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Thomas R, Mantero J, Pérez-Moreno SM, Ruiz-Canovas C, Vioque I, Isaksson M, Forssell-Aronsson E, Holm E, García-Tenorio R. 226Ra, 210Po and lead isotopes in a pit lake water profile in Sweden. J Environ Radioact 2020; 223-224:106384. [PMID: 32919820 DOI: 10.1016/j.jenvrad.2020.106384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/01/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
A pit lake arises as a consequence of anthropogenic activities in opencast mining areas. These water bodies may be enriched in hazardous stable contaminants and/or in naturally occurring radionuclides depending on the local geological conditions. Mining legacy in Sweden produced hundreds of these pit lakes and most of them are used for recreational purposes in the southern part of the country. In this paper, one pit lake was selected for having enhanced levels of natural radionuclides. Physico-chemical parameters (temperature, pH, oxidation-reduction potential, dissolved oxygen and depth), elemental composition (via Inductive Coupled Plasma Mass Spectrometry) and radiometric characterization (via alpha spectrometry of 226Ra, 210Po and 210Pb) were carried along the depth of a 60 m depth pit lake, with the main aim to describe how natural radionuclides and elements behaves with depth in a non-uraniferous pit lake. Based on observed changes in physico-chemical parameters, a thermocline and a chemocline region were identified at around 10 and 30 m depth respectively. Concerning radionuclides, 226Ra ranged from 75 ± 3 up to 360 ± 12 mBq/kg while 210Po ranged from 11 ± 1 up to 71 ± 3 mBq/kg. 210Pb distribution with depth was also determined via secular equilibrium with 210Po after 2 years and also stable Pb was measured. Disequilibrium 226Ra-210Pb was found and the residence time of 210Pb in the water column was assessed. Additionally, different vertical distributions between 210Pb and Pb were found which points out different sources for different lead isotopes in the water body.
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Affiliation(s)
- R Thomas
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden
| | - J Mantero
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden; Department of Applied Physics II, ETSA, Universidad de Sevilla, Seville, 41012 Spain.
| | - S M Pérez-Moreno
- Group of Radiation Physics and Environment, Universidad de Huelva, Huelva, Spain
| | - C Ruiz-Canovas
- Department of Earth Sciences & Research Center on Natural Resources, Health and the Environment. University of Huelva, Huelva, 21071, Spain
| | - I Vioque
- Department of Applied Physics II, ETSA, Universidad de Sevilla, Seville, 41012 Spain
| | - M Isaksson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden
| | - E Forssell-Aronsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden
| | - E Holm
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden
| | - R García-Tenorio
- Department of Applied Physics II, ETSA, Universidad de Sevilla, Seville, 41012 Spain; Spanish National Accelerator Centre (CNA), US-JA-CSIC, Sevilla, 41092, Spain
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Thomas R, Charrier L, Bo M, Zotti CM. Is obligation the proper policy to increase immunization coverage? A comparison of 16 OECD countries. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1408] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
Globally, between 2016 and 2018, low vaccination coverage rates led to an increase of measles cases and related deaths. The WHO European Region reported a total of 83540 measles cases and 74 deaths in 2018, versus the 5273 cases and 13 deaths in 2016, with WHO global estimates reporting 333445 cases. In order to contrast these outbreaks, the European Vaccine Action Plan 2015-2020 states that the ideal immunization coverage for measles must be 95%. Although, this rate is not reached and maintained everywhere, thus one debated solution is to adopt compulsory vaccination plans rather than recommended. Our aim is to analyse if compulsory policies may increase coverage.
Description
Between 2014 and 2018 3 countries (Italy, France and California) changed their measles vaccination policies from recommended to compulsory to fight low immunization. In order to describe the effects of this action, we compared their measles coverage rates in 2014 and 2018 together with other 12 OECD countries rates who adopt both recommendation and obligation, evaluating the trend variations. Data were collected from OECD's, WHO's and Ministries of Health's documents.
Results
After the introduction of obligation, California (91% in 2014; 95% in 2018) and Italy (87% to 94%) coverage rates increased, while France's reduced (91% to 90%). Of other mandatory countries, only Australia showed an increase (94% to 95%); totally, 37.5% mandatory countries showed an increase among the analysed ones. Through the same period, 50% of analysed countries with recommendation maintained rates over 95%, 10% increased, while 40% remained below 95%.
Lessons
Even if mandatory vaccinations can lead to a sharp increase of coverage in a short time in response to emergency situations, the causes and solutions of hesitancy are more complex than law enforcement. Some countries without obligation show rates constantly above 95% throughout the years, demonstrating that other measures can be taken to fight low immunization.
Key messages
Apart from estimates coming from WHO and OECD, it is difficult to find extensive and official information about the application and the effectiveness of vaccination policies in different countries. Low immunization coverage rates rely on different causes (information, religion, personal beliefs, trust), thus the application of mandatory vaccination alone is not sufficient to fight hesitancy.
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Affiliation(s)
- R Thomas
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - L Charrier
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - M Bo
- Department of Forensic Medicine, ASL TO5, Chieri, Italy
| | - C M Zotti
- Department of Public Health Sciences, University of Turin, Turin, Italy
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Page C, Videka L, Neale J, Buche J, Thomas R, Gaiser M, Wayment C, Beck A. The Effects of State Regulations and Medicaid Plans on the Peer Support Specialist Workforce. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- C. Page
- University of Michigan Behavioral Health Workforce Research Center Ann Arbor MI United States
| | - L. Videka
- University of Michigan Ann Arbor MI United States
| | - J. Neale
- University of Michigan Ann Arbor MI United States
| | - J. Buche
- University of Michigan Behavioral Health Workforce Research Center Ann Arbor MI United States
| | - R. Thomas
- University of Michigan Behavioral Health Workforce Research Center Ann Arbor MI United States
| | - M. Gaiser
- University of Michigan Behavioral Health Workforce Research Center Ann Arbor MI United States
| | - C. Wayment
- University of Michigan Behavioral Health Workforce Research Center Ann Arbor MI United States
| | - A. Beck
- American Journal of Preventive Medicine Ann Arbor MI United States
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Sheetal S, Thomas R, Kumar AS, Tomy LG. Plus-minus lid syndrome with ataxia and severe apathy-A rare manifestation of midbrain infarct. J Postgrad Med 2020; 66:162-164. [PMID: 32675453 PMCID: PMC7542061 DOI: 10.4103/jpgm.jpgm_709_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Plus-minus lid syndrome is a rare manifestation of midbrain infarct, characterized by ptosis of one eye and lid retraction in the other eye. It has also been described in ocular myasthenia gravis, orbital myositis, or after lesions of the oculomotor nerve. Our patient was a 55-year-old man with hypertension and atrial fibrillation, who presented to us with acute onset left-sided ptosis and right-sided eyelid retraction. He was apathic and had right-sided ataxia. His MRI of the brain showed acute infarct involving the paramedian midbrain. To our knowledge, severe apathy and resultant executive function disorder have not been described previously in a patient having plus-minus lid syndrome with ataxia.
