226
|
Hadjikoumi I, Ghazavi M, Fallon P, Clarke A. Survey of telephone calls to tertiary paediatric neurology specialist registrars. Arch Dis Child 2007; 92:561-2. [PMID: 17515632 PMCID: PMC2066176 DOI: 10.1136/adc.2007.117531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
227
|
Stiell I, Clement C, Grimshaw J, Brison R, Rowe B, Schull M, Lee J, Brehaut J, Letovsky E, MacPhail I, Shah A, Ross S, McKnight R, Dreyer J, Edmonds M, Rutledge T, Clarke A, Perry J, Wells G, Study Group. A Cluster Randomized Knowledge Transfer Trial in 4,457 Minor Head Injury Patients. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
228
|
Fraser K, Bowgen A, Peck L, Clarke A. Are the costs of synthesising proteins elevated or decreased at polar water temperatures? Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
229
|
Gregory M, Boddington P, Dimond R, Atkinson P, Clarke A, Collins P. Communicating about haemophilia within the family: the importance of context and of experience. Haemophilia 2007; 13:189-98. [PMID: 17286773 DOI: 10.1111/j.1365-2516.2006.01417.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study examines communication within families affected by haemophilia, focusing especially on communication about carrier status. A qualitative study using semi-structured interviews with family members in the UK revealed recurrent patterns in communication strategies and styles. Participants drew a marked contrast between the nature of communication within the clinic and within the home. In families, it is notable that communication usually occurs within the context of concrete experience of the condition. Noticeable differences existed in families with obligate carriers when compared with families with non-obligate carrier daughters. In families with affected sons, daughters may have more experience of haemophilia and consequently more understanding of their possible carrier status than in families with an affected father. Families also typically make value judgements and comments on coping strategies when they communicate about the condition. Readiness to receive information is very variable, and depends upon factors such as personality and life stage. Information may seem to be successfully communicated but the recipient may sometimes actually comprehend much less, only understanding more fully later or when the information becomes directly relevant to them. Periodic checking of understanding of different family members, and the provision of written information, may be helpful.
Collapse
|
230
|
Bernatsky S, Clarke A, Gladman DD, Urowitz M, Fortin PR, Barr SG, Senécal JL, Zummer M, Edworthy S, Sibley J, Pope J, Ensworth S, Ramsey-Goldman R, Hanly JG. Mortality related to cerebrovascular disease in systemic lupus erythematosus. Lupus 2007; 15:835-9. [PMID: 17211987 DOI: 10.1177/0961203306073133] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to examine mortality rates related to cerebrovascular disease in systemic lupus erythematosus (SLE) compared to the general population. Our sample was a multisite Canadian SLE cohort (10 centres, n = 2688 patients). Deaths due to cerebrovascular disease were ascertained by vital statistics registry linkage using ICD diagnostic codes. Standardized mortality ratio (SMR, ratio of deaths observed to expected) estimates were calculated. The total SMR for death due to cerebrovascular disease was 2.0 (95% confidence interval [CI] 1.0, 3.7). When considering specific types of events, the category with the greatest increased risk was that of ill-defined cerebrovascular events (SMR 44.9 95% CI 9.3, 131.3) and other cerebrovascular disease (SMR 8.4, 95% CI 2.3, 21.6). Deaths due to cerebral infarctions appeared to be less common than hemorrhages and other types of cerebrovascular events. Our data suggest an increase in mortality related to cerebrovascular disease in SLE patients compared to the general population. The large increase in ill-defined cerebrovascular events may represent cases of cerebral vasculitis or other rare forms of nervous system disease; alternately, it may reflect diagnostic uncertainty regarding the etiology of some clinical presentations in SLE patients. The suggestion that more deaths are attributed to cerebral hemorrhage, as opposed to infarction, indicates that inherent or iatrogenic factors (eg, thrombocytopenia or anticoagulation) may be important. In view of the paucity of large-scale studies of mortality attributed to neuropsychiatric outcomes in SLE, our findings highlight the need for additional research in large SLE cohorts.
