Bisphenol A affects larval growth and advances the onset of metamorphosis in Drosophila melanogaster

Exposure to Bisphenol A (BPA) has been reported to dysregulate endocrine pathways in a wide array of vertebrate species. The effects of BPA on invertebrate species are less well understood. We tested the effects of BPA on growth and development in Drosophila as these processes are governed by well-studied endocrine pathways. In this study, we tested the effects of three concentrations of BPA (0.1mg/L, 1mg/L or 10mg/L) and found a statistically significant increase in larval growth for the low dose treatment group (0.1mg/L), but not statistically significant for the high dose treatment group (10mg/L). BPA exposure resulted in an increased body size in treated animals at 48, 72 and 96h after egg laying (AEL). This finding reflects a non-monotonic dose-response that has been observed for an increasing number of endocrine disrupting compounds. The increase in growth rate found for all treatment groups was associated with a statistically significant increase in food intake observed at 72h AEL. Furthermore, we observed that the increased growth rate was coupled with an earlier onset of pupariation consistent with previously reported phenotypes resulting from increased activity of insulin/insulin growth factor signaling (IIS) in Drosophila. Since the timing of the onset of pupariation in Drosophila is controlled through the complex interaction of the IIS and the ecdysone signaling pathways, our findings suggest that BPA exerts its effects through disruption of endocrine signaling in Drosophila.

Regional variation in prescribing for chronic conditions among an elderly population using a pharmacy claims database

BACKGROUND

Age, gender and geographical regions are recognised factors in inequalities in prescribing for chronic diseases in the elderly.

AIM

To compare the health board regional distribution of chronic disease among the elderly and to examine variation in quality prescribing across age, gender and regions.

METHODS

Population based study of prescribing for chronic disease using a national pharmacy claims database. All individuals aged 70 years and over (n = 271,518) were eligible.

RESULTS

Over 60% of the elderly in all regions received cardiovascular related medication. The South Eastern, North Western and Western Health Boards had below average prescribing for many chronic conditions. Logistic regression identified age, gender and regional variations in prescribing of preventative therapies for CVD and diabetes.

CONCLUSION

There is a high prevalence of prescribing for chronic conditions in the elderly in Ireland, and there is evidence of gender, age and residing health board inequalities in prescribing.

Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression

BACKGROUND

By identifying which predictors and moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals.

METHOD

An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was conducted comparing two new interventions (Interpersonal Psychotherapy [IPT; n=620] and Cognitive Behavioral Therapy [CBT; n=610]) to an active control intervention (MoodGYM; n=613) over a period of 4 weeks to spontaneous visitors of an internet-delivered therapy website (e-couch). A range of putative predictors and moderators (socio-demographic characteristics [age, gender, marital status, education level], clinical characteristics [depression/anxiety symptoms, disability, quality of life, medication use], skills [mastery and dysfunctional attitudes] and treatment preference) were assessed using internet-delivered self-report measures at baseline and immediately following treatment and at six months follow-up. Analyses were conducted using Mixed Model Repeated Measures (MMRM).

RESULTS

Female gender, lower mastery and lower dysfunctional attitudes predicted better outcome at post-test and/or follow-up regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered IPT may be the preferred treatment choice, whereas older participants derive more benefits from internet-delivered CBT programs.

LIMITATIONS

Although the sample of participants was large, power to detect moderator effects was still lacking.

CONCLUSIONS

Different e-mental health programs may be more beneficial for specific age groups. The findings raise important possibilities for increasing depression treatment effectiveness and improving clinical practice guidelines for depression treatment of different age groups.

Prescribing of antidiabetic therapies in Ireland: 10-year trends 2003-2012

BACKGROUND

Over the last decade there have been significant changes in the prescribing of antidiabetic therapies. It is of interest to know about these trends and variations in the Irish population so that future prescribing patterns can be estimated.

AIMS

To examine the trends in prescribed antidiabetic treatments, including variations across age, gender, socioeconomic status and regions in the Irish population over the last 10 years.

METHODS

The Irish national pharmacy claims database was used to identify patients ≥ 16 years dispensed antidiabetic agents (oral or insulin) from January 2003 to December 2012 through the two main community drug schemes for diabetes. The rate of prescribing per 1,000 population was calculated. Logistic regression was used to examine variations in prescribing in patients with diabetes.