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Affiliation(s)
- S Sheetal
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
| | - R Thomas
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
| | - A S Kumar
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
| | - L G Tomy
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
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Weston O, Thomas R, Adshead R, Donnelly S, Pakozdi A, Purkayastha N. FRI0297 COMPARISON OF EFFICACY OF SECUKINUMAB VS ANTI-TNF AS SECOND LINE BIOLOGIC THERAPY IN AXIAL SPONDYLOARTHROPATHY BASED ON BASDAI RESPONSE IN AN OBSERVATIONAL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Modern biologic therapies have demonstrated encouraging results in the treatment of axial spondylarthropathy (AxSpA). The benefits of interleukin-17 inhibitors (IL-17i), as first and second line therapies, are well established [1, 2]. A systematic literature review by Navarro-Compán has shown some benefit of second line therapies using both anti-tumour necrosis factor (anti-TNF) and IL-17i [3]. To our knowledge, there are currently no studies that have directly compared which pathway has a better overall outcome. This is therefore the first observational study directly comparing both treatment arms after anti-TNF had been administered as first line therapy.Objectives:To investigate which second line therapy is superior, anti TNF or IL-17i (secukinumab), in patients with AxSpA, that have failed first line anti-TNF therapy.Methods:Patient data was extracted from the Whipps Cross Hospital Rheumatology biologics registry database. All patients selected were required to have a diagnosis of AxSpA on magnetic resonance imaging (MRI). The patient cohort that was selected had previously been treated with anti-TNF as a first line therapy and were being considered for second line therapy with either anti-TNF or IL-17i. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded at 3, 6 and 12 months to assess treatment response. The unpaired t-test was used to assess the significance between the treatment groups and were analysed using the R statistical package.Results:Seventy patients were identified for this study of which, 57% (46/70) were male and 37% (26/70) were female. The age ranged from 30-97 years, with an average age of 72. The HLA-B27 gene association in this cohort was 71% (50/70). Three patients out of the cohort had psoriatic spondylarthropathy and the remaining had isolated AxSpA. There were an equal number of secukinumab and anti-TNF patients. The anti-TNF patients were subdivided into their respective anti-TNF drug (listed in Table 1).Table 1.Frequency of individual anti-TNF drugs used in this cohort.Anti-TNF drugFrequency usedAdalimumab9/35Certolizumab8/35Etanercept17/35Golimumab1/35This study revealed that the patients experienced an average of a 52% reduction in the BASDAI score after 6 months of anti-TNF treatment compared to only a 6% reduction in patients on secukinumab (P 0.009). However, the disease activity improvement at 12 months was not sustained in the anti-TNF group and at this stage there was no difference between the groups. Overall both treatment groups showed an average reduction in the BASDAI score by more than 30% at each 3 monthly interval.Figure 1.BASDAI percentage reduction at 3 monthly intervals between the two second line treatment groups using anti-TNF and Secukinumab.Conclusion:A significant difference could not be demonstrated between the anti-TNF and secukinumab groups in this observational cohort. Interestingly, at 6 months, anti-TNF demonstrated better outcomes according to BASDAI scores than Secukinumab but this efficacy was lost at 12 months. It was difficult to interpret these isolated results without further testing, as this is a small non-randomised study. We observed similar outcomes to the Navarro-Compán review where there was a low percentage change in the BASDAI improvement in patients on second line therapy when compared to first line treatment BASDAI scores. Therefore, exploring the mechanism for the reduction in the BASDAI response would be an interesting future study. Moreover, to fully understand these results, randomised controlled studies would need to be conducted.References:[1]Baeten el al. NEJM 2015.[2]van der Heijde et al. ARD 2018.[3]Navarro-Compán et al. RMD Open 2017.Disclosure of Interests:None declared
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Sun H, Dunham K, Cunningham L, Ni Y, Westover M, Thomas R. 0348 Sleep EEG-Based Brain Age Index is Reduced Under Continuous Positive Airway Pressure Treatment. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.345] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Continuous positive airway pressure (CPAP) is a treatment for apnea. With long-term CPAP, changes in electroencephalogram (EEG) include increased delta power (1 - 4Hz) and sigma power (11 - 15Hz, spindle). However, the short-term EEG response to CPAP in a split-night study is less quantified. We recently developed a “brain age” model using sleep EEG features. The brain age index (BAI) is defined as the difference between chronological age and brain age (BA - CA). Here we first quantify how BAI changes during CPAP in the same patient, and then investigate how much brain age features during the diagnostic part can predict the reduction in apnea-hypopnea index (AHI) during CPAP.
Methods
The dataset consisted of 160 subjects. The average age was 59 years with 53% male, 24% female and 23% unknown. We extracted 480 features including band powers, and then computed the BAIs for both diagnostic and CPAP parts. To predict the reduction in AHI during CPAP, we fit a Bayesian regression model using the brain age features, demographics, and sleep parameters during the diagnostic part, and assessed the feature importance using dominance analysis.
Results
The BAI from the diagnostic part is significantly reduced compared to BAI during CPAP for the same subject (paired t-test, p < 0.01). The diagnostic part has an average BAI 2.24 years; and the CPAP part -4.75 years. The brain age features that are increased during CPAP include sigma powers in N2 and N3. The prediction of AHI reduction has Pearson’s correlation 0.85. The features predictive of reduced AHI are the diagnostic AHI (explained variance 69%), followed by high/low waveforms during N2 (e.g. K-complex, measured by kurtosis) (8.6%), delta power during REM (4.5%) and N1 (2%). The feature predictive of increased AHI is frontal alpha power during quiet awake (2.6%).
Conclusion
The average BAI is reduced during CPAP. BAI provides a novel view of the acute response to CPAP in sleep EEG. Future study with more CPAP failure patients has the potential of predicting CPAP failure.
Support
MBW is supported by Glenn Foundation for Medical Research. RJT is supported by Category I AASM Foundation.
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Affiliation(s)
- H Sun
- Massachusetts General Hospital, Boston, MA
| | - K Dunham
- Beth Israel Deaconess Medical Center, Boston, MA
| | - L Cunningham
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Y Ni
- Beth Israel Deaconess Medical Center, Boston, MA
| | - M Westover
- Massachusetts General Hospital, Boston, MA
| | - R Thomas
- Beth Israel Deaconess Medical Center, Boston, MA
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Ni Y, Dunhsm K, Cunningham L, Thomas R. 0661 Comparison Between Ventilator Detected Apnea Hypopnea Index and Manual Scored Results. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.657] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The apnea hypopnea index and percentage of periodic breathing detected by the ventilator machine are often used by sleep doctors to evaluate whether sleep apnea has been adequately treated or need further interventions. There are concerns about the accuracy of this autodetection.
Methods
Patients with sleep apnea who were treated with positive airway pressure at the Beth Israel Deaconess Medical Center (Boston) and tracked by the EncoreAnywhere system were included. The machine detected AHI(AHIm) and PB(PBm) were extracted from the first week data in every month from the start of use. The manual scored AHI(AHIs) and PB(PBs) were calculated from the last waveform graph during every month. The apnea hypopnea index as well as periodic breathing in 1st, 2nd, 3rd,6th month AHIm, AHIs, PBm and PBs were compared respectively.
Results
A total of 128 patients were included. The mean age was 56.5 and 66% of them were male. In the first month, the mean AHIs was significantly higher than AHIm, 16.27 vs. 5.36, p<0.001. There was also a large difference between percentage of PBs and PBm, 15.55% vs. 1.96, p<0.001. 78% patients whose AHIm <5 were actually has AHIs >5. The Kappa value for the AHIm and AHIs were 0.074, p=0.069; the value of PBm and PBs was 0.216, p=0.015. In the 2nd, 3rd and 6th months, the mean difference between AHIs and AHIm was 10.58, 10.68, 10.12, respectively. The mean difference between PBs and PBm was 12.32%,11.53%,and 9.18%.
