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Hamilton AJ, Caskey FJ, Casula A, Ben-Shlomo Y, Inward CD. Psychosocial Health and Lifestyle Behaviors in Young Adults Receiving Renal Replacement Therapy Compared to the General Population: Findings From the SPEAK Study. Am J Kidney Dis 2019; 73:194-205. [PMID: 30293669 DOI: 10.1053/j.ajkd.2018.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/21/2018] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Patients in late adolescence and early adulthood receiving renal replacement therapy (RRT) face disruption to normal activities, which affects well-being. We aimed to define psychosocial and lifestyle outcomes for young adults on RRT compared to the general population. STUDY DESIGN We undertook a cross-sectional survey (the SPEAK [Surveying Patients Experiencing Young Adult Kidney Failure] Study) using validated measures and general population comparator data from the Health Survey for England and Avon Longitudinal Study of Parents and Children. Additional clinical information was obtained from the UK Renal Registry. SETTING & PARTICIPANTS 16- to 30-year-olds receiving RRT. OUTCOMES Psychosocial health and lifestyle behaviors. ANALYTICAL APPROACH We compared outcomes between populations using age- and sex-adjusted regression models, weighted to account for response bias by sex, ethnicity, and socioeconomic status. Our findings were used to update recent meta-analyses. RESULTS We recruited 976 young adults and 64% responded to the survey: 417 (71%) with kidney transplants and 173 (29%) on dialysis therapy. Compared to the general population, young adults on RRT were less likely to be in a relationship and have children and more likely to live in the family home, receive no income, and be unable to work due to health. They had poorer quality of life, worse well-being, and twice the likelihood of a psychological disturbance (OR, 2.7; 95% CI, 2.0-3.7; P<0.001). They reported less smoking, alcohol and drug abuse, and crime. In a meta-analysis, our study showed the greatest differences in quality of life compared to the general population. LIMITATIONS Cross-sectional study design, meaning that we could not track the impact of treatment changes on the outcomes. CONCLUSIONS This study involving a large cohort of young adult transplant recipients and dialysis patients provides evidence of worse psychosocial outcomes but more positive lifestyle behaviors in young adults on RRT compared to the age-matched general population.
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Affiliation(s)
- Alexander J Hamilton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom; UK Renal Registry, Bristol, United Kingdom.
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom; UK Renal Registry, Bristol, United Kingdom
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Carol D Inward
- Bristol Royal Hospital for Children, Bristol, United Kingdom
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Gregson J, Kaptoge S, Bolton T, Pennells L, Willeit P, Burgess S, Bell S, Sweeting M, Rimm EB, Kabrhel C, Zöller B, Assmann G, Gudnason V, Folsom AR, Arndt V, Fletcher A, Norman PE, Nordestgaard BG, Kitamura A, Mahmoodi BK, Whincup PH, Knuiman M, Salomaa V, Meisinger C, Koenig W, Kavousi M, Völzke H, Cooper JA, Ninomiya T, Casiglia E, Rodriguez B, Ben-Shlomo Y, Després JP, Simons L, Barrett-Connor E, Björkelund C, Notdurfter M, Kromhout D, Price J, Sutherland SE, Sundström J, Kauhanen J, Gallacher J, Beulens JWJ, Dankner R, Cooper C, Giampaoli S, Deen JF, Gómez de la Cámara A, Kuller LH, Rosengren A, Svensson PJ, Nagel D, Crespo CJ, Brenner H, Albertorio-Diaz JR, Atkins R, Brunner EJ, Shipley M, Njølstad I, Lawlor DA, van der Schouw YT, Selmer RM, Trevisan M, Verschuren WMM, Greenland P, Wassertheil-Smoller S, Lowe GDO, Wood AM, Butterworth AS, Thompson SG, Danesh J, Di Angelantonio E, Meade T. Cardiovascular Risk Factors Associated With Venous Thromboembolism. JAMA Cardiol 2019; 4:163-173. [PMID: 30649175 PMCID: PMC6386140 DOI: 10.1001/jamacardio.2018.4537] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/15/2018] [Indexed: 02/02/2023]
Abstract
Importance It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE). Objective To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism. Design, Setting, and Participants This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018. Exposures A panel of several established cardiovascular risk factors. Main Outcomes and Measures Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25 131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI). Results Of the 731 728 participants from the ERFC, 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421 537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers. Conclusions and Relevance Older age, smoking, and adiposity were consistently associated with higher VTE risk.
