp Med 2006. [DOI: 10.1103/physrevd.74.059906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pritchett Y, McCarberg B, Watkin J, Chappell A, Robinson M, Xu J, Rotz B, Wernicke J, Detke M, Iyengar S, Henck J, Bymaster F, Callaghan J, Knadler M, Thase M, Meratee M, Chung J, Schweitzer J, Byrnes K, Stoica B, Giovanni S, Biase A, Knoblach S, Hoffman E, Faden A, Michaeli S, Sorce D, Öz G, Ugurbil K, Garwood M, Tuite P, Jett D, Deberdt W, Csernansky J, Buckley P, Peiskens J, Lipkovich I, Kollack-Walter S, Houston J, Zhang Y, Liu-Siefert H, Buckley PF, Csernansky JG, Peuskens J, Kollack-Walker S, Houston JP, Rotelli M, Theodore W, Giovacchini G, Bagic A, Herscovitch P, Carson R, Herholz K, Weisenbach S, Hilker R, Heiss W, Nahab F, Hallett M, El-Khodor B, Edgar N, Chen A, Heyes MP, Jiang Q, Ahmed S, Pedersen R, Musgnung J, Entsuah R, Nordberg A, Masdeu J, Gerhard A, Ebmeier K, Pappata S, Perani D, Laere K, Halldin C, Salmon E, Knudsen G, Robins S, Fehlings M, Baptiste D, Skolnick BE, Davis SM, Bran NC, Mathew SE, Mayer SA, Kaminski RM, Marini H, Ortinski PI, Yonekawa W, Vicini S, Rogawski MA, Gasior M, Tang R, White N. Abstracts from the ASENT 2006 Annual Meeting March 8–11, 2006. NeuroRx 2006. [DOI: 10.1016/j.nurx.2006.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chekanov S, Derrick M, Krakauer D, Magill S, Musgrave B, Pellegrino A, Repond J, Yoshida R, Mattingly MCK, Antonioli P, Bari G, Basile M, Bellagamba L, Boscherini D, Bruni A, Bruni G, Romeo GC, Cifarelli L, Cindolo F, Contin A, Corradi M, De Pasquale S, Giusti P, Iacobucci G, Levi G, Margotti A, Massam T, Nania R, Palmonari F, Pesci A, Sartorelli G, Zichichi A, Aghuzumtsyan G, Brock I, Goers S, Hartmann H, Hilger E, Irrgang P, Jakob HP, Kappes A, Katz UF, Kerger R, Kind O, Paul E, Rautenberg J, Schnurbusch H, Stifutkin A, Tandler J, Voss KC, Weber A, Wieber H, Bailey DS, Brook NH, Cole JE, Foster B, Heath GP, Heath HF, Robins S, Rodrigues E, Scott J, Tapper RJ, Wing M, Capua M, Mastroberardino A, Schioppa M, Susinno G, Jeoung HY, Kim JY, Lee JH, Lim IT, Ma KJ, Pac MY, Caldwell A, Helbich M, Liu W, Liu X, Mellado B, Paganis S, Sampson S, Schmidke WB, Sciulli F, Chwastowski J, Eskreys A, Figiel J, Klimek K, Olkiewicz K, Przybycień MB, Stopa P, Zawiejski L, Bednarek B, Grabowska-Bold I, Jeleń K, Kisielewska D, Kowal AM, Kowal M, Kowalski T, Mindur B, Przybycień M, Rulikowska-Zarȩbska E, Suszycki L, Szuba D, Szuba J, Kotański A, Bauerdick LAT, Behrens U, Borras K, Chiochia V, Crittenden J, Dannheim D, Desler K, Drews G, Fox-Murphy A, Fricke U, Geiser A, Goebel F, Göttlicher P, Graciani R, Haas T, Hain W, Hartner GF, Hebbel K, Hillert S, Koch W, Kötz U, Kowalski H, Labes H, Löhr B, Mankel R, Martens J, Martínez M, Milite M, Moritz M, Notz D, Petrucci MC, Polini A, Schneekloth U, Selonke F, Stonjek S, Wolf G, Wollmer U, Whitmore JJ, Wichmann R, Youngman C, Zeuner W, Coldewey C, Viani ALD, Meyer A, Schlenstedt S, Barbagli G, Gallo E, Pelfer PG, Bamberger A, Benen A, Coppola N, Markun P, Raach H, Wölfle S, Bell M, Bussey PJ, Doyle AT, Glasman C, Lee SW, Lupi A, McCance GJ, Saxon DH, Skillicorn IO, Bodmann B, Gendner N, Holm U, Salehi H, Wick K, Yildirim A, Ziegler A, Carli T, Garfagnini A, Gialas I, Lohrmann E, Foudas C, Gonçalo R, Long KR, Metlica F, Miller DB, Tapper AD, Walker R, Cloth P, Filges D, Kuze M, Nagano K, Tokushuku K, Yamada S, Yamazaki Y, Barakbaev AN, Boos EG, Pokrovskiy NS, Zhautykov BO, Ahn SH, Lee SB, Park SK, Lim H, Son D, Barreiro F, García G, González O, Labarga L, del Peso J, Redondo I, Terrón J, Vázquez M, Barbi M, Bertolin A, Corriveau F, Ochs A, Padhi S, Stairs DG, Tsurugai T, Antonov A, Bashkirov