Collapse
|
231
|
Bernatsky S, Ramsey-Goldman R, Isenberg D, Rahman A, Dooley MA, Sibley J, Boivin JF, Joseph L, Armitage J, Zoma A, Clarke A. Hodgkin's lymphoma in systemic lupus erythematosus. Rheumatology (Oxford) 2007; 46:830-2. [PMID: 17255135 DOI: 10.1093/rheumatology/kel444] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In systemic lupus erythematosus (SLE), there is a well-documented increased risk of non-Hodgkin's lymphoma (NHL), but little is known about the risk of Hodgkin's lymphoma (HL). The purpose of our work was to describe the phenomenon of HL in SLE. METHODS A multi-site cohort of 9547 SLE subjects was assembled; HL cases were ascertained through cancer registry linkage, and the standardized incidence ratio (SIR) for HL was determined. We also performed a literature search for HL cases in SLE, and compared these with our sample. Finally, we pooled results from our cohort study with two large population-based cohort studies providing SIR estimates for HL in SLE. RESULTS Five cases of HL occurred in our SLE cohort during the observation interval, for an SIR of 2.4 (95% CI 0.8, 5.5). The literature review documented 13 HL case reports developing in patients with SLE. A pooled analysis combining our data with the other large cohort studies yielded a standardized incidence ratio of 3.16 (95% CI, 1.63-5.51) for HL in SLE. CONCLUSIONS Data suggest that risk in SLE is increased not only for NHL, but also for other malignancies arising from B-lymphocytes, including HL.
Collapse
|
232
|
Clarke A, Gatineau M, Thorogood M, Wyn-Roberts N. Health promotion research literature in Europe 1995 2005. Eur J Public Health 2007; 17 Suppl 1:24-8. [PMID: 17666418 DOI: 10.1093/eurpub/ckm062] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To undertake an overview of health promotion research in the EEA to inform the collaborative study-SPHERE (Strengthening Public Health Research in Europe). METHODS A 'filter' (search strategy) was used to search Medline and Embase for a 10-year period from 1995 to 2005. A 32% (6000) sample of the filter output was assessed for proportion constituting health promotion. Output was analysed by country, population, gross domestic product (GDP) and health need (disability-adjusted life years, DALYs). Disease prevention (screening and immunization) and health improvement papers were separately identified. The latter were classified by methodology, level of intervention and topic area. RESULTS 18,862 papers were identified. One-third was identified as health promotion (2206/6000, 36.7%) equivalent to 6935 (CI 6651-7230). Production varied: Nordic countries were highest producers per million population; the UK the largest net producer. There was a weak relationship between health promotion publication and population size (r(2) = 0.38); a weak inverse relationship with relative health (DALYs per million population) (r(2) = 0.07) and a slightly stronger relationship with GDP (r(2) = 0.45). Twenty-eight percent (626/2206) of the papers identified were disease prevention (screening and immunization). The largest topic areas of the remainder (1580) were diet and exercise, smoking and tobacco, and cardiovascular disease reduction. Accidents and violence, alcohol and mental health each accounted for <5% of total output. Intervention studies were a minority; with less aimed at the regional/national or policy or legal and fiscal levels. CONCLUSION Health promotion research production varies across Europe. Research commissioning should stress interventional and policy level research.
Collapse
|
233
|
|
234
|
Bernatsky S, Clarke A, Pope J, Hanly JG, Smith CD, Peschken C, Rich E, Boire G, Fortin PR. Malignancy prevalence in the first-degree relatives of persons with systemic lupus erythematous: a pilot study. Lupus 2006; 15:695-6. [PMID: 17120599 DOI: 10.1177/0961203306072424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
235
|
Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Gladman DD, Urowitz M, Fortin PR, Petri M, Barr S, Gordon C, Bae SC, Isenberg D, Zoma A, Aranow C, Dooley MA, Nived O, Sturfelt G, Steinsson K, Alarcón G, Senécal JL, Zummer M, Hanly J, Ensworth S, Pope J, Edworthy S, Rahman A, Sibley J, El-Gabalawy H, McCarthy T, St Pierre Y, Clarke A, Ramsey-Goldman R. Mortality in systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 54:2550-7. [PMID: 16868977 DOI: 10.1002/art.21955] [Citation(s) in RCA: 755] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled. METHODS Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined. RESULTS The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001. CONCLUSION Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.