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Affiliation(s)
- John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen Kaptoge
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Bolton
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Lisa Pennells
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Peter Willeit
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Medical University of Innsbruck, Innsbruck, Austria
| | - Stephen Burgess
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- MRC Biostatistics Unit, Cambridge University, Cambridge, United Kingdom
| | - Steven Bell
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Michael Sweeting
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Eric B. Rimm
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Bengt Zöller
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gerd Assmann
- Assmann Foundation for Prevention, Münster, Germany
| | | | - Aaron R. Folsom
- University of Minnesota School of Public Health, Minneapolis
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Astrid Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul E. Norman
- University of Western Australia, Perth, Western Australia, Australia
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Bakhtawar K. Mahmoodi
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Matthew Knuiman
- University of Western Australia, Perth, Western Australia, Australia
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Christa Meisinger
- Ludwig Maximilian University of Munich, Munich, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Department of Internal Medicine II–Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Maryam Kavousi
- Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | | | - Jackie A. Cooper
- UCL Medical School, University College London, London, United Kingdom
| | | | | | | | - Yoav Ben-Shlomo
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jean-Pierre Després
- Institute of Nutraceuticals and Functional Foods, Université Laval, Quebec, Quebec, Canada
| | - Leon Simons
- The University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Daan Kromhout
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jackie Price
- University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - John Gallacher
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Joline W. J. Beulens
- VU University Medical Center Amsterdam, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | | - Jason F. Deen
- Center of Health Equity, Diversity and Inclusion, University of Washington School of Medicine, Seattle
| | - Agustín Gómez de la Cámara
- Clinical Research and Clinical Trials Unit, Plataforma de Innovación en Tecnologías Médicas y Sanitarias, Madrid, Spain
| | - Lewis H. Kuller
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | | | | | | | - Hermann Brenner
- University of Minnesota School of Public Health, Minneapolis
| | | | | | - Eric J. Brunner
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | | | - Deborah A. Lawlor
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | - W. M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Philip Greenland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Gordon D. O. Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Angela M. Wood
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Adam S. Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Simon G. Thompson
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Tom Meade
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lawton M, Ben-Shlomo Y, May MT, Baig F, Barber TR, Klein JC, Swallow DMA, Malek N, Grosset KA, Bajaj N, Barker RA, Williams N, Burn DJ, Foltynie T, Morris HR, Wood NW, Grosset DG, Hu MTM. Developing and validating Parkinson's disease subtypes and their motor and cognitive progression. J Neurol Neurosurg Psychiatry 2018; 89:1279-1287. [PMID: 30464029 PMCID: PMC6288789 DOI: 10.1136/jnnp-2018-318337] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To use a data-driven approach to determine the existence and natural history of subtypes of Parkinson's disease (PD) using two large independent cohorts of patients newly diagnosed with this condition. METHODS 1601 and 944 patients with idiopathic PD, from Tracking Parkinson's and Discovery cohorts, respectively, were evaluated in motor, cognitive and non-motor domains at the baseline assessment. Patients were recently diagnosed at entry (within 3.5 years of diagnosis) and were followed up every 18 months. We used a factor analysis followed by a k-means cluster analysis, while prognosis was measured using random slope and intercept models. RESULTS We identified four clusters: (1) fast motor progression with symmetrical motor disease, poor olfaction, cognition and postural hypotension; (2) mild motor and non-motor disease with intermediate motor progression; (3) severe motor disease, poor psychological well-being and poor sleep with an intermediate motor progression; (4) slow motor progression with tremor-dominant, unilateral disease. Clusters were moderately to substantially stable across the two cohorts (kappa 0.58). Cluster 1 had the fastest motor progression in Tracking Parkinson's at 3.2 (95% CI 2.8 to 3.6) UPDRS III points per year while cluster 4 had the slowest at 0.6 (0.1-1.1). In Tracking Parkinson's, cluster 2 had the largest response to levodopa 36.3% and cluster 4 the lowest 28.8%. CONCLUSIONS We have found four novel clusters that replicated well across two independent early PD cohorts and were associated with levodopa response and motor progression rates. This has potential implications for better understanding disease pathophysiology and the relevance of patient stratification in future clinical trials.