Conclusion
Autodetection of respiratory events consistently under-estimates the severity of residual events. Mean differences remained stable over 6 months. Caution is recommended when attributing non-apnea reasons for residual symptoms in patients with apparently low machine estimated AHI and PB.
Support
This study is supported by American Academy of Sleep Medicine Foundation, category-I award to RJT
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Affiliation(s)
- Y Ni
- Beth Israel Deaconess Medical Center, Brookline, MA
| | - K Dunhsm
- Beth Israel Deaconess Medical Center, Brookline, MA
| | - L Cunningham
- Beth Israel Deaconess Medical Center, Brookline, MA
| | - R Thomas
- Beth Israel Deaconess Medical Center, Brookline, MA
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Chopra S, Luthra S, Dalal L, Blattner M, August J, Thomas R, Heckaman E. 0592 Prevalence of Sleep Apnea in Patients with Tracheobronchomalacia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.589] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Tracheobronchomalacia (TBM) is a pathologic weakness in the trachea and bronchi leading to excessive dynamic narrowing of the airway. A relationship between sleep disordered breathing (SDB) and TBM has been observed before. SBD may be an important contributor to development or progression of TBM. The objective was to determine the Prevalence and characteristics of sleep disordered breathing in patients with tracheobronchomalacia.
Methods
We performed a retrospective chart review of patients who have been diagnosed with tracheobronchomalacia and who also underwent a polysomnogram (PSG) at the AASM - accredited Sleep Center of Beth Israel Deaconess Medical Center.
Results
In our 24 patient cohort of TBM, 71% were females, mean age 55 years (SD ± 12.3 years) and mean BMI 31.7 kg/m2 (SD ± 9.4 kg/m2). In patients with TBM we found a sleep apnea prevalence of 62.5% (n= 15), defined as an apnea-hypopnea index>5/hour (hour) with a desaturation greater than 4%. Of the 15 patients, 73.3% (n = 11) had mild sleep apnea, 20% (n = 3) had moderate sleep apnea, 6.6% (n = 1) had severe sleep apnea, defined per the AASM criteria with oxygen desaturation greater than 4%. The TBM cohort had a mean sleep efficiency of 72.7% (SD ± 22.2%) with a mean REM of 16.3% (SD ± 9.8 %). Other characteristics included a median AHI 3% of 19.9/hour (95% CI 3.9 - 25.0), median AHI 4% of 5.5/hour (95% CI 3.9 - 9.3), Respiratory disturbance index of 22/hour (95% CI 15.1 to 28.4). No unique challenges for treatment with positive airway pressure were noted.
Conclusion
Sleep apnea may be more common in patients with tracheobronchomalacia and could be regularly screened.
Support
none
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Cramp F, Thomas R, Haase A, Domaille M, Swales C, Hurfurt J, Manns S, Walsh N. A novel, theory based intervention to promote engagement in physical activity in early rheumatoid arthritis. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cheung M, Campbell J, Braybrook J, Thomas R, Petzing J. Benchmarking automated flow cytometry data analysis software using synthetic datasets. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Odgers-Jewell K, Ball LE, Reidlinger DP, Isenring EA, Thomas R, Kelly JT. Replicating group-based education interventions for the management of type 2 diabetes: a review of intervention reporting. Diabet Med 2020; 37:768-778. [PMID: 31646673 DOI: 10.1111/dme.14158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
AIMS To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes. METHODS A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors. RESULTS Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any individual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%). CONCLUSIONS Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.
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Affiliation(s)
- K Odgers-Jewell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - L E Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - D P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - E A Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - R Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - J T Kelly
- School of Public Health, University of Queensland, Brisbane, Australia
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Thomas R, Glen K, Stacey A, Holland P, Shariatzadeh M. Efficient design of cell based product manufacturing using low data demand modelling approaches. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.333] [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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Thomas R, Kjærgaard N. A digital feedback controller for stabilizing large electric currents to the ppm level for Feshbach resonance studies. Rev Sci Instrum 2020; 91:034705. [PMID: 32260003 DOI: 10.1063/1.5128935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/23/2020] [Indexed: 06/11/2023]
Abstract
Magnetic Feshbach resonances are a key tool in the field of ultracold quantum gases, but their full exploitation requires the generation of large, stable magnetic fields up to 1000 G with fractional stabilities of better than 10-4. Design considerations for electromagnets producing these fields, such as optical access and fast dynamical response, mean that electric currents in excess of 100 A are often needed to obtain the requisite field strengths. We describe a simple digital proportional-integral-derivative current controller constructed using a field-programmable gate array and off-the-shelf evaluation boards that allows for gain scheduling, enabling optimal control of current sources with non-linear actuators. Our controller can stabilize an electric current of 337.5 A to the level of 7.5 × 10-7 in an averaging time of 10 min and with a control bandwidth of 2 kHz.
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Affiliation(s)
- R Thomas
- Department of Physics, QSO-Centre for Quantum Science, and Dodd-Walls Centre, University of Otago, Dunedin 9016, New Zealand
| | - N Kjærgaard
- Department of Physics, QSO-Centre for Quantum Science, and Dodd-Walls Centre, University of Otago, Dunedin 9016, New Zealand
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Mahmoodi E, Leitch J, Barlow M, Davies A, Collins N, Leigh L, Oldmeadow C, Fitzgerald J, Thomas R, Healey P, Boyle A, Jackson N. 252 Sedation Approaches in Atrial Fibrillation Ablation: Comparing Conscious Sedation with General Anaesthesia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.259] [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: 11/29/2022]
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Krewski D, Andersen ME, Tyshenko MG, Krishnan K, Hartung T, Boekelheide K, Wambaugh JF, Jones D, Whelan M, Thomas R, Yauk C, Barton-Maclaren T, Cote I. Toxicity testing in the 21st century: progress in the past decade and future perspectives. Arch Toxicol 2019; 94:1-58. [DOI: 10.1007/s00204-019-02613-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022]
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Mota T, Mccann C, Huang S, Dean M, Yanqin R, Thomas R, Colin K, David H, Jeffery S, Brad J. Histone deacetylase inhibitors induce transcription of unspliced but not multiply spliced HIV-1 RNA from proviral genomes during latency reversal, affecting antigen presentation and detection by CD8+ T cells. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30086-8] [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: 10/23/2022] Open