Collapse
|
236
|
Evans JC, Archer HL, Whatley SD, Clarke A. Germline mosaicism for a MECP2 mutation in a man with two Rett daughters. Clin Genet 2006; 70:336-8. [PMID: 16965328 DOI: 10.1111/j.1399-0004.2006.00691.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rett syndrome is a severe neurodevelopmental disorder that is caused by mutations in the X-linked gene, methyl-CpG binding protein 2 (MECP2). The majority of cases are sporadic, but rarely germline mosaicism can lead to familial cases. Here, we report the first case where germline mosaicism for a MECP2 mutation has been shown in a man. He has two affected daughters who are half sisters, and both have the c.808delC mutation. We show that this mutation is present at a low level in DNA extracted from the patient's semen. This case has implications for genetic counseling, and pre-natal testing should be offered for the partners of men who have a daughter with Rett syndrome.
Collapse
|
237
|
|
238
|
Parikh AR, Kok K, Redfern B, Clarke A, Withey S, Butler PEM. A Portal to Validated Websites on Cosmetic Surgery. Ann Plast Surg 2006; 57:350-2. [PMID: 16929210 DOI: 10.1097/01.sap.0000216244.81900.3b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has recently been an increase in the usage of the Internet as a source of patient information. It is very difficult for laypersons to establish the accuracy and validity of these medical websites. Although many website assessment tools exist, most of these are not practical.A combination of consumer- and clinician-based website assessment tools was applied to 200 websites on cosmetic surgery. The top-scoring websites were used as links from a portal website that was designed using Microsoft Macromedia Suite.Seventy-one (35.5%) websites were excluded. One hundred fifteen websites (89%) failed to reach an acceptable standard.The provision of new websites has proceeded without quality controls. Patients need to be better educated on the limitations of the Internet. This paper suggests an archetypal model, which makes efficient use of existing resources, validates them, and is easily transferable to different health settings.
Collapse
|
239
|
Torrance N, Mollison J, Wordsworth S, Gray J, Miedzybrodzka Z, Haites N, Grant A, Campbell M, Watson MS, Clarke A, Wilson B. Genetic nurse counsellors can be an acceptable and cost-effective alternative to clinical geneticists for breast cancer risk genetic counselling. Evidence from two parallel randomised controlled equivalence trials. Br J Cancer 2006; 95:435-44. [PMID: 16832415 PMCID: PMC2360658 DOI: 10.1038/sj.bjc.6603248] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 06/05/2006] [Accepted: 06/08/2006] [Indexed: 11/09/2022] Open
Abstract
This study compared genetic nurse counsellors with standard services for breast cancer genetic risk counselling services in two regional genetics centres, in Grampian region, North East Scotland and in Cardiff, Wales. Women referred for genetic counselling were randomised to an initial genetic counselling appointment with either a genetic nurse counsellor (intervention) or a clinical geneticist (current service, control). Participants completed postal questionnaires before, immediately after the counselling episode and 6 months later to assess anxiety, general health status, perceived risk and satisfaction. A parallel economic evaluation explored factors influencing cost-effectiveness. The two concurrent randomised controlled equivalence trials were conducted and analysed separately. In the Grampian trial, 289 patients (193 intervention, 96 control) and in the Wales trial 297 patients (197 intervention and 100 control) returned a baseline questionnaire and attended their appointment. Analysis suggested at least likely equivalence in anxiety (the primary outcome) between the two arms of the trials. The cost per counselling episode was 11.54 UK pounds less for nurse-based care in the Grampian trial and 12.50 UK pounds more for nurse-based care in Cardiff. The costs were sensitive to the grade of doctor (notionally) replaced and the extent of consultant supervision required by the nurse. In conclusion, care based on genetic nurse counsellors was not significantly different from conventional cancer genetic services in both trial locations.