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Affiliation(s)
- Michael Lawton
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Margaret T May
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Fahd Baig
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK.,Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Thomas R Barber
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK.,Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Johannes C Klein
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK.,Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Diane M A Swallow
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Naveed Malek
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | | | - Nin Bajaj
- Department of Neurology, Queen's Medical Centre, Nottingham, UK
| | - Roger A Barker
- Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, UK
| | - Nigel Williams
- Cardiff University, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - Huw R Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Nicholas W Wood
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK.,Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
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154
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Hayes L, Forrest L, Adams J, Hidajat M, Ben-Shlomo Y, White M, Sharp L. Age-related inequalities in colon cancer treatment persist over time: a population-based analysis. J Epidemiol Community Health 2018; 73:34-41. [DOI: 10.1136/jech-2018-210842] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 11/03/2022]
Abstract
BackgroundOlder people experience poorer outcomes from colon cancer. We examined if treatment for colon cancer was related to age and if inequalities changed over time.MethodsData from the UK population-based Northern and Yorkshire Cancer Registry on 31 910 incident colon cancers (ICD10 C18) diagnosed between 1999–2010 were obtained. Likelihood of receipt of: (1) cancer-directed surgery, (2) chemotherapy in surgical patients, (3) chemotherapy in non-surgical patients by age, adjusting for sex, area deprivation, cancer stage, comorbidity and period of diagnosis, was examined.ResultsAge-related inequalities in treatment exist after adjustment for confounding factors. Patients aged 60– 69, 70–79 and 80+ years were significantly less likely to receive surgery than those aged <60 years (multivariable ORs (95% CI) 0.84(0.74 to 0.95), 0.54(0.48 to 0.61) and 0.19(0.17 to 0.21), respectively). Age-related differences in receipt of surgery and adjuvant chemotherapy (but not chemotherapy in non-surgical patients) narrowed over time for the ’younger old’ (aged <80 years) but did not diminish for the oldest patients.ConclusionsAge inequality in treatment of colon cancer remains after adjustment for confounders, suggesting age remains a major factor in treatment decisions. Research is needed to better understand the cancer treatment decision-making process, and how to influence this, for older patients.
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155
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Henderson EJ, Morgan GS, Amin J, Gaunt DM, Ben-Shlomo Y. The minimum clinically important difference (MCID) for a falls intervention in Parkinson's: A delphi study. Parkinsonism Relat Disord 2018; 61:106-110. [PMID: 30455158 DOI: 10.1016/j.parkreldis.2018.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Falls are common in Parkinson's disease so any intervention that reduced falls risk would be of value. One potential intervention is the use of cholinesterase inhibitor (ChEi) drugs. OBJECTIVE To establish the minimum clinically important difference (MCID) for fall rates to inform the effect estimate for sample size calculations of future clinical trials. METHODS We performed a Delphi study assembling a panel of experts in Parkinson's disease from academic and clinical medicine in order to reach a consensus of opinion. Responses from a panel were summarised and resent to the group, until consensus was reached. RESULTS 780 clinicians, who had been caring for people with Parkinson's for an average of 14 years, were contacted via three routes. The median (Interquartile range (IQR)) MCID after round 1 was 25% (IQR 20-30%) which equates to the prevention of 5 (IQR 4-6) falls per year. Increasing consensus after round two confirmed the MCID of 25%, narrowing the (IQ) range to 20%-25%. This was unchanged when the panel were shown the number of participants that would need to be recruited to a clinical trial in order to achieve this difference. CONCLUSIONS We have established that an expert panel of PD specialists consider that an intervention that demonstrated a 25% (IQR 20-25%) relative reduction in falls rate would be clinically meaningful. This estimate can be used to help determine the sample size for any future clinical trial.
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Affiliation(s)
- Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom; Royal United Hospitals NHS Foundation Trust Bath, BA1 3NG, United Kingdom.