V, Danilov P, Dolgoshein BA, Gladkov D, Sosnovtsev V, Suchkov S, Dementiev RK, Ermolov PF, Golubkov YA, Katkov II, Khein LA, Korotkova NA, Korzhavina IA, Kuzmin VA, Levchenko BB, Lukina OY, Proskuryakov AS, Shcheglova LM, Solomin AN, Vlasov NN, Zotkin SA, Bokel C, Engelen J, Grijpink S, Maddox E, Koffeman E, Kooijman P, Schagen S, Tassi E, Tiecke H, Tuning N, Velthuis JJ, Wiggers L, de Wolf E, Brümmer N, Bylsma B, Durkin LS, Gilmore J, Ginsburg CM, Kim CL, Ling TY, Boogert S, Cooper-Sarkar AM, Devenish RCE, Ferrando J, Große-Knetter J, Matsushita T, Rigby M, Ruske O, Sutton MR, Walczak R, Brugnera R, Carlin R, Corso FD, Dusini S, Limentani S, Longhin A, Parenti A, Posocco M, Stanco L, Turcato M, Adamczyk L, Iannotti L, Oh BY, Saull PRB, Toothacker WS, Iga Y, D’Agostini G, Marini G, Nigro A, Cormack C, Hart JC, McCubbin NA, Epperson D, Heusch C, Sadrozinski H, Seiden A, Williams DC, Park IH, Pavel N, Abramowicz H, Dagan S, Gabareen A, Kananov S, Kreisel A, Levy A, Abe T, Fusayasu T, Kohno T, Umemori K, Yamashita T, Hamatsu R, Hirose T, Inuzuka M, Kitamura S, Matsuzawa K, Nishimura T, Arneodo M, Cartiglia N, Cirio R, Costa M, Ferrero MI, Maselli S, Monaco V, Peroni C, Ruspa M, Sacchi R, Solano A, Staiano A, Bailey DC, Fagerstroem CP, Galea R, Koop T, Levman GM, Martin JF, Mirea A, Sabetfakhri A, Butterworth JM, Gwenlan C, Hall-Wilton R, Hayes ME, Heaphy EA, Jones TW, Lane JB, Lightwood MS, West BJ, Ciborowski J, Ciesielski R, Grzelak G, Nowak RJ, Pawlak JM, Smalska B, Tymieniecka T, Ukleja A, Ukleja J, Zakrzewski JA, Żarnecki AF, Adamus M, Plucinski P, Sztuk J, Eisenberg Y, Gladilin LK, Hochman D, Karshon U, Breitweg J, Chapin D, Cross R, Kçira D, Lammers S, Reeder DD, Savin AA, Smith WH, Deshpande A, Dhawan S, Hughes VW, Straub PB, Bhadra S, Catterall CD, Frisken WR, Khakzad M, Menary S. Properties of hadronic final states in diffractive deep inelasticepscattering at DESY HERA. Int J Clin Exp Med 2002. [DOI: 10.1103/physrevd.65.052001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tobias JH, Clarke S, Mitchell K, Robins S, Amer H, Fraser WD. Analysis of the contribution of dydrogesterone to bone turnover changes in postmenopausal women commencing hormone replacement therapy. J Clin Endocrinol Metab 2001; 86:1194-8. [PMID: 11238508 DOI: 10.1210/jcem.86.3.7321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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] [Indexed: 11/19/2022]
Abstract
Although gestagens have been reported to influence bone metabolism, whether these contribute to the beneficial effects of hormone replacement therapy (HRT) on the skeleton of postmenopausal women is currently unclear. To address this question, we compared changes in bone turnover markers after commencing HRT in 26 postmenopausal women randomized to receive 8 weeks of treatment with 2 mg estradiol daily or 2 mg estradiol plus 10 mg dydrogesterone daily. Serum and second morning void urine samples were obtained at baseline (twice) and after 1, 2, 4, and 8 weeks. Serum estradiol was measured by RIA, urinary total deoxypyridinoline (DPD) excretion by high pressure liquid chromatography, and serum osteocalcin and C-terminal procollagen peptide by enzyme-linked immunosorbent assay. The increase in serum estradiol after treatment with estradiol alone was slightly, but significantly, greater than that in the combination group (P = 0.04). Although estradiol suppressed urinary DPD excretion to a greater extent when given alone (P = 0.02), osteocalcin levels were significantly higher in this group than in women receiving combination therapy (P = 0.04). To assess the effect of dydrogesterone on