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Tokarev A, Geretz A, Ehrenberg P, Roederer M, Thomas R, Bolton D. Single-cell transcriptome of in vivo SIV-infected rhesus macaque CD4 T cells. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30128-x] [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: 10/23/2022] Open
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Thomas R, Waickman A, Ehrenberg P, Geretz A, Eller M, Tovanabutra S, Ananworanich J, Chomont N, Currier J, Michael N. Single cell RNA-seq identifies host genes that correlate with HIV-1 reservoir size. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30176-x] [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: 10/23/2022] Open
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Kron A, Alidousty C, Scheffler M, Merkelbach-Bruse S, Seidel D, Riedel R, Ihle MA, Michels S, Nogova L, Fassunke J, Heydt C, Kron F, Ueckeroth F, Serke M, Krüger S, Grohe C, Koschel D, Benedikter J, Kaminsky B, Schaaf B, Braess J, Sebastian M, Kambartel KO, Thomas R, Zander T, Schultheis AM, Büttner R, Wolf J. Impact of TP53 mutation status on systemic treatment outcome in ALK-rearranged non-small-cell lung cancer. Ann Oncol 2019; 29:2068-2075. [PMID: 30165392 PMCID: PMC6225899 DOI: 10.1093/annonc/mdy333] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background We analyzed whether co-occurring mutations influence the outcome of systemic therapy in ALK-rearranged non-small-cell lung cancer (NSCLC). Patients and methods ALK-rearranged stage IIIB/IV NSCLC patients were analyzed with next-generation sequencing and fluorescence in situ hybridization analyses on a centralized diagnostic platform. Median progression-free survival (PFS) and overall survival (OS) were determined in the total cohort and in treatment-related sub-cohorts. Cox regression analyses were carried out to exclude confounders. Results Among 216 patients with ALK-rearranged NSCLC, the frequency of pathogenic TP53 mutations was 23.8%, while other co-occurring mutations were rare events. In ALK/TP53 co-mutated patients, median PFS and OS were significantly lower compared with TP53 wildtype patients [PFS 3.9 months (95% CI: 2.4–5.6) versus 10.3 months (95% CI: 8.6–12.0), P < 0.001; OS 15.0 months (95% CI: 5.0–24.9) versus 50.0 months (95% CI: 22.9–77.1), P = 0.002]. This difference was confirmed in all treatment-related subgroups including chemotherapy only [PFS first-line chemotherapy 2.6 months (95% CI: 1.3–4.1) versus 6.2 months (95% CI: 1.8–10.5), P = 0.021; OS 2.0 months (95% CI: 0.0–4.6) versus 9.0 months (95% CI: 6.1–11.9), P = 0.035], crizotinib plus chemotherapy [PFS crizotinib 5.0 months (95% CI: 2.9–7.2) versus 14.0 months (95% CI: 8.0–20.1), P < 0.001; OS 17.0 months (95% CI: 6.7–27.3) versus not reached, P = 0.049] and crizotinib followed by next-generation ALK-inhibitor [PFS next-generation inhibitor 5.4 months (95% CI: 0.1–10.7) versus 9.9 months (95% CI: 6.4–13.5), P = 0.039; OS 7.0 months versus 50.0 months (95% CI: not reached), P = 0.001). Conclusions In ALK-rearranged NSCLC co-occurring TP53 mutations predict an unfavorable outcome of systemic therapy. Our observations encourage future research to understand the underlying molecular mechanisms and to improve treatment outcome of the ALK/TP53 co-mutated subgroup.
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Affiliation(s)
- A Kron
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - C Alidousty
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - M Scheffler
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - S Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - D Seidel
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - R Riedel
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - M A Ihle
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - S Michels
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - L Nogova
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - J Fassunke
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - C Heydt
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - F Kron
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - F Ueckeroth
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - M Serke
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Lungenklinik Hemer des Deutschen Gemeinschafts-Diakonieverbandes GmbH, Hemer, Germany
| | - S Krüger
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Florence Nightingale Hospital, Düsseldorf, Germany
| | - C Grohe
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Evangelische Lungenklinik Berlin (Paul Gerhardt Diakonie), Berlin, Germany
| | - D Koschel
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Fachkrankenhaus Coswig, Coswig, Germany
| | - J Benedikter
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Klinikum Bogenhausen, Munich, Germany
| | - B Kaminsky
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Krankenhaus Bethanien, Solingen, Germany
| | - B Schaaf
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Center, Klinikum Dortmund GmbH, Dortmund, Germany
| | - J Braess
- Network Genomic Medicine, Cologne, Germany; Department of Oncology and Hematology, Krankenhaus Barmherzige Brueder, Regensburg, Germany
| | - M Sebastian
- Network Genomic Medicine, Cologne, Germany; Department of Oncology and Hematology, University Hospital Frankfurt (Johannes-Wolfgang Goethe Institute), Frankfurt am Main, Germany
| | - K-O Kambartel
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Bethanien Hospital Moers-Lungenzentrum, Moers, Germany
| | - R Thomas
- Network Genomic Medicine, Cologne, Germany; Cologne Center for Genomics, University Hospital of Cologne, Cologne, Germany
| | - T Zander
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - A M Schultheis
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - R Büttner
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - J Wolf
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany.
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Aguilar-Arevalo A, Amidei D, Baxter D, Cancelo G, Cervantes Vergara BA, Chavarria AE, Darragh-Ford E, de Mello Neto JRT, D'Olivo JC, Estrada J, Gaïor R, Guardincerri Y, Hossbach TW, Kilminster B, Lawson I, Lee SJ, Letessier-Selvon A, Matalon A, Mello VBB, Mitra P, Molina J, Paul S, Piers A, Privitera P, Ramanathan K, Da Rocha J, Sarkis Y, Settimo M, Smida R, Thomas R, Tiffenberg J, Torres Machado D, Vilar R, Virto AL. Constraints on Light Dark Matter Particles Interacting with Electrons from DAMIC at SNOLAB. Phys Rev Lett 2019; 123:181802. [PMID: 31763884 DOI: 10.1103/physrevlett.123.181802] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Indexed: 06/10/2023]
Abstract
We report direct-detection constraints on light dark matter particles interacting with electrons. The results are based on a method that exploits the extremely low levels of leakage current of the DAMIC detector at SNOLAB of 2-6×10^{-22} A cm^{-2}. We evaluate the charge distribution of pixels that collect <10e^{-} for contributions beyond the leakage current that may be attributed to dark matter interactions. Constraints are placed on so-far unexplored parameter space for dark matter masses between 0.6 and 100 MeV c^{-2}. We also present new constraints on hidden-photon dark matter with masses in the range 1.2-30 eV c^{-2}.