| | - Gemma S Morgan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Jigisha Amin
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Daisy M Gaunt
- Bristol Randomised Trials Collaboration (BRTC), Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
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156
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Hamilton AJ, Caskey FJ, Casula A, Inward CD, Ben-Shlomo Y. Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy. Clin J Am Soc Nephrol 2018; 13:1669-1679. [PMID: 30327297 PMCID: PMC6237074 DOI: 10.2215/cjn.02450218] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Young adults receiving kidney replacement therapy (KRT) have impaired quality of life and may exhibit low medication adherence. We tested the hypothesis that wellbeing and medication adherence are associated with psychosocial factors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a cross-sectional online survey for young adults on KRT. Additional clinical information was obtained from the UK Renal Registry. We compared outcomes by treatment modality using age- and sex-adjusted regression models, having applied survey weights to account for response bias by sex, ethnicity, and socioeconomic status. We used multivariable linear regression to examine psychosocial associations with scores on the Warwick-Edinburgh Mental Wellbeing Scale and the eight-item Morisky Medication Adherence Scale. RESULTS We recruited 976 young adults and 64% responded to the survey; 417 (71%) with transplants and 173 (29%) on dialysis. Wellbeing was positively associated with extraversion, openness, independence, and social support, and negatively associated with neuroticism, negative body image, stigma, psychologic morbidity, and dialysis. Higher medication adherence was associated with living with parents, conscientiousness, physician access satisfaction, patient activation, age, and male sex, and lower adherence was associated with comorbidity, dialysis, education, ethnicity, and psychologic morbidity. CONCLUSIONS Wellbeing and medication adherence were both associated with psychologic morbidity in young adults. Dialysis treatment is associated with poorer wellbeing and medication adherence.
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Affiliation(s)
- Alexander James Hamilton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom; and
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom; and
| | - Anna Casula
- United Kingdom Renal Registry, Bristol, United Kingdom; and
| | - Carol D Inward
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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157
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Zienius K, Brennan P, Ben-Shlomo Y, Ozawa M, Keeney E, Weller D, Hamilton W, Hollingworth W, Grant R. EPID-07. RELATIONSHIP BETWEEN COGNITION, SPEED OF PRESENTATION AND SEMANTIC VERBAL FLUENCY TEST IN PATIENTS WITH NEW INTRA-CEREBRAL TUMORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.334] [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: 11/12/2022] Open
Affiliation(s)
- Karolis Zienius
- Edinburgh Centre for Neuro-Oncology, Edinburgh, Scotland, United Kingdom
| | - Paul Brennan
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | - Mio Ozawa
- University of Bristol, Bristol, England, United Kingdom
| | - Edna Keeney
- University of Bristol, Bristol, England, United Kingdom
| | - David Weller
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | | | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Edinburgh, Scotland, United Kingdom
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158
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Arora S, Baig F, Lo C, Barber TR, Lawton MA, Zhan A, Rolinski M, Ruffmann C, Klein JC, Rumbold J, Louvel A, Zaiwalla Z, Lennox G, Quinnell T, Dennis G, Wade-Martins R, Ben-Shlomo Y, Little MA, Hu MT. Smartphone motor testing to distinguish idiopathic REM sleep behavior disorder, controls, and PD. Neurology 2018; 91:e1528-e1538. [PMID: 30232246 PMCID: PMC6202945 DOI: 10.1212/wnl.0000000000006366] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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] [Received: 04/30/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022] Open
Abstract
Objective We sought to identify motor features that would allow the delineation of individuals with sleep study-confirmed idiopathic REM sleep behavior disorder (iRBD) from controls and Parkinson disease (PD) using a customized smartphone application. Methods A total of 334 PD, 104 iRBD, and 84 control participants performed 7 tasks to evaluate voice, balance, gait, finger tapping, reaction time, rest tremor, and postural tremor. Smartphone recordings were collected both in clinic and at home under noncontrolled conditions over several days. All participants underwent detailed parallel in-clinic assessments. Using only the smartphone sensor recordings, we sought to (1) discriminate whether the participant had iRBD or PD and (2) identify which of the above 7 motor tasks were most salient in distinguishing groups. Results Statistically significant differences based on these 7 tasks were observed between the 3 groups. For the 3 pairwise discriminatory comparisons, (1) controls vs iRBD, (2) controls vs PD, and (3) iRBD vs PD, the mean sensitivity and specificity values ranged from 84.6% to 91.9%. Postural tremor, rest tremor, and voice were the most discriminatory tasks overall, whereas the reaction time was least discriminatory. Conclusions Prodromal forms of PD include the sleep disorder iRBD, where subtle motor impairment can be detected using clinician-based rating scales (e.g., Unified Parkinson's Disease Rating Scale), which may lack the sensitivity to detect and track granular change. Consumer grade smartphones can be used to accurately separate not only iRBD from controls but also iRBD from PD participants, providing a growing consensus for the utility of digital biomarkers in early and prodromal PD.