the balance between formation and resorption in more detail, we subsequently compared the ratio between formation and resorption markers in the two treatment groups. We found that osteocalcin/DPD and C-terminal procollagen peptide/DPD ratios were significantly higher in women treated with estradiol alone (P < 0.0001 and P = 0.002, respectively), suggesting that dydrogesterone may reduce formation relative to resorption. These results suggest that gestagens may reduce estrogen's beneficial effects on the skeleton of postmenopausal women, as assessed over the first 8 weeks of replacement therapy.
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Affiliation(s)
- J H Tobias
- Rheumatology Unit, University of Bristol Division of Medicine, Rowett Research Institute, Aberdeen, United Kingdom AB21 9SB.
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Baxter-Jones AD, Helms PJ, Russell G, Grant A, Ross S, Cairns JA, Ritchie L, Taylor R, Reid DM, Osman LM, Robins S, Fletcher ME. Early asthma prophylaxis, natural history, skeletal development and economy (EASE): a pilot randomised controlled trial. Health Technol Assess 2001; 4:1-89. [PMID: 11074396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES (1) To establish recruitment rates of newly presenting asthmatic children. (2) To establish acceptability of study protocols. (3) To pilot age-specific quality of life (QoL) assessment. (4) To assess short-term (6 months) outcomes of inhaled corticosteroids (ICS) treatment. (5) To refine sample size calculations for a definitive study. DESIGN A randomised pragmatic longitudinal trial design was used, with no blinding or placebo, to examine early ICS introduction similar to its use in practice. Subjects were assessed at entry, 3 and 6 months. SETTING Subjects were recruited from six general practices. Children under 6 years were assessed at the Craig Research and Investigation Unit, Royal Aberdeen Children's Hospital, or their family home, and subjects 6 years and over were assessed at their general practice. SUBJECTS Children (aged 6 months-16 years) with symptoms suggestive of asthma/wheeze that had commenced no longer than 12 months before were identified retrospectively and prospectively from general practices. Subjects were also required to be naïve to prophylactic therapy with no other lung disease/concomitant illness. INTERVENTIONS Subjects were randomised to ss2-agonist (ss2-only group) or ss2-agonist and ICS (ICS group) for 6 months. Physicians could later prescribe ICS in controls if needed. MAIN OUTCOME MEASURES (1) Pulmonary function. (2) Asthma symptom diary. (3) Symptomatic health status questionnaire. (4) Caregiver's and child's QoL. (5) Growth. (6) Bone mass. (7) Bone turnover. (8) Economic issues. RESULTS Of over 15,000 children yielded from general practice records, 11% had symptoms suggestive of asthma/wheeze, and two-thirds of these already used ICS. Of the remaining, 141 subjects met the criterion of early asthma, and 86 were randomised. Two-thirds of those randomised were < 6 years old, the males:females ratio was 2:1, and 67% had a family history of atopy. RESULTS - PHYSIOLOGICAL DEVELOPMENT: Pulmonary function did not significantly improve in the older children. Although tidal breathing measures in the pre-school children were significantly higher at 6 months in the ss2-only group, there was great variability. Incidence of wheeze and night-time cough reduced equally in both groups. Reduction of night-time symptom score and reliever use, and increase in symptom-free days were only significant in the ss2-only group. No significant differences were found in