Collapse
|
240
|
Justham T, Jarvis S, Clarke A, Garner CP, Hargrave GK, Halliwell NA. Simultaneous Study of Intake and In-Cylinder IC Engine Flow Fields to Provide an Insight into Intake Induced Cyclic Variations. ACTA ACUST UNITED AC 2006. [DOI: 10.1088/1742-6596/45/1/019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
241
|
Jarvis S, Justham T, Clarke A, Garner CP, Hargrave GK, Halliwell NA. Time Resolved Digital PIV Measurements of Flow Field Cyclic Variation in an Optical IC Engine. ACTA ACUST UNITED AC 2006. [DOI: 10.1088/1742-6596/45/1/007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
242
|
Tatton-Brown K, Douglas J, Coleman K, Baujat G, Chandler K, Clarke A, Collins A, Davies S, Faravelli F, Firth H, Garrett C, Hughes H, Kerr B, Liebelt J, Reardon W, Schaefer GB, Splitt M, Temple IK, Waggoner D, Weaver DD, Wilson L, Cole T, Cormier-Daire V, Irrthum A, Rahman N. Multiple mechanisms are implicated in the generation of 5q35 microdeletions in Sotos syndrome. J Med Genet 2006; 42:307-13. [PMID: 15805156 PMCID: PMC1736029 DOI: 10.1136/jmg.2004.027755] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sotos syndrome is characterised by learning difficulties, overgrowth, and a typical facial appearance. Microdeletions at 5q35.3, encompassing NSD1, are responsible for approximately 10% of non-Japanese cases of Sotos. In contrast, a recurrent approximately 2 Mb microdeletion has been reported as responsible for approximately 50% of Japanese cases of Sotos. METHODS We screened 471 cases for NSD1 mutations and deletions and identified 23 with 5q35 microdeletions. We investigated the deletion size, parent of origin, and mechanism of generation in these and a further 10 cases identified from published reports. We used "in silico" analyses to investigate whether repetitive elements that could generate microdeletions flank NSD1. RESULTS Three repetitive elements flanking NSD1, designated REPcen, REPmid, and REPtel, were identified. Up to 18 cases may have the same sized deletion, but at least eight unique deletion sizes were identified, ranging from 0.4 to 5 Mb. In most instances, the microdeletion arose through interchromosomal rearrangements of the paternally inherited chromosome. CONCLUSIONS Frequency, size, and mechanism of generation of 5q35 microdeletions differ between Japanese and non-Japanese cases of Sotos. Our microdeletions were identified from a large case series with a broad range of phenotypes, suggesting that sample selection variability is unlikely as a sole explanation for these differences and that variation in genomic architecture might be a contributory factor. Non-allelic homologous recombination between REPcen and REPtel may have generated up to 18 microdeletion cases in our series. However, at least 15 cannot be mediated by these repeats, including at least seven deletions of different sizes, implicating multiple mechanisms in the generation of 5q35 microdeletions.