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Affiliation(s)
| | - D Amidei
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
| | - D Baxter
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
| | - G Cancelo
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - A E Chavarria
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - E Darragh-Ford
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
| | - J R T de Mello Neto
- Universidade Federal do Rio de Janeiro, Instituto de Física, Rio de Janeiro 21.941-611, Brazil
| | - J C D'Olivo
- Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - J Estrada
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Gaïor
- Laboratoire de Physique Nucléaire et des Hautes Énergies (LPNHE), Sorbonne Université, Université de Paris, CNRS-IN2P3 75005, Paris France
| | - Y Guardincerri
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T W Hossbach
- Pacific Northwest National Laboratory (PNNL), Richland, Washington 99354, USA
| | - B Kilminster
- Universität Zürich Physik Institut, Zurich 8057, Switzerland
| | - I Lawson
- SNOLAB, Lively, Ontario P3Y 1N2, Canada
| | - S J Lee
- Universität Zürich Physik Institut, Zurich 8057, Switzerland
| | - A Letessier-Selvon
- Laboratoire de Physique Nucléaire et des Hautes Énergies (LPNHE), Sorbonne Université, Université de Paris, CNRS-IN2P3 75005, Paris France
| | - A Matalon
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
- Laboratoire de Physique Nucléaire et des Hautes Énergies (LPNHE), Sorbonne Université, Université de Paris, CNRS-IN2P3 75005, Paris France
| | - V B B Mello
- Universidade Federal do Rio de Janeiro, Instituto de Física, Rio de Janeiro 21.941-611, Brazil
| | - P Mitra
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - J Molina
- Facultad de Ingeniería, Universidad Nacional de Asunción, Asuncion 2169, Paraguay
| | - S Paul
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
| | - A Piers
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - P Privitera
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
- Laboratoire de Physique Nucléaire et des Hautes Énergies (LPNHE), Sorbonne Université, Université de Paris, CNRS-IN2P3 75005, Paris France
| | - K Ramanathan
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
| | - J Da Rocha
- Laboratoire de Physique Nucléaire et des Hautes Énergies (LPNHE), Sorbonne Université, Université de Paris, CNRS-IN2P3 75005, Paris France
| | - Y Sarkis
- Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - M Settimo
- SUBATECH, CNRS-IN2P3, IMT Atlantique, Université de Nantes, Nantes 44300, France
| | - R Smida
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
| | - R Thomas
- Kavli Institute for Cosmological Physics and The Enrico Fermi Institute, The University of Chicago, Chicago, Illinois 60637, USA
| | - J Tiffenberg
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Torres Machado
- Universidade Federal do Rio de Janeiro, Instituto de Física, Rio de Janeiro 21.941-611, Brazil
| | - R Vilar
- Instituto de Física de Cantabria (IFCA), CSIC-Universidad de Cantabria, Santander 39005, Spain
| | - A L Virto
- Instituto de Física de Cantabria (IFCA), CSIC-Universidad de Cantabria, Santander 39005, Spain
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Rajpurkar M, Williams S, Goldenberg N, Van Ommen C, Chan A, Thomas R, Biss T. Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children. Thromb Res 2019; 183:98-105. [DOI: 10.1016/j.thromres.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 01/08/2023]
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Thomas R, Diemer E, Siliquini R, Jansen PW. Childhood life events and disturbed eating behaviors in a population-based cohort in the Netherlands. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.168] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adversities such as maltreatment and physical and emotional abuse are recognized risk factors for eating disorders (EDs) in adolescents and adults, but whether such adversities are also associated with eating behaviors in childhood has been less explored. Our aim was to examine whether a wide range of life events can predict emotional overeating and restrained eating in childhood, which are potential precursors of EDs.
Methods
The study is embedded in Generation R, a prospective population-based cohort. The sample included 4653 children aged 10 years. Emotional overeating was assessed with the Children’s Eating Behavior Questionnaire, and restrained eating with the Dutch Eating Behavior Questionnaire. Mothers reported the occurrence of 24 adverse events in their offspring’s childhood. Regression analyses were conducted, both unadjusted and adjusted for gender, ethnicity, and parental education and psychopathology.
Results
Unadjusted models showed that a higher number of life events is associated with more emotional overeating and more restrained eating; effect estimates attenuated slightly in the adjusted model, but remained significant (per 1 more life event: B = 0.05, 95%CI 0.02-0.08; B = 0.04, 95%CI 0.02-0.07, respectively). Particularly, participants who experienced at least 3 life events had high levels of emotional overeating and restrained eating (adjusted model: B = 0.20, 95%CI 0.06-0.33; B = 0.21, 95%CI 0.08-0.33, respectively). The specific maltreatment related life events were not significantly associated with eating behaviors, probably due to low prevalence of these events (n = 149).
Conclusions
This novel, population-based study shows that early life adversities may predict disordered eating behaviors in childhood. The results are in line with clinical studies on life events and EDs. If the studied eating behaviors are indeed precursors of EDs, these results may offer potential for prevention and early intervention to avoid the development of full-blown EDs.
Key messages
Eating disorders account for more than 2% of the global disease burden, thus representing a major Public Mental Health topic in the EU; more and new measures are required for early detection purposes. Life adversities predict disordered eating behaviors in childhood, which are considered precursors of eating disorders: early detection of this association may avoid development of eating disorders.
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Affiliation(s)
- R Thomas
- Department of Public Health Sciences, University of Turin, Turin, Italy
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - E Diemer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
- The Generation R Study Group, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - P W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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de Nard F, De Vita E, Quattrone F, Thomas R, de la Torre L. Training on health communication and social media: European public health residents’ perceptions. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.099] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Theoretical knowledge about health communication (HC) and expertise in planning, implementation and evaluation of HC interventions are essential tools for Public Health (PH) specialists. In the social media (SM) era, specific abilities and digital communication skills are gaining importance.
Objective
Our aim is to describe European PH residents’ perceptions regarding their training in the HC field, with a focus on SM. We piloted a survey using Google Forms during the European Network of Medical Residents in PH (EuroNet MRPH) meeting in Turin, April 2019. We then spread the survey to other PH residents across Europe in July 2019. The survey consists of 25 questions (Likert scales from 1=strongly disagree to 5=strongly agree, or multiple-choices) divided in 5 thematic sections (HC theory, public speaking, traditional media based HC, SM based HC, HC impact evaluation). Questions aim to map HC topics covered in residency educational programs, learning methods, and the perceived importance of HC skills.
Results
The study included 114 residents from 10 countries (37% Italy, 23% Portugal, 10% UK, 9% Spain, 8% France, 13% other). Participants perceived they receive the best training in the areas of public speaking, impact assessment and HC theory (median 3, IQR 2-4). Conversely, for traditional and SM based HC, training was perceived as unsatisfactory (median 2, IQR 1-4 and 1-3 respectively) with self-education as main learning method (51%). Public speaking and traditional HC were identified as the most important HC skills for PH specialists (median 5, IQR 5-5), while less importance was attributed to SM based HC (median 3,5, IQR 3,25-5).
Conclusions
Despite SM are playing a crucial role in public HC, specific training seems to be scarce in this sample. Although residents perceive SM based HC skills as important, they consider them less important than other HC skills. Further analysis is needed in order to explore the perceived relevance of SM in PH residents training.
Key messages
Training on health communication via social media is scarce among European public health residencies. Common training programs across European residencies in PH should address this educational need. European public health residents perceive social media based health communication skills as important, but not as important as traditional media based health communication skills.
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Affiliation(s)
- F de Nard
- Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - E De Vita
- Traslational Research, New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Quattrone
- Traslational Research, New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Thomas
- Public Health Sciences, University of Turin, Turin, Italy
- Euronet Leads, EuroNet MRPH, Paris, France
| | - L de la Torre
- Servei de Medicina Preventiva i Epidemiologia, Hospital Clinic de Barcelona, Barcelona, Spain
- Euronet Board, EuroNet MRPH, Paris, France
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Turner S, Cotton SC, Emele CD, Thomas R, Fielding S, Gaillard EA, de Jongste JC, Morgan H, Neilson AR, Norrie J, Pijnenburg M, Price D, Thomas M. Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO). Trials 2019; 20:573. [PMID: 31585544 PMCID: PMC6778366 DOI: 10.1186/s13063-019-3500-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma. Methods This is a multi-centre, randomised controlled study. Children will be included of age 6–16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a “phenotyping” assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place. Discussion This study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children. Trial registration ISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.