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Affiliation(s)
- Siddharth Arora
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Fahd Baig
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Christine Lo
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Thomas R Barber
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Michael A Lawton
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Andong Zhan
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Michal Rolinski
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Claudio Ruffmann
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Johannes C Klein
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Jane Rumbold
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Amandine Louvel
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Zenobia Zaiwalla
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Graham Lennox
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Tim Quinnell
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Gary Dennis
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Richard Wade-Martins
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Yoav Ben-Shlomo
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Max A Little
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Michele T Hu
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA.
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159
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Abstract
Background Brain tumours often present with varied, non-specific features with other diagnoses usually being more likely. Objective To examine how different symptoms and patient demographics predict variations in time to brain tumour diagnosis. Methods We conducted a secondary analysis of brain tumour cases from National Audit of Cancer Diagnosis in Primary Care. We grouped neurological symptoms into six domains (headache, behavioural/cognitive change, focal neurology, 'fits, faints or falls', non-specific neurological, and other/non-specific) and calculated times for patient presentation, GP referral, specialist consultation and total pathway interval. We calculated odds ratios (ORs) for symptom domains comparing the slowest to other quartiles. Results Data were available for 226 cases. Median (interquartile range) time for the total pathway interval was 24 days (7-65 days). The most common presentation was focal neurology (33.2%) followed by 'fits, faints or falls' and headache (both 20.8%). Headache only (OR = 4.11, 95% CI = 1.10, 15.5) and memory complaints (OR = 4.82, 95% CI = 1.15, 20.1) were associated with slower total pathway compared to 'fits, faints or falls'. GPs were more likely to consider that there had been avoidable delays in referring patients with headache only (OR = 4.17, 95% CI = 1.14, 15.3). Conclusion Patients presenting to primary care with headache only or with memory complaints remain problematic with potentially avoidable delays in referral leading to a longer patient pathway. This may or may not impact on the efficacy and morbidity of therapies. Additional aids are required to help doctors differentiate when to refer headaches and memory complaints urgently for a specialist opinion.
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Affiliation(s)
- Mio Ozawa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul M Brennan
- Translational Neurosurgery Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Brain Tumour Research Group, University of Bristol, Institute of Clinical Neuroscience, Learning and Research Building, Southmead Hospital, Bristol, UK
| | - Karolis Zienius
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kathreena M Kurian
- Institute of Clinical Neurosciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, College House, St Luke’s Campus, University of Exeter, Exeter, UK
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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160
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Joshi R, Wannamethee G, Rhodes D, Engmann J, Dale C, Gaunt T, Jefferis B, Papacosta O, Shah T, Tillin T, Wong A, Chaturvedi N, Kivimaki M, Kuh D, Kumari M, Hughes A, Ben-Shlomo Y, Casas JP, Hingorani AD, Schmidt AF. P15 TRIGLYCERIDE-CONTAINING LIPOPROTEIN SUB-FRACTIONS AND CORONARY HEART DISEASE AND STROKE RISK. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy216.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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161
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Walkden G, Anderson E, Vink M, Tilling K, Howe L, Ben-Shlomo Y. Frailty in older-age European migrants: Cross-sectional and longitudinal analyses of the Survey of Health, Aging and Retirement in Europe (SHARE). Soc Sci Med 2018; 213:1-11. [DOI: 10.1016/j.socscimed.2018.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/01/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
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162
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Walters K, Falcaro M, Freemantle N, King M, Ben-Shlomo Y. Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data. Psychol Med 2018; 48:1504-1513. [PMID: 29017624 DOI: 10.1017/s0033291717003014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies. METHODS Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009-2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset. RESULTS Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55-59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75-79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1-0.29) than those aged 55-59 years, and men aged 80-84 years had around seven times lower (OR 0.14, 95% CI 0.05-0.36). CONCLUSIONS The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.