RESULTS

There was a significant increase in the prescribing of fast and long-acting insulin analogues with a rapid decline in the prescribing of human insulin (p < 0.0001). Increased prescribing of metformin, incretin modulators and fixed oral combination agents was observed (p < 0.0001). Females and older aged patients were more likely to be prescribed human insulin than other insulins. Metformin was less likely while sulphonylureas were more likely to be prescribed in older than younger aged patients. Socioeconomic differences were observed in increased prescribing of the newer and more expensive antidiabetic agents in the non-means tested scheme. Regional variations were observed in the prescribing of both insulin and oral antidiabetic agents.

CONCLUSION

There has been an increase over time in the prescribing of both insulin and oral antidiabetic agents in the Irish population with increasing uptake of newer antidiabetic agents. This has implications for projecting future uptake and expenditure of these agents given the rising level of diabetes in the population.

Modelling obesity outcomes: reducing obesity risk in adulthood may have greater impact than reducing obesity prevalence in childhood

A common policy response to the rise in obesity prevalence is to undertake interventions in childhood, but it is an open question whether this is more effective than reducing the risk of becoming obese during adulthood. In this paper, we model the effect on health outcomes of (i) reducing the prevalence of obesity when entering adulthood; (ii) reducing the risk of becoming obese throughout adult life; and (iii) combinations of both approaches. We found that, while all approaches reduce the prevalence of chronic diseases and improve life expectancy, a given percentage reduction in obesity prevalence achieved during childhood had a smaller effect than the same percentage reduction in the risk of becoming obese applied throughout adulthood. A small increase in the probability of becoming obese during adulthood offsets a substantial reduction in prevalence of overweight/obesity achieved during childhood, with the gains from a 50% reduction in child obesity prevalence offset by a 10% increase in the probability of becoming obese in adulthood. We conclude that both policy approaches can improve the health profile throughout the life course of a cohort, but they are not equivalent, and a large reduction in child obesity prevalence may be reversed by a small increase in the risk of becoming overweight or obese in adulthood.

Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial

PURPOSE

This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2-6 months of chemotherapy completion.

METHODS

Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (n = 23) or a usual care group (n = 20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.

RESULTS

The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [mean 3.0 mL kg(-1) min(-1) (95 % CI -1.1-7.0)] and 3-month follow-up [2.1 mL kg(-1) min(-1) (-2.3-6.6)] were found, although these differences did not achieve statistical significance (p values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (p = 0.01) and 3-month follow-up (p = 0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (p = 0.03) and 3-month follow-up (p = 0.04). Improvements in fatigue (p = 0.01), total quality of life plus fatigue (p = 0.04), and a composite physical functioning score (p = 0.01) at the 3-month follow-up were also found.

CONCLUSION

The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.

IMPLICATIONS FOR CANCER SURVIVORS

Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.

Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial

PURPOSE

This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2-6 months of chemotherapy completion.

METHODS

Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (n = 23) or a usual care group (n = 20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.

RESULTS

The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [mean 3.0 mL kg(-1) min(-1) (95 % CI -1.1-7.0)] and 3-month follow-up [2.1 mL kg(-1) min(-1) (-2.3-6.6)] were found, although these differences did not achieve statistical significance (p values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (p = 0.01) and 3-month follow-up (p = 0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (p = 0.03) and 3-month follow-up (p = 0.04). Improvements in fatigue (p = 0.01), total quality of life plus fatigue (p = 0.04), and a composite physical functioning score (p = 0.01) at the 3-month follow-up were also found.

CONCLUSION

The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.

IMPLICATIONS FOR CANCER SURVIVORS

Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.

Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008

INTRODUCTION

Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures.

AIM

To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region.

METHODOLOGY

We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James's Hospital, Dublin.

RESULTS

The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers.

CONCLUSION

The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.

Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis

In Ireland, the absolute numbers of hospitalisations for all osteoporotic-type fractures including hip fractures increased between 2000 and 2009 along with the mean length of stay. The cost of hospitalisations for these fractures also increased between 2003 and 2008.

INTRODUCTION

The purposes of the study were to carry out a trend analyses of the total number of osteoporotic-type fractures in males and females aged 50 years and over in Ireland between 2000 and 2009 and to project the number of osteoporotic-type fractures in the Republic of Ireland expected by 2025.