Collapse
|
243
|
Hamilton D, Aronsen P, Løken JH, Berg IM, Skotheim R, Hopper D, Clarke A, Briffa NK. Dance training intensity at 11-14 years is associated with femoral torsion in classical ballet dancers. Br J Sports Med 2006; 40:299-303; discussion 303. [PMID: 16556782 PMCID: PMC2577517 DOI: 10.1136/bjsm.2005.020941] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine in a cross sectional study the influence of femoral torsion (FT) and passive hip external rotation (PER) on turnout (TO). Starting age, years of classical ballet training, and current and past dance training intensity were assessed to determine their influence on FT, PER, and TO in pre-professional female dancers. METHODS Sixty four dancers (mean (SD) age 18.16 (1.80) years) were recruited from four different dance training programmes. They completed a dance history questionnaire. FT was measured using a clinical method. PER was measured with the subjects prone, and TO was measured with the subjects standing. RESULTS Mean TO was 136 degrees, mean unilateral PER was 49.4 degrees, and mean FT was 18.4 degrees. A positive correlation was observed between PER combined (PERC) and TO (r = 0.443, p < 0.001). A negative association was found between FT combined (FTC) and PERC (r = -0.402, p = 0.001). No association was found between starting age or years of classical ballet training and FTC, PERC, or TO. Dancers who trained for six hours a week or more during the 11-14 year age range had less FT than those who trained less (mean difference 6 degrees, 95% confidence interval 1.4 to 10.3). Students currently training for longer had higher levels of TO (p < 0.001) but comparable PERC and FTC. CONCLUSION FT is significantly associated with PERC. Dancers who trained for six hours a week or more at 11-14 years of age had significantly less FT. FTC had a significant influence on PERC, but no influence on the execution of TO.
Collapse
|
244
|
Parikh AR, Clarke A, Butler PEM. Plastic surgery and the undergraduate medical school curriculum. MEDICAL EDUCATION 2006; 40:476-7. [PMID: 16635148 DOI: 10.1111/j.1365-2929.2006.02425.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
|
245
|
Abstract
Since the discovery of hepatitis C virus (HCV) in 1989, there has been much debate regarding its potential modes of transmission particularly as only about half of the reported cases of acute HCV have a defined parenteral exposure. It has been clearly established that blood-blood contact is important in its transmission, but the question of sexual transmission has caused more controversy with studies producing conflicting evidence. The objective of this review was to examine the current evidence on all reported routes of transmission of hepatitis C with particular attention to sexual transmission in men having sex with men (MSM) and HIV-positive individuals. We conducted PubMed searches using keywords hepatitis C, transmission, sexual, HIV, MSM, mother to child, haemophilia, intravenous drug use, tattooing and skin piercing. The bibliographies in articles identified were also searched.
Collapse
|
246
|
Archer HL, Evans J, Edwards S, Colley J, Newbury-Ecob R, O'Callaghan F, Huyton M, O'Regan M, Tolmie J, Sampson J, Clarke A, Osborne J. CDKL5 mutations cause infantile spasms, early onset seizures, and severe mental retardation in female patients. J Med Genet 2006; 43:729-34. [PMID: 16611748 PMCID: PMC2564572 DOI: 10.1136/jmg.2006.041467] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the frequency of mutations in CDKL5 in both male and female patients with infantile spasms or early onset epilepsy of unknown cause, and to consider whether the breadth of the reported phenotype would be extended by studying a different patient group. METHODS Two groups of patients were investigated for CDKL5 mutations. Group 1 comprised 73 patients (57 female, 16 male) referred to Cardiff for CDKL5 analysis, of whom 49 (42 female, 7 male) had epileptic seizure onset in the first six months of life. Group 2 comprised 26 patients (11 female, 15 male) with infantile spasms previously recruited to a clinical trial, the UK Infantile Spasms Study. Where a likely pathogenic mutation was identified, further clinical data were reviewed. RESULTS Seven likely pathogenic mutations were found among female patients from group 1 with epileptic seizure onset in the first six months of life, accounting for seven of the 42 in this group (17%). No mutations other than the already published mutation were found in female patients from group 2, or in any male patient from either study group. All patients with mutations had early signs of developmental delay and most had made little developmental progress. Further clinical information was available for six patients: autistic features and tactile hypersensitivity were common but only one had suggestive Rett-like features. All had a severe epileptic seizure disorder, all but one of whom had myoclonic jerks. The EEG showed focal or generalised changes and in those with infantile spasms, hypsarrhythmia. Slow frequencies were seen frequently with a frontal or fronto-temporal predominance and high amplitudes. CONCLUSIONS The spectrum of the epileptic seizure disorder, and associated EEG changes, in those with CDKL5 mutations is broader than previously reported. CDKL5 mutations are a significant cause of infantile spasms and early epileptic seizures in female patients, and of a later intractable seizure disorder, irrespective of whether they have suspected Rett syndrome. Analysis should be considered in these patients in the clinical setting.