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Affiliation(s)
- K Walters
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - M Falcaro
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - N Freemantle
- Research Department of Primary Care & Population Health,University College London (UCL),Rowland Hill St,London,UK
| | - M King
- Division of Psychiatry,UCL,Sixth Floor Maple House,147 Tottenham Court Rd,London,UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine,University of Bristol,39 Whatley Road, Bristol,UK
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163
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Malek N, Weil RS, Bresner C, Lawton MA, Grosset KA, Tan M, Bajaj N, Barker RA, Burn DJ, Foltynie T, Hardy J, Wood NW, Ben-Shlomo Y, Williams NW, Grosset DG, Morris HR. Features of GBA-associated Parkinson's disease at presentation in the UK Tracking Parkinson's study. J Neurol Neurosurg Psychiatry 2018; 89:702-709. [PMID: 29378790 PMCID: PMC6031283 DOI: 10.1136/jnnp-2017-317348] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/30/2017] [Accepted: 01/03/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To examine the influence of the glucocerebrosidase (GBA) mutation carrier state on age at onset of Parkinson's disease (PD), the motor phenotype and cognitive function at baseline assessment in a large cohort of UK patients. We also analysed the prevalence of mood and behavioural problems that may confound the assessment of cognitive function. METHODS We prospectively recruited patients with PD in the Tracking Parkinson's study. We fully sequenced the GBA gene in all recently diagnosed patients (≤3.5 years). We examined cognitive (Montreal Cognitive Assessment) and motor (Movement Disorder Society Unified Parkinson's Disease Rating Scale part 3) function at a baseline assessment, at an average of 1.3 years after diagnosis. We used logistic regression to determine predictors of PD with mild cognitive impairment and PD with dementia. RESULTS We studied 1893 patients with PD: 48 (2.5%) were heterozygous carriers for known Gaucher's disease (GD) causing pathogenic mutations; 117 (6.2%) had non-synonymous variants, previously associated with PD, and 28 (1.5%) patients carried variants of unknown significance in the GBA gene. L444P was the most common pathogenic GBA mutation. Patients with pathogenic GBA mutations were on average 5 years younger at disease onset compared with non-carriers (P=0.02). PD patients with GD-causing mutations did not have an increased family risk of PD. Patients with GBA mutations were more likely to present with the postural instability gait difficulty phenotype compared with non-carriers (P=0.02). Patients carrying pathogenic mutations in GBA had more advanced Hoehn and Yahr stage after adjustment for age and disease duration compared with non-carriers (P=0.005). There were no differences in cognitive function between GBA mutation carriers and non-carriers at this early disease stage. CONCLUSIONS Our study confirms the influence of GBA mutations on the age of onset, disease severity and motor phenotype in patients with PD. Cognition did not differ between GBA mutation carriers and non-carriers at baseline, implying that cognitive impairment/dementia, reported in other studies at a later disease stage, is not present in recently diagnosed cases. This offers an important window of opportunity for potential disease-modifying therapy that may protect against the development of dementia in GBA-PD. CLINICAL TRIAL REGISTRATION NCT02881099; Results.
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Affiliation(s)
- Naveed Malek
- Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, UK
| | - Rimona S Weil
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Catherine Bresner
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Michael A Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Katherine A Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Manuela Tan
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Nin Bajaj
- Department of Neurology, Queen's Medical Centre, Nottingham, UK
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, UK
| | - David J Burn
- Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - John Hardy
- Department of Molecular Neuroscience, Reta Lila Weston Laboratories, UCL Institute of Neurology, London, UK
| | - Nicholas W Wood
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nigel W Williams
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Huw R Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
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164
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Bennett-Britton I, Teyhan A, Macleod J, Sattar N, Davey Smith G, Ben-Shlomo Y. Response to: 'On the approach for determining association between changes in marital quality and cardiovascular disease risk factors' by MM Pike. J Epidemiol Community Health 2018; 72:759-760. [PMID: 29848581 DOI: 10.1136/jech-2018-210797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Ian Bennett-Britton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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165
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El-Damanawi R, Lee M, Harris T, Mader LB, Bond S, Pavey H, Sandford RN, Wilkinson IB, Burrows A, Woznowski P, Ben-Shlomo Y, Karet Frankl FE, Hiemstra TF. Randomised controlled trial of high versus ad libitum water intake in patients with autosomal dominant polycystic kidney disease: rationale and design of the DRINK feasibility trial. BMJ Open 2018; 8:e022859. [PMID: 29743334 PMCID: PMC5942404 DOI: 10.1136/bmjopen-2018-022859] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Vasopressin stimulates cyst growth in autosomal dominant polycystic kidney disease (ADPKD) leading to enlarged kidneys, hypertension and renal failure. Vasopressin receptor blockade slows disease progression. Physiological suppression of vasopressin secretion through high water (HW) intake could achieve a similar effect, necessitating a definitive large-scale trial of HW intake in ADPKD. The objective of the DRINK trial is to answer the key design and feasibility questions required to deliver a successful definitive water intake trial. METHODS AND ANALYSIS We describe the design of a single-centre, open-label, prospective, randomised controlled trial. The "Determining feasibility of R andomisation to high vs. ad libitum water In take in Polycystic K idney Disease" (DRINK) trial aims to enrol 50 patients with ADPKD, over the age of 16 years with an estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m2. Participants will be randomised 1:1 to HW intake based on an individualised water intake prescription, or to ad libitum (AW) water intake. The HW group will aim for a dilute urine (urine osmolality ≤270 mOsm/kg) as a surrogate marker of vasopressin suppression, and those in the AW group will target more concentrated urine. Participants will have an 8-week treatment period, and will be seen at weeks 0, 2, 4 and 8, undergoing assessments of fluid status, renal function and serum and urine osmolalities. They will receive dietary advice, and self-monitor urine specific gravity and fluid intake. The trial employs smartphone technology to permit home monitoring and remote direct data capture. The primary feasibility end points are recruitment rate and separation between arms in measured urinary osmolality. Key secondary assessments include acceptability, adherence, health-related quality of life, acute effects of HW intake on measured (51Cr-EDTA) and eGFR and ADPKD-related pain. ETHICS AND DISSEMINATION Ethical approval was awarded by the East of England Essex Research Ethics Committee (16/EE/0026). The results of DRINK will be submitted to peer-reviewed journals, and presented to patients via the PKD Charity. TRIAL REGISTRATION NUMBER NCT02933268 and ISCRTN16794957.
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Affiliation(s)
- Ragada El-Damanawi
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Michael Lee
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Laura B Mader
- Cambridge Clinical Trials Unit, Cambridge, UK
- Patient Led Research Hub, Cambridge, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Holly Pavey
- Cambridge Clinical Trials Unit, Cambridge, UK
| | | | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
| | | | | | | | | | - Thomas F Hiemstra
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
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166
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Hamilton A, Caskey F, Casula A, Inward C, Ben-Shlomo Y. SP325THE IMPACT OF DIALYSIS TREATMENT ON THE PSYCHOLOGICAL HEALTH OF YOUNG ADULTS: DATA FROM THE SPEAK STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp325] [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: 11/12/2022] Open
Affiliation(s)
- Alexander Hamilton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Anna Casula
- Statistics, UK Renal Registry, Bristol, United Kingdom
| | - Carol Inward
- Paediatric Nephrology, Bristol Royal Hospital For Children, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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167
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Walkden G, Anderson E, Vink M, Tilling K, Howe L, Ben-Shlomo Y. 4.2-O4Frailty in older-age European migrants: cross-sectional and longitudinal analyses of the survey of health, aging and retirement in Europe (SHARE). Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.128] [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: 11/15/2022] Open
Affiliation(s)
- G Walkden
- University of Bristol, United Kingdom
| | | | - M Vink
- Maastricht University, The Netherlands
| | - K Tilling
- University of Bristol, United Kingdom
| | - L Howe
- University of Bristol, United Kingdom
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168
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Hamilton A, Caskey F, Casula A, Ben-Shlomo Y, Inward C. FP349PSYCHOSOCIAL HEALTH AND LIFESTYLE BEHAVIOURS IN YOUNG ADULTS RECEIVING RRT COMPARED TO THE GENERAL POPULATION: DATA FROM THE SPEAK STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp349] [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)
- Alexander Hamilton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Anna Casula
- Statistics, UK Renal Registry, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Carol Inward
- Paediatric Nephrology, Bristol Royal Hospital For Children, Bristol, United Kingdom
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169
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Scott J, Jones T, Ben-Shlomo Y, Redaniel T, May M, Caskey F. SP234ESTIMATING THE RISK OF ACUTE KIDNEY INJURY ASSOCIATED WITH USE OF DIURETICS AND RENIN ANGIOTENSIN ALDOSTERONE SYSTEM BLOCKERS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp234] [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)
- Jemima Scott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Theresa Redaniel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Margaret May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Fergus Caskey
- UK Renal Registry, UK Renal Registry, Bristol, United Kingdom
- Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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170
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Shatwan IM, Winther KH, Ellahi B, Elwood P, Ben-Shlomo Y, Givens I, Rayman MP, Lovegrove JA, Vimaleswaran KS. Association of apolipoprotein E gene polymorphisms with blood lipids and their interaction with dietary factors. Lipids Health Dis 2018; 17:98. [PMID: 29712557 PMCID: PMC5928585 DOI: 10.1186/s12944-018-0744-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/13/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors. METHODS The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country. RESULTS There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P = 4 × 10- 4 and P = 0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54 ± 0.97 mmol/L) than those with the E3 (5.98 ± 1.05 mmol/L) (P = 0.001) and E4 (6.09 ± 1.06 mmol/L) (P = 2 × 10- 4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P = 2 × 10- 6 and P = 3 × 10- 4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P = 4 × 10- 4 and P = 0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction on lipid outcomes. CONCLUSION In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
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Affiliation(s)
- Israa M Shatwan
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP, UK.,Food and Nutrition Department, Faculty of Home Economics, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Basma Ellahi
- Faculty of Health and Social Care, University of Chester, Chester, CH1 1SL, UK
| | - Peter Elwood
- Department of Epidemiology, Statistics and Public Health, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Ian Givens
- Institute for Food, Nutrition and Health, University of Reading, Earley Gate, Reading, RG6 6AR, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP, UK
| | - Karani S Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP, UK.