METHODS

Age- and gender-specific trends in the absolute numbers and direct age-standardised rates of hospitalisations for all osteoporotic-type fractures in men and women ≥ 50 years were analysed, along with the associated hospitalisation costs and length of stay using the Hospital In-Patient Enquiry system database. Future projections of absolute numbers of osteoporotic-type fractures in years 2015, 2020 and 2025 were computed based on the 2009 incidence rates applied to the projected populations.

RESULTS

Between 2000 and 2009, the absolute numbers of all osteoporotic-type fractures increased by 12 % in females and by 15 % in males while the absolute numbers of hip fractures increased by 7 % in women and by 20 % in men. The age-specific rates for hip fractures decreased in all age groups with the exception of the 55-59-year age group which showed an increase of 4.1 % (p = 0.023) within the study period. The associated hospitalisation costs and length of stay increased. Assuming stable age-standardised incidence rates from 2009 over the next 20 years, the number of all types of osteoporotic-type fractures is projected to increase by 79 % and the number of hip fractures is expected to increase by 88 % by 2025.

CONCLUSIONS

Hospitalisations for osteoporotic-type fractures continued to increase in Ireland. Hip fractures increased by 7 % in women and 20 % in men.

Preparation of Datex-Ohmeda Aestiva® and Aisys® anaesthetic machines for use in malignant hyperthermia susceptible patients

Preparation of anaesthesia machines for use by malignant hyperthermia susceptible patients requires purging the machines of halogenated anaesthetic agents. The endpoint of this process is to reach a gas concentration of 5 ppm or less, which has been arbitrarily chosen as the safe limit of exposure to avoid triggering a malignant hyperthermia event. We examined the washout characteristics of sevoflurane and desflurane from the Datex-Ohmeda Aestiva® Anaesthesia System and Aisys® Anaesthesia Carestation®anaesthetic machines. The machines were contaminated for two hours using either sevoflurane 2 vol% or desflurane 6 vol%. At the end of the priming period, the patient breathing circuit and reservoir bag, carbon dioxide absorbent, sampling line and test lung were replaced with uncontaminated components. During the test period, machines were purged using oxygen flows of 10 l/minute. The average time to reach 5 ppm with the Aestiva machines was 51 minutes with sevoflurane and 71 minutes with desflurane. The average time to reach 5 ppm for the Aisys machines was 55 minutes with sevoflurane and 69 minutes with desflurane. All configurations of machines and anaesthetic gases demonstrated a rebound effect in agent concentration above 5 ppm when the fresh gas flow was subsequently reduced from 10 to 2 l/minute. Aestiva and Aisys anaesthetic machines require a prolonged period to adequately purge them of halogenated volatile anaesthetic agent. The rebound effect poses a serious concern, suggesting that after the purging period, fresh gas flows of 10 l/minute should be maintained for the duration of anaesthesia care of the malignant hyperthermia susceptible patient.

Dense electron-positron plasmas and ultraintense γ rays from laser-irradiated solids

In simulations of a 10 PW laser striking a solid, we demonstrate the possibility of producing a pure electron-positron plasma by the same processes as those thought to operate in high-energy astrophysical environments. A maximum positron density of 10(26) m(-3) can be achieved, 7 orders of magnitude greater than achieved in previous experiments. Additionally, 35% of the laser energy is converted to a burst of γ rays of intensity 10(22) W cm(-2), potentially the most intense γ-ray source available in the laboratory. This absorption results in a strong feedback between both pair and γ-ray production and classical plasma physics in the new "QED-plasma" regime.

Patient profile in a bone health and osteoporosis prevention service in Ireland

OBJECTIVES

To (1) characterise a cohort of patients attending a major osteoporosis clinic in Ireland and (2) examine the prescribing of preventative therapies amongst these patients.

METHODS

Data were taken from 2006-2007 on patients attending the Osteoporosis Clinic at St. James's Hospital, Dublin. Information gathered included age, gender, fracture history, past medical and surgical history, co-morbidities, the results of the first DXA scans, anti-resorptive therapies along with other medications prescribed.

RESULTS

Of all patients 87.6% were female and the mean age was 68 years (SD = 14.31). In total 166 (74%) patients had osteoporosis, 40 (17.8%) had osteopenia and 18 patients (8%) had normal T-score values, 163 (72.7%) had a history of a fracture. Only 13.7% of the patients did not have a documented history of other co-morbidities.