Collapse
|
247
|
Mannan A, Ghani S, Clarke A, White P, Salmanta S, Butler PEM. Psychosocial outcomes derived from an acid burned population in Bangladesh, and comparison with Western norms. Burns 2006; 32:235-41. [PMID: 16448773 DOI: 10.1016/j.burns.2005.08.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 08/31/2005] [Indexed: 11/20/2022]
Abstract
Assault by acid burns typically results in severe disfigurement, yet the psychosocial impact of this injury is so far unreported. This study provides the first empirical data using standardised assessment scales, from 44 acid burns survivors in Bangladesh. Compared with published norms, individuals show high levels of psychological distress including social anxiety and avoidance, anxiety and depression. Consistent with the published literature, there is no relationship between severity of injury and level of psychological distress. One interesting feature of this population is the relative preservation of perceived self-concept, and this is discussed with relation to the supportive and therapeutic environment of the clinic where this group were studied. We also note an interesting sub-group who were attacked by members of their own family and for whom psychological morbidity seems particularly pronounced.
Collapse
|
248
|
Hanly JG, Urowitz MB, Sanchez-Guerrero J, Bae SC, Gordon C, Wallace DJ, Isenberg D, Alarcón GS, Clarke A, Bernatsky S, Merrill JT, Petri M, Dooley MA, Gladman D, Fortin PR, Steinsson K, Bruce I, Manzi S, Khamashta M, Zoma A, Aranow C, Ginzler E, Van Vollenhoven R, Font J, Sturfelt G, Nived O, Ramsey-Goldman R, Kalunian K, Douglas J, Thompson K, Farewell V. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study. ACTA ACUST UNITED AC 2006; 56:265-73. [PMID: 17195230 DOI: 10.1002/art.22305] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the prevalence, characteristics, attribution, and clinical significance of neuropsychiatric (NP) events in an international inception cohort of systemic lupus erythematosus (SLE) patients. METHODS The study was conducted by the Systemic Lupus International Collaborating Clinics (SLICC). Patients were enrolled within 15 months of fulfilling the American College of Rheumatology (ACR) SLE classification criteria. All NP events within a predefined enrollment window were identified using the ACR case definitions of 19 NP syndromes. Decision rules were derived to determine the proportion of NP disease attributable to SLE. Clinical significance was determined using the Short Form 36 (SF-36) Health Survey and the SLICC/ACR Damage Index (SDI). RESULTS A total of 572 patients (88% female) were recruited, with a mean +/- SD age of 35 +/- 14 years. The mean +/- SD disease duration was 5.2 +/- 4.2 months. Within the enrollment window, 158 of 572 patients (28%) had at least 1 NP event. In total, there were 242 NP events that encompassed 15 of 19 NP syndromes. The proportion of NP events attributed to SLE varied from 19% to 38% using alternate attribution models and occurred in 6.1-11.7% of patients. Those with NP events, regardless of attribution, had lower scores on the SF-36 and higher SDI scores compared with patients with no NP events. CONCLUSION Twenty-eight percent of SLE patients experienced at least 1 NP event around the time of diagnosis of SLE, of which only a minority were attributed to SLE. Regardless of attribution, the occurrence of NP events was associated with reduced quality of life and increased organ damage.
Collapse
|
249
|
Clarke A. Commentary on Duncan and Delatycki, ‘Predictive genetic testing in young people for adult onset conditions: where is the empiric evidence? Clin Genet 2005. [DOI: 10.1111/j.1399-0004.2006.00556.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
250
|
Clarke A, Jancy J, Howat P. 275 Recruitment and retention in a physical activity intervention for insufficiently active 65 to 75 year old adults. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|