growth and bone mass between the two groups, but bone metabolism was significantly reduced at 6 months in the ICS group. RESULTS - PSYCHOLOGICAL DEVELOPMENT: The caregiver's QoL questionnaire was sensitive to child symptom changes over 3 months, but absolute impact of child symptoms on their QoL varied, whereas the child-centred questionnaire was not sensitive to change. RESULTS - ECONOMICS: There were no significant differences in medical consultation costs between the groups, but, as expected, prescription costs in the ICS group were higher over 6 months. Combined healthcare costs were significantly higher for patients assigned to ICS, but there were no significant differences in any effectiveness measures between the groups. CONCLUSIONS Most (96%) of the proposed sample was recruited, and the low drop-out rate (8%) demonstrated acceptability of the study protocol. Most children first presenting with symptoms suggestive of asthma were < 6 years old and represented a group biased towards mild to moderate asthma, or virally induced wheeze. The caregiver's QoL questionnaire was found to better reflect a child's symptom changes than a child-centred instrument. In the short term, no adverse effects were seen on growth, but ICS treatment significantly reduced bone metabolism. Most of the young children with asthma/wheeze improved over time with ss2-agonist treatment alone, and clinical benefits of early ICS intervention amongst these children were not detected; however, there was inadequate power in this pilot study to establish this. (AB
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Gaumet-Meunier N, Coxam V, Robins S, Pastoureau P, Pointillart A, Davicco MJ, Lebecque P, Barlet JP. Gonadal steroids and bone metabolism in young castrated male rats. Calcif Tissue Int 2000; 66:470-5. [PMID: 10821886 DOI: 10.1007/s002230010094] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
At 45 days of age, 40 male Wistar rats were castrated, then randomly divided into four groups, S.C. injected for 60 days after surgery either with 17beta-estradiol (E) 10 microg/kg BW/48 hours, progesterone (P) 140 microg/kg BW/48 hours, dihydrotestosterone (D) 2 microg/kg BW/48 hours, E + P + D same doses, or solvent alone (CX). Ten other rats were sham-operated (SH) and used as controls. Animals were put in balance to determine Ca and phosphorus (Pi) intestinal apparent absorption (IA Ca, IA Pi) and urinary pyridinium crosslinks excretion. Plasma was collected for measurement of intact-parathyroid hormone (PTH), calcitonin (CT), insulin-like growth factor I (IGF-I), 1,25 dihydroxyvitamin D (1,25(OH)(2)D), Ca, and Pi. Orchidectomy induced marked seminal vesicles atrophy and increased plasma CT, PTH, and Ca concentrations. IA Ca was significantly higher in P rats, however, neither castration nor any other treatment had significant effects. Orchidectomy decreased femoral length, dry weight, and Ca content, whereas E or D given alone or together with P improved endochondral growth and enhanced femoral Ca content. Again, bone mineral density was lowered by orchidectomy and reestablished by both E and EPD, even above SH values, this effect being more important at the metaphyseal levels. Urinary pyridinium cross-links excretion and plasma osteocalcin concentrations were higher in the CX animals than in the controls. Although E and D given alone did reduce both biochemical turnover markers, they showed additive effect when given together (EPD). In conclusion, in the young castrated male rat, E was more efficient than D for preventing bone loss, the most important effect being induced by a combination of E+P+D.