CONCLUSION

Comprehensive services such as the Osteoporosis Clinic at St. James's Hospital can provide the necessary screening, monitoring and prescribing of appropriate osteoporosis medications with additional follow-up if required to this at risk group reducing the unnecessarily traumatic effects of the disease on patients.

Predicting outcomes in emergency medical admissions - role of laboratory data and co-morbidity

BACKGROUND

The utility of risk stratification following an emergency medical admission has been debated. We have examined the predictability of outcomes, from a database of all emergency admissions to St James' Hospital, Dublin, over a six year period (2005-2010).

METHODS

Analysis was performed using the hospital in-patient enquiry system, linked to the patient administration system and laboratory data. The utility of a fractional polynomial laboratory only model to predict 30-day in-hospital mortality was determined.

RESULTS

The AUROC for the laboratory parameters to predict a 30 day death was 0.90 ( 95% CI 0.89, 0.90) in the 2002 - 2010 derivation dataset and was 0.88 (95% CI 0.86, 0.90) in the 2011 validation set. The addition of co-morbidity measures did not improve the model prediction (0.89 : 95% CI 0.88 - 0.89).

CONCLUSION

A fractional polynomial laboratory only model can reliably predict 30-day hospital mortality following an emergency medical admission, potentially allowing resources to be risk focused and patients to be prioritised.

P1-08-12: Hormonal Therapy Compliance and Mortality in Metastatic Breast Cancer

Methods: A retrospective analysis was conducted using linked pharmacy claims and cancer registry data from the population-based National Cancer Registry Ireland (NCRI). Women with stage IV breast cancer at initial diagnosis (2004-2006), who received HTx as 1st line treatment for ≥90 days were identified (tamoxifen, toremifene, fulvestrant, anastrozole, letrozole, exemestane). Compliance was calculated over the time that patients remained on HTx i.e. from the date of treatment initiation to the earliest of either HTx discontinuation or end of follow up (31/12/07, 3 years or death). Patients discontinuing HTx were assigned their compliance rate at this time for the remainder of follow-up. In the primary analysis Cox proportional hazard models with late entry at 90 days post HTx initiation and time varying compliance (defined dichotomously as: low &lt; 80%, high ≥ 80%), were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and breast cancer specific mortality. Secondary analyses of (a) time to treatment discontinuation and (b) compliance in the first 90 days of treatment were conducted. All models were adjusted for age, tumor grade, number/site of metastases, estrogen, progesterone and human epidermal growth factor 2 receptor status.

Results: 359 women with stage IV breast cancer at diagnosis were identified. Of these, 151 received HTx as 1st line treatment. Median HTx compliance was 84.8%, (range 19.4%-100%; interquartile range 75.5%-100%). Demographic, tumor and treatment characteristics were similar between low (n=51) and high (n=100) compliance groups. The number and distribution of metastatic sites at diagnosis was also similar (low/high compliance: bone only 70.6%/70.0%, lung only 17.6%/18.0%, liver only 11.8%/14.0%, brain only 0.0%/0.0%, other 13.7%/17.0%, multiple sites 15.7%/18.0%). Compliance rates for both compliance groups increased marginally over time.

Unadjusted all-cause mortality rates were 143 and 359 deaths/1000 woman years for low and high compliance respectively. Low compliance was associated with a 90% increased risk of all-cause (HR 1.90; 95%CI 1.06, 3.41) and breast cancer specific (HR 1.91; 95%CI 1.03, 3.55) mortality. In the secondary analyses low compliance was associated with a shorter time to HTx discontinuation (HR 1.97; 95%CI 1.01, 3.84). Low compliance within the first 90 days of treatment was associated with non-significantly increased mortality (all-cause HR 1.57; 95%CI 0.88, 2.80; breast cancer specific HR 1.58; 95%CI 0.85, 2.93).

Discussion: This study demonstrates, for the first time to our knowledge, a significant association between low HTx compliance and increased mortality in patients with MBC. In addition, the observed association between compliance and treatment duration is consistent with a reduced time to disease progression in low compliance patients. The findings do not appear to be related to either the burden of metastatic disease at diagnosis or to increasing disease severity causing lower compliance over time. These results suggest that the development and evaluation of effective interventions to support HTx compliance in patients with MBC is warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-12.