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Affiliation(s)
- S Turner
- Child Health, University of Aberdeen, Aberdeen, UK.
| | - S C Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - C D Emele
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - R Thomas
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - S Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - E A Gaillard
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - J C de Jongste
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - H Morgan
- Postgraduate Education Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A R Neilson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - M Pijnenburg
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - D Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - M Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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Quintavalle C, Esposito C, Ingenito F, Affinito A, Roscigno G, Scognamiglio I, Nuzzo S, Catuogno S, Thomas R, Condorelli G. Aptamer-mediated exosomes detection for early breast cancer identification. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz269.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Iv M, Liu X, Lavezo J, Gentles AJ, Ghanem R, Lummus S, Born DE, Soltys SG, Nagpal S, Thomas R, Recht L, Fischbein N. Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making. AJNR Am J Neuroradiol 2019; 40:1649-1657. [PMID: 31515215 DOI: 10.3174/ajnr.a6211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Fractional tumor burden better correlates with histologic tumor volume fraction in treated glioblastoma than other perfusion metrics such as relative CBV. We defined fractional tumor burden classes with low and high blood volume to distinguish tumor from treatment effect and to determine whether fractional tumor burden can inform treatment-related decision-making. MATERIALS AND METHODS Forty-seven patients with high-grade gliomas (primarily glioblastoma) with recurrent contrast-enhancing lesions on DSC-MR imaging were retrospectively evaluated after surgical sampling. Histopathologic examination defined treatment effect versus tumor. Normalized relative CBV thresholds of 1.0 and 1.75 were used to define low, intermediate, and high fractional tumor burden classes in each histopathologically defined group. Performance was assessed with an area under the receiver operating characteristic curve. Consensus agreement among physician raters reporting hypothetic changes in treatment-related decisions based on fractional tumor burden was compared with actual real-time treatment decisions. RESULTS Mean lower fractional tumor burden, high fractional tumor burden, and relative CBV of the contrast-enhancing volume were significantly different between treatment effect and tumor (P = .002, P < .001, and P < .001), with tumor having significantly higher fractional tumor burden and relative CBV and lower fractional tumor burden. No significance was found with intermediate fractional tumor burden. Performance of the area under the receiver operating characteristic curve was the following: high fractional tumor burden, 0.85; low fractional tumor burden, 0.7; and relative CBV, 0.81. In comparing treatment decisions, there were disagreements in 7% of tumor and 44% of treatment effect cases; in the latter, all disagreements were in cases with scattered atypical cells. CONCLUSIONS High fractional tumor burden and low fractional tumor burden define fractions of the contrast-enhancing lesion volume with high and low blood volume, respectively, and can differentiate treatment effect from tumor in recurrent glioblastomas. Fractional tumor burden maps can also help to inform clinical decision-making.
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Affiliation(s)
- M Iv
- From the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
| | - X Liu
- Department of Neurosurgery (X.L.), Shengjing Hospital of China Medical University, Shenyang, China
| | - J Lavezo
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - A J Gentles
- Medicine (Biomedical Informatics Research) (A.J.G.)
| | - R Ghanem
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - S Lummus
- Pathology (J.L., R.G., S.L., D.E.B.)
| | - D E Born
- Pathology (J.L., R.G., S.L., D.E.B.)
| | | | - S Nagpal
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - R Thomas
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - L Recht
- Neurology (Neuro-Oncology) (S.N., R.T., L.R.), Stanford University, Stanford, California
| | - N Fischbein
- From the Departments of Neuroimaging and Neurointervention (M.I., N.F.)
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Thomas R. WS03.08 Panel - Emerging Therapies - Immunotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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78
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Thomas R, Daly S. EP1.06-08 A Retrospective Analysis on Sarcomatoid Mesothelioma to Identify If Chemotherapy Provides Greater Overall Survival Compared to BSC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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79
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Roscigno G, Quintavalle C, Affinito A, Cirella A, Cuccuru A, Thomas R, Condorelli G. Breast cancer organoids: A new tool for the prediction of drug penetration and patient outcome. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz269.022] [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: 11/12/2022] Open
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80
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Fischer R, George J, Scheel A, Schlösser H, Vehreschild M, Abdulla D, Koleczko S, Michels S, Nogova L, Riedel R, Scheffler M, Maas L, Brossart P, Engel-Riedel W, Griesinger F, Grohé C, Kern J, Hermes B, Nachtkamp K, Panse J, Sebastian M, Lehmann M, Wiewrodt R, Buettner R, Thomas R, Wolf J. OA15.05 BIOLUMA: A Phase II Trial of Nivolumab and Ipilimumab in Lung Cancer – Prospective Evaluation of TMB in SCLC Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.492] [Citation(s) in RCA: 1] [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: 10/25/2022]
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81
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Pinato D, Cole T, Bengsch B, Tait P, Sayed A, Abomeli F, Gramenitskaya D, Allara E, Thomas R, Ward C, Wong C, Akarca A, Miguens Blanco J, Marafioti T, Marchesi J, Sharma R. A phase Ib study of pembrolizumab following trans-arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): PETAL. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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82
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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Corrigendum to "Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of breast surgeons (ANISC)" [Breast 2019 56-60]. Breast 2019; 48:101. [PMID: 31543291 DOI: 10.1016/j.breast.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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83
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Thomas R, Wicks S, Toose C, Pacey V. Outcomes of Early Use of an End of Range Axilla Orthotic in Children Following Burn Injury. J Burn Care Res 2019; 40:678-688. [PMID: 30950500 DOI: 10.1093/jbcr/irz058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Scar contracture is a significant complication of burn injury. This study aimed to describe outcomes of early axilla orthotic use at end of range abduction in children, following a burn to the axilla region. A retrospective review of 76 children (mean age 3.9 years [SD 3.6]) treated at a tertiary children's hospital from 2006 to 2016 was conducted. No child developed axilla contracture for the duration of the 2-year study follow-up with no adverse events recorded. If orthotic use was ceased <60 days post-burn, it was considered not an essential intervention to maintain range of movement, leaving 49 children using the orthotic ≥60 days. Compared with the children who ceased orthotic use in <60 days, children who required the orthotic ≥60 days had a significantly higher frequency of deep-dermal burn (59 vs 25%, p = .01), flame mechanism (25 vs 5%, p = .03), and burn injury distribution involving the anterior trunk, flank, and arm (18 vs 3%, p = .03). Early signs of contracture, considered loss of full axilla range or significant banding, developed in nine children within 3 months post-burn. With intensive therapy, all returned to full axilla range by 9 months post-burn. Children with skin tension at end of range shoulder movement at the 1-month clinical assessment were 11 times more likely to develop early signs of contracture (95% confidence interval [CI]: 1.9-62.1, p = .007). Intensive orthotic use at end of range shoulder abduction in children with axilla burns is well tolerated. When undertaken with ongoing therapist review, full axilla range can be maintained.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Stephanie Wicks
- Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Claire Toose
- Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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84
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Furmenti M, Rossello P, Bianco S, Olivero E, Thomas R, Emelurumonye I, Zotti C, Moro ML, Brusaferro S, Sticchi C, Chadenier GM, D'Errico M, Ripabelli G, Prato R, Mura II, Agodi A, Collini F, Torri E, Novati R, Fedeli U. Healthcare-associated infections and antimicrobial use in long-term care facilities (HALT3): an overview of the Italian situation. J Hosp Infect 2019; 102:425-430. [DOI: 10.1016/j.jhin.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
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85
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Yaron J, Ambadapadi S, Zhang L, Tibbetts S, Keinan S, Chavan R, Varsani A, Maldonado J, Tafoya A, Bullard W, Kilbourne J, Munk B, Thomas R, Koppang E, Lim E, Lucas A. Gut Microbiota Determine Severity Of Lethal Gammaherpesvirus-Induced Vasculitis And Efficacy Of Immune-Modulating Therapy In Mice. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.220] [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: 10/26/2022]
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86
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Lyness A, Picken A, Thomas R. Evaluation of a vial adaptor to ensure safe and efficient needle-free transfer of cells post-cryopreservation in preparation for drug delivery. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.374] [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: 11/29/2022]
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87
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Abstract
Dendritic cells (DCs) are the key professional antigen-presenting cells which bridge innate and adaptive immune responses, inducing the priming and differentiation of naive to effector CD4+ T cells, the cross-priming of CD8+ T cells and the promotion of B cell antibody responses. DCs also play a critical role in the maintenance of immune homeostasis and tolerance. DC-T cell interactions underpin the generation of an autoimmune response in rheumatoid arthritis (RA). Here we describe the function of DCs and review evidence for DC and T cell involvement in RA pathogenesis, in particular through the presentation of self-peptide by DCs that triggers differentiation and activation of autoreactive T cells. Finally, we discuss the emerging field of targeting the DC-T cell interaction for antigen-specific immunotherapy of RA.