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Abstract
Clinicians, researchers, and patients tend to view anger as attributable to immediate circumstances and current thoughts. In contrast, systems-oriented thinking approaches anger as a contextual and dynamic phenomenon. Personal dispositional systems of anger (cognitive, physiological, and behavioral) are embedded in an interdependent network of interpersonal and environmental systems. Anger coevolves with and is in equilibrium with these systems. The more adaptive and embedded it is within a system, the greater will be its inertia or resistance to change. The automaticity of anger further challenges its regulation, as does its transfer across domains. Other troublesome systems phenomena associated with anger and aggression are escalation and threshold effects. Anger arousal, as a deviation from homeostasis, is inhibited and counteracted by various negative feedback loops that are properties of internal, interpersonal, and environmental systems. Treatment augments anger-regulatory mechanisms. Interventions aimed at anger reduction should consider the systems in which anger is embedded and the adaptive functions anger serves within those systems. These and other systems concepts are explicated and are illustrated with material from two clinical cases.
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Affiliation(s)
- S Robins
- University of California, Irvine 92697-7085, USA
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Papademetriou V, Narayan P, Rubins H, Collins D, Robins S. Influence of risk factors on peripheral and cerebrovascular disease in men with coronary artery disease, low high-density lipoprotein cholesterol levels, and desirable low-density lipoprotein cholesterol levels. HIT Investigators. Department of Veterans Affairs HDL Intervention Trial. Am Heart J 1998; 136:734-40. [PMID: 9778079 DOI: 10.1016/s0002-8703(98)70023-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Veterans Administration-HDL Intervention Trial is an ongoing, 20-center, randomized, double-blind, placebo-controlled study aiming to assess the effect of gemfibrozil-improved low high-density lipoprotein cholesterol levels on cardiovascular morbidity and mortality rates. METHODS AND RESULTS Eligible patients were men with low high-density lipoprotein cholesterol levels and demonstrable coronary heart disease. A total of 2531 patients (average age 63.5 years) were randomly assigned in this study, with a mean high-density lipoprotein cholesterol level of 0.83 mmol/L (32 mg/dL) and low-density lipoprotein cholesterol level of 2.87 mmol/L (111 mg/dL). Baseline data provided the opportunity to assess the interaction of several coronary heart disease risk factors and comorbid vascular diseases. Of these patients, 206 had diabetes mellitus (DM) alone, 1021 had hypertension (HTN) alone, 421 had both DM and HTN, and 883 had neither ("others"). Considering the influence of these risk factors on comorbidities independent of smoking status, patients with DM alone had a 2-fold increase in the prevalence of peripheral vascular disease and a 1.5-fold increase in congestive heart failure. Patients with HTN had a significant increase in the prevalence of cerebrovascular disease, stroke, and congestive heart failure. Patients with HTN and DM had a significant increase in all comorbidities. Smoking resulted in substantial increase of both peripheral vascular disease and cerebrovascular disease. Compared with nonsmoking patients with no DM or HTN, patients with DM and HTN and smoking had a 3-fold increase in the prevalence of peripheral vascular disease and a 3.5-fold increase in cerebrovascular disease (P < .001). CONCLUSIONS We conclude that DM is a strong correlate of peripheral vascular disease, hypertension of cerebrovascular disease, and that there is a strong additive effect between DM, HTN, and smoking on both.
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Rigby M, Robins S. Practical success of an electronic patient record system in community care--a manifestation of the vision and discussion of the issues. Int J Biomed Comput 1996; 42:117-22. [PMID: 8880277 DOI: 10.1016/0020-7101(96)01189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This paper analyses the purpose, background, scope, and success to date of designing and implementing a comprehensive electronic patient record system for community care in the UK, in the context of the increasing policy focus upon community care. The project is situated in Plymouth in the UK, a major provider of community care. The paper indicates intended benefits of the system for patients, professionals, and health care organisations. The rationale behind the record content is explained, as is the record structure. Intended uses of the records form a further baseline for study, and the paper assesses the key success factors to achieving the goal of reliability, quality, and effective use of resources.
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Affiliation(s)
- M Rigby
- Centre for Health Planning and Management, Keele University, Staffordshire, UK
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Abstract
OBJECTIVE Changes in calcium homeostasis and bone mass around the climacteric are poorly understood. We examined relations between endocrine factors and indices of bone mass and metabolism in healthy women approaching the menopause. DESIGN Cross-section study. PATIENTS Sixty-eight spontaneously menstruating women aged 45-55. MEASUREMENTS Bone density measured at lumbar spine (LS) and femoral neck (FN) using dual energy X-ray absorptiometry and distal non-dominant forearm using peripheral quantitative computed tomography. We recorded menstrual history, physical activity and dietary calcium, and measured serum calcium, phosphate, alkaline phosphatase, osteocalcin, vitamin D, fT3, T4, TSH, PTH, FSH and oestradiol (E2), and urinary pyridinoline (PYD) and deoxypyridinoline (DPD) excretion. RESULTS Using serum FSH level as a marker of ovarian function, 63 subjects could be classified into one of three groups: group A (serum FSH < 10 U/l, n = 29), group B (10-35 U/l, n = 27) and group C (> 35 U/l, n = 7). Bone density fell with declining ovarian function at the LS, FN and forearm trabecular (but not cortical) sites. Serum PTH was lower in group A vs B (mean (SD) 2.68 (0.97) vs 3.52 (1.17) pmol/l, P < 0.05), but similar to group C (2.90 (1.09) pmol/l, P = NS). Serum phosphate was elevated in group C compared to groups A and B (1.17 (0.15) vs 1.04 (0.11) and 1.05 (0.13) mmol/l, P < 0.05), and urinary PYD (61.1 (8.0) vs 50.4 (11.6) and 43.9 (8.1) mumol/mol creatinine) and DPD (15.9 (3.9) vs 12.0 (3.6) and 11.4 (3.6) mumol/mol creatinine) excretion were also increased. There were no significant differences in vitamin D metabolites or osteocalcin. Multivariate analysis suggested serum osteocalcin was positively related to physical activity and serum 1,25-dihydroxycholecalciferol levels. Serum free T3 was positively correlated with urinary DPD excretion, and inversely related to serum PTH. In all subjects, serum PTH was related to body weight (r = 0.38, P = 0.002). CONCLUSIONS Declining ovarian function before menopause is accompanied by reductions in bone mass and altered calcium metabolism. Free T3 may regulate bone resorption and indirectly modulate PTH release.
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Affiliation(s)
- M Garton
- Department of Rheumatology, Aberdeen Royal Hospitals NHS Trust, UK
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Abstract
The purine contents of commercial, low-alcohol and alcohol-free beers were determined. Four gout sufferers were studied under controlled conditions before and after ingestion of four different beverages containing alcohol, alcohol and purine, purine and neither alcohol nor purine. The results show a significant increase in purine excretion with a fluid load alone and impairment or reversal of this response with the other three beverages. These results are difficult to interpret on the basis of the alcohol and purine contents of the beverages alone. Isohumulones are present in all beers. Their effect on urate metabolism and excretion is unknown but needs further study as a possible explanation of these results. These results suggest that the three beverages other than a fluid load alone are unsuitable for gout sufferers.