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Affiliation(s)
- P. Wehr
- The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra HospitalBrisbaneAustralia
| | - H. Purvis
- King's College London, Academic Department of Rheumatology, Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and MedicineLondonUK
| | - S.‐C. Law
- The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra HospitalBrisbaneAustralia
| | - R. Thomas
- The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra HospitalBrisbaneAustralia
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88
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Nogova L, Malchers F, Hillmer A, Merkelbach-Bruse S, Pinto A, Woempner C, Riedel R, Scheffler M, Michels S, De Porre P, Santiago-Walker A, Fischer R, Abdulla D, Thomas R, Buettner R, Wolf J. FIND: A phase II study to evaluate the efficacy of erdafitinib in FGFR-altered squamous NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.082] [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: 11/12/2022] Open
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89
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Gualano MR, Bert F, Passi S, Stillo M, Brescia V, Scaioli G, Thomas R, Voglino G, Minniti D, Boraso F, Siliquini R. Could shared decision making affect staying in hospital? A cross-sectional pilot study. BMC Health Serv Res 2019; 19:174. [PMID: 30885180 PMCID: PMC6423869 DOI: 10.1186/s12913-019-4002-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients’ perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region. Methods A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test. Results The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving “good” or “excellent” information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a “shared” decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure. Conclusions The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
| | - S Passi
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - M Stillo
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - V Brescia
- Department of Management, University of Torino, Torino, Italy
| | - G Scaioli
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - D Minniti
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - F Boraso
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
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90
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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of Breast Surgeons (ANISC). Breast 2019; 45:56-60. [PMID: 30877870 DOI: 10.1016/j.breast.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/07/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast angiosarcoma is a malignant mesenchymal neoplasm, which accounts for approximately 2% of all soft tissue sarcomas. Secondary breast angiosarcoma (SBA) may be related to chronic lymphedema after a mastectomy with lymph node dissection (Stewart Treves syndrome) and previous radiotherapy for complications from breast radiation treatment. It is a very rare condition; therefore, diagnosis and management are still a challenge. METHODS The ANISC collected SBA data by means of a survey sent to all Italian breast centres in the ANISC. The clinicopathological characteristics and the management of this disease were analysed. RESULTS Twenty-four centres participated in this survey in which 112 cases of SBA were analysed. The median age of the women with SBA was 68.9 years and it appeared approximately 90 months after the first irradiation for breast cancer. In 92% of cases, a mastectomy was performed without axillary dissection for those patients having a high grade of SBA (74.2%). The prognosis was worse in the high-grade cases (overall survival-OS: 36 months) as compared with the low-grade cases (OS: 48 months). After a follow-up of 5 years, 50.5% of the patients were still alive. Disease-free survival (DFS) was 35 months, and there were no differences between the groups of patients with either high- or low-grade histology. CONCLUSIONS Secondary breast angiosarcoma is a very aggressive disease associated with a short survival outcome. The surgical approach still remains an important step in the course of treatment; furthermore, an accurate histological examination is helpful in establishing the prognosis of the patient. A mastectomy is mandatory. A longer OS was observed in patients with low-grade angiosarcoma as compared to high-grade angiosarcoma (C.I. 40-57 vs. 31-41 months).
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Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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91
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Pepin A, Peterson J, Thomas R, Johnson K, Stark E, Biagi T, Kaltman R. Abstract PD6-12: Evaluating racial disparities in breast cancer referrals for hereditary risk assessment. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-12] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There is a pronounced onco-racial disparity in Washington, D.C., which had the highest national incidence of breast cancer in African Americans (AA) patients in between 2010-2015 and the worst outcomes (American Cancer Society). Recent data indicates a higher incidence of deleterious BRCA1 [and BRCA2] mutations and variants of uncertain significance (VUS) in AA patients compared to Caucasian (C) patients when controlled for patients of Ashkenazi Jewish (AJ) populations (Hall 2009). Despite this, AA women meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing are less likely to complete such testing compared to C women nationally. Studies have investigated psycho-social drivers of minority patient aversion to genetic testing. We hypothesize that lack of physician referral for cancer genetic counseling and testing for AA women contributes to this disparity.
Methods: The George Washington Cancer Center (GWCC) Registry was used to identify non-Hispanic African Americans (BNH) and non-Hispanic whites (WNH) treated for breast cancer between 2014-2018. Of those individuals selected for inclusion were those who met select NCCN criteria for referral for genetic evaluation including breast cancer diagnosis under age 50, triple negative breast cancer (TNBC) under age 60, and two primary breast cancers. Only BNH and WNH individuals were included. Excluded patients were those who were not BNH or WNH or who did not meet the NCCN criteria listed above. Patients were then stratified by race according to who underwent genetic evaluation, whether at our Ruth Paul Cancer Genetics and Prevention Service (RPCGPS) or elsewhere, by reviewing GWCC, RPCGPS, and patient clinic records for genetic testing results from outside institutions. Patient charts were used to identify individuals who received a physician referral over the course of their cancer care.
Results: 1180 patients were treated at the GWCC for breast cancer (both in situ and invasive carcinoma) between 2014–2018. Of those, BNH n=502; WNH n=435. Twenty-seven percent of BNH and WNH patients met the study criteria for referral for genetic evaluation (n=252; BNH n=115, WNH n=137), including breast cancer diagnosis under age 50 (BNH n=76; WNH n=108), TNBC under age 60 (BNH n=14; WNH n=5), and two primary breast cancers (BNH n=18, WNH n=16). Several patients identified met two or more criteria for referral (BNH n=7, WNH n=8). Physician referral rates differed significantly by race (BNH 76%, n=87 and WNH 91%; n=125; χ2=11.4, p-value<0.001). Of referred patients, there was no significant difference in those who followed-up at RPCGPS by race (BNH 93%, n=81; WNH= 93%, n=116, χ2 =0.0072, p-value=0.93).
Conclusions: Low genetic testing rates for AA breast cancer patients are an impediment to resolving the prominent onco-racial breast cancer disparities. This study identified physician referral as a potential contributor to racial disparity in the utilization of cancer genetics services. Potential reasons for the discrepancy in referral may include lag in physician education on the topic of hereditary risk and barriers in physician-patient communication. These findings need to be confirmed and explored at other sites to help improve the identification of at-risk women in the AA community.
Citation Format: Pepin A, Peterson J, Thomas R, Johnson K, Stark E, Biagi T, Kaltman R. Evaluating racial disparities in breast cancer referrals for hereditary risk assessment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-12.
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Affiliation(s)
- A Pepin
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
| | - J Peterson
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
| | - R Thomas
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
| | - K Johnson
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
| | - E Stark
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
| | - T Biagi
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
| | - R Kaltman
- GW Medical School, Washington, DC; Des Moines University Medical School, Des Moines, IA; GW Medical Faculty Associates, Washington, DC
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92
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Olivero E, Bert F, Thomas R, Scarmozzino A, Raciti IM, Gualano MR, Siliquini R. E-tools for hospital management: An overview of smartphone applications for health professionals. Int J Med Inform 2019; 124:58-67. [PMID: 30784427 DOI: 10.1016/j.ijmedinf.2019.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/15/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Commonly, management of the main hospital activities is organized by different software packages that run on desktop computers, which may not always allow fast and practical use by health operators. This problem could be alleviated by combining these software packages with mobile health. The aim of this study is to provide an overview of smartphone and tablet applications used for hospital management and administration in order to evaluate their features and analyze them according to their content, number of downloads and field of application. METHODS Researchers performed the survey on the two main application stores available on the Internet: iTunes for Apple devices and Google Play for Android devices. Using specific keywords, 47 apps that met the inclusion criteria were identified. RESULTS Most of the applications were designed for health operators and patient management (76.6%); 12.8% of the apps were focused on the organization and setting of hospital resources, and 10.6% of the apps could help hospital administrators perform self-evaluations of their structures, processes and outcomes. The large majority of apps (80.7%) counted less than 1000 downloads. Most of them (87.5%) were in English and free to download (93.6%). DISCUSSION The results of the first attempt to provide an overview of this emerging topic showed that, despite the existence of several applications for hospital management purposes, these tools appear to be not very widespread. In our opinion, there is a strong need to further assess the quality of these applications; thus, it may be worth continuing to monitor this field in order to analyze eventual improvements in the design and distribution of these apps.
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Affiliation(s)
- E Olivero
- Department of Public Health Sciences, University of Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Italy.
| | | | - I M Raciti
- A.O.U. City of Health and Science of Turin, Italy
| | - M R Gualano
- Department of Public Health Sciences, University of Turin, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Italy
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Hauck K, Morton A, Chalkidou K, Chi YL, Culyer A, Levin C, Meacock R, Over M, Thomas R, Vassall A, Verguet S, Smith PC. How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations. Soc Sci Med 2019; 220:141-149. [PMID: 30428401 PMCID: PMC6323413 DOI: 10.1016/j.socscimed.2018.10.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022]
Abstract
Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.
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Affiliation(s)
- K Hauck
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom.
| | - A Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow, G4 0QU, United Kingdom.
| | - K Chalkidou
- Center for Global Development, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom.
| | - Y-Ling Chi
- Global Health and Development Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom.
| | - A Culyer
- Department of Economics and Related Studies, University of York, Heslington, York, YO10 5DD, United Kingdom.
| | - C Levin
- Department of Global Health, University of Washington, NJB Box #359931, 325 Ninths Avenue, Seattle, WA, 98104, USA.
| | - R Meacock
- Centre for Primary Care, The University of Manchester, 4.311 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - M Over
- Center for Global Development, 2055 L Street NW, Fifth Floor, Washington, DC, 20036, USA.
| | - R Thomas
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - A Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
| | - S Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - P C Smith
- Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom.
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94
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Scaioli G, Bert F, Martorana M, Gili R, Thomas R, Gualano MR, Siliquini R. Advertisement of electronic cigarettes in Italy: characteristics of online videos and the most popular promotional messages. Health Educ Res 2018; 33:473-480. [PMID: 30247572 DOI: 10.1093/her/cyy030] [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] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
Given the increasing popularity of electronic cigarettes (ECs) and a lack of regulation of EC advertising, this study aimed to analyse online videos promoting ECs to assess the main marketing messages that could influence consumers' perceptions of associated risks and benefits. A web search of EC advertising videos was performed on YouTube by using keywords related to EC promotion. An evaluation grid was used to analyse promotional messages contained in each video. The most frequent promotional messages were related to health benefits (67.7%) and to the possibility of quitting smoking (57.4%). Messages that could also be appealing to adolescents and young adults, such as those promoting the multiple flavors available and the technological improvement of ECs, were present in 41.2% and 42.7% of the videos respectively. ECs similar to traditional cigarettes in appearance were included in 52.9% of the videos. EC promotional videos address messages not only to smokers who want to quit or decrease tobacco consumption but also to nonsmokers, especially young people. The use of ECs similar to traditional cigarettes may be a gateway to tobacco cigarette use. Since EC use may represent an important public health concern, regulatory policies on EC advertising should be established.
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Affiliation(s)
- G Scaioli
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - M Martorana
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - R Gili
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - M R Gualano
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
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95
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Sit D, Thomas R, Giuliani M, Lee P, Shaverdian N, Walker C, Swaminath A. Can the Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Predict Survival or Local Control in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC)? A Systematic Review. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1899] [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: 10/28/2022]
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96
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Fujimoto D, Sborov K, Von Eyben R, Osmundson E, Thomas R, Nagpal S, Soltys S. One-Week Chemoradiotherapy is Associated with Less Treatment-Related Lymphopenia Compared to a Standard Treatment Course for Newly Diagnosed Glioblastoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.039] [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: 10/28/2022]
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97
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Furmenti MF, Bianco S, Olivero E, Rossello P, Emelurumonye IN, Thomas R, Zotti CM. HALT3 study in Piedmont Region: improvement in policies and practises for an appropriate assistance. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- MF Furmenti
- Department of Public Health, University of Turin, Turin, Italy
| | - S Bianco
- Department of Public Health, University of Turin, Turin, Italy
| | - E Olivero
- Department of Public Health, University of Turin, Turin, Italy
| | - P Rossello
- Department of Public Health, University of Turin, Turin, Italy
| | - IN Emelurumonye
- Department of Public Health, University of Turin, Turin, Italy
| | - R Thomas
- Department of Public Health, University of Turin, Turin, Italy
| | - CM Zotti
- Department of Public Health, University of Turin, Turin, Italy
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98
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Thomas R, Bert F, Scarmozzino A, Coggiola M, Olivero E, Voglino G, Rossello P, Quattrocolo F, Scaioli G, Zotti CM, Siliquini R. A new strategy to promote flu vaccination among healthcare workers: “Molinette” hospital’s experience. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Thomas
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - F Bert
- “Molinette” Hospital, City of Health and Science of Turin, Turin, Italy
| | - A Scarmozzino
- “Molinette” Hospital, City of Health and Science of Turin, Turin, Italy
| | - M Coggiola
- “Molinette” Hospital, City of Health and Science of Turin, Turin, Italy
| | - E Olivero
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - P Rossello
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - F Quattrocolo
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - G Scaioli
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - CM Zotti
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
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99
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Olivero E, Bert F, Thomas R, Scarmozzino A, Raciti IM, Gualano MR, Siliquini R. E-tools for the hospital management: an overview of smartphone applications for health professionals. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Olivero
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | | | - R Thomas
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - A Scarmozzino
- AOU Città della Salute e della Scienza, Turin, Italy
| | - IM Raciti
- AOU Città della Salute e della Scienza, Turin, Italy
| | - MR Gualano
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
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100
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Bergin R, Emery J, Bollard R, Falborg A, Jensen H, Weller D, Menon U, Vedsted P, Thomas R, Whitfield K, White V. Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10700] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.
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Affiliation(s)
- R. Bergin
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - J. Emery
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - R. Bollard
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - A. Falborg
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - H. Jensen
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - D. Weller
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - U. Menon
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - P. Vedsted
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - R. Thomas
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - K. Whitfield
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - V. White
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
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