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Affiliation(s)
- C J Eastmond
- Department of Rheumatology, Aberdeen Royal Infirmary
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Garton M, Martin J, Stewart A, Krukowski Z, Matheson N, Robins S, Loveridge N, Reid D. Changes in bone mass and metabolism after surgery for primary hyperparathyroidism. Clin Endocrinol (Oxf) 1995; 42:493-500. [PMID: 7621568 DOI: 10.1111/j.1365-2265.1995.tb02668.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Bone mass is often reduced in patients with primary hyperparathyroidism (pHPT) and is usually partially reversible after parathyroidectomy. However, site specific and overall skeletal benefits of surgery in mild asymptomatic pHPT remain uncertain. DESIGN Cross-sectional and longitudinal studies. PATIENTS Fourteen patients (12 women and 2 men) with pHPT. MEASUREMENTS Baseline bone mass was assessed at the lumbar spine, left hip and whole body using dual-energy X-ray absorptiometry, and at the left os calcis using broad-band ultrasound attenuation. Changes in bone mass, serum intact PTH and osteocalcin, and urinary pyridinium cross-link excretion were recorded in 10 patients followed for 6 months after surgery. RESULTS (1) Cross-sectional study: Baseline measurements at the lumbar spine and hip were inversely related to both the serum PTH concentration and the weight of the parathyroid gland removed at surgery. (2) Longitudinal study: Six months after adenectomy, bone mass had increased significantly at the femoral neck, greater trochanter, whole body and os calcis, but not at the lumbar spine or Ward's area. Serum PTH, osteocalcin and pyridinium cross-link excretion all fell significantly after surgery. The percentage increment in whole body bone mineral content at 6 months was proportional to the baseline PTH. CONCLUSION In primary hyperparathyroidism, preoperative reductions and post-operative gains in bone mass are proportional to the initial serum PTH concentration. Mild primary hyperparathyroidism probably does not cause appreciable bone loss at clinically relevant fracture sites such as the spine and hip, and in such cases the overall skeletal benefits of surgery are likely to be negligible.
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Affiliation(s)
- M Garton
- Department of Rheumatology, City Hospital, Aberdeen, UK
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Garton M, Reid I, Loveridge N, Robins S, Murchison L, Beckett G, Reid D. Bone mineral density and metabolism in premenopausal women taking L-thyroxine replacement therapy. Clin Endocrinol (Oxf) 1994; 41:747-55. [PMID: 7889610 DOI: 10.1111/j.1365-2265.1994.tb02789.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [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] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Excess endogenous thyroxine causes bone loss, but the effects of exogenous thyroxine are disputed. We report on bone mass and metabolism in women taking L-thyroxine therapy. DESIGN Cross-sectional and longitudinal studies. PATIENTS Cross-sectional study: 40 healthy premenopausal women with autoimmune thyroiditis taking either physiological (serum TSH usually normal, 0.35-3.3 mU/l) or suppressive (serum TSH usually < 0.35 mU/l) doses of L-thyroxine; patients were also compared with previously acquired age and weight matched premenopausal volunteers with no history of thyroid dysfunction. Longitudinal study: 28 patients were followed-up > or = 1 year later. MEASUREMENTS In all subjects bone mineral density (BMD) was measured at the anteroposterior lumbar spine and left hip (femoral neck, greater trochanter and Ward's area) using dual-energy X-ray absorptiometry, and physical activity assessed using the Framingham physical activity index. Serum osteocalcin (OC), PTH and vitamin D, and urinary pyridinoline and deoxypyridinoline excretion were measured in patients. RESULTS Cross-sectional study: The patient groups were well matched for disease duration and physical activity although the suppressed group were slightly younger (mean 38.1 (SD 7.5) vs 43.3 (3.9) years, P < 0.05). BMD, serum OC, PTH and vitamin D, and urinary cross-link excretion did not differ significantly between the two groups. Multivariate analysis of the whole group suggested that BMD at the femoral neck and greater trochanter was related positively to weight and physical activity and negatively to thyroxine dose (microgram/kg/day) and patient age. At the lumbar spine BMD was reduced non-specifically in the presence of thyroid disease and treatment, but this effect appeared to decline with increasing duration of therapy. A similar analysis of the patient group suggested that urinary cross-link excretion correlated positively with thyroxine dose, and negatively with duration of treatment. Longitudinal study: Annualized changes in BMD were inversely related to thyroxine dose (microgram/kg/day) at all sites but achieved statistical significance only at the femoral neck and Ward's area. CONCLUSION We did not find any effect of persistent historical TSH suppression on current bone mass, and this might relate to the relative insensitivity of older TSH assays. However, the cross-sectional and longitudinal data suggest that high daily doses of thyroxine in relation to patient body weight might adversely affect bone mass, particularly at the hip. These findings support the contention that excess exogenous thyroxine might predominantly deplete skeletal sites, such as the femoral neck, rich in cortical bone.
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Affiliation(s)
- M Garton
- Department of Rheumatology, City Hospital, Aberdeen, UK
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