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171
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Edwards HB, Smith M, Herrett E, MacGregor A, Blom A, Ben-Shlomo Y. The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes: A Study Involving the United Kingdom National Joint Registry Dataset. JB JS Open Access 2018; 3:e0042. [PMID: 30280132 PMCID: PMC6145568 DOI: 10.2106/jbjs.oa.17.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Total knee replacement (TKR) is a common procedure for the treatment of osteoarthritis that provides a substantial reduction of knee pain and improved function in most patients. We investigated whether sociodemographic factors could explain variations in the benefit resulting from TKR. Methods: Data were collected from 3 sources: the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man; National Health Service (NHS) England Patient Reported Outcome Measures; and Hospital Episode Statistics. These 3 sources were linked for analysis. Pain and function of the knee were measured with use of the Oxford Knee Score (OKS). The risk factors of interest were age group, sex, deprivation, and social support. The outcomes of interest were sociodemographic differences in preoperative scores, 6-month postoperative scores, and change in scores. Results: Ninety-one thousand nine hundred and thirty-six adults underwent primary TKR for the treatment of osteoarthritis in an NHS England unit from 2009 to 2012. Sixty-six thousand seven hundred and sixty-nine of those patients had complete knee score data and were included in the analyses for the present study. The preoperative knee scores were worst in female patients, younger patients, and patients from deprived areas. At 6 months postoperatively, the mean knee score had improved by 15.2 points. There were small sociodemographic differences in the benefit of surgery, with greater area deprivation (−0.71 per quintile of increase in deprivation; 95% confidence interval [CI], −0.76 to −0.66; p < 0.001) and younger age group (−3.51 for ≤50 years compared with 66 to 75 years; 95% CI, −4.00 to −3.02; p < 0.001) associated with less benefit. Cumulatively, sociodemographic factors explained <1% of the total variability in improvement. Conclusions: Sociodemographic factors have a small influence on the benefit resulting from TKR. However, as they are associated with the clinical threshold at which the procedure is performed, they do affect the eventual outcomes of TKR. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of evidence.
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Affiliation(s)
- Hannah B Edwards
- University of Bristol, Bristol, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom
| | | | - Emily Herrett
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Ashley Blom
- University of Bristol, Bristol, United Kingdom.,North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- University of Bristol, Bristol, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom
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172
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Diaz E, Ortiz-Barreda G, Ben-Shlomo Y, Holdsworth M, Salami B, Rammohan A, Chung RYN, Padmadas SS, Krafft T. Interventions to improve immigrant health. A scoping review. Eur J Public Health 2018; 27:433-439. [PMID: 28339883 PMCID: PMC5445720 DOI: 10.1093/eurpub/ckx001] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 12/17/2022] Open
Abstract
Background: Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. Aims: To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. Methods: A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Results: Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Conclusions: Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Gaby Ortiz-Barreda
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michelle Holdsworth
- School of Health and Related Research- ScHARR, University of Sheffield, Sheffield, UK
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Anu Rammohan
- Discipline of Economics, University of Western Australia, Perth, Australia
| | - Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | | | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
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173
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Weir-McCall JR, Brown L, Summersgill J, Talarczyk P, Bonnici-Mallia M, Chin SC, Khan F, Struthers AD, Sullivan F, Colhoun HM, Shore AC, Aizawa K, Groop L, Nilsson J, Cockcroft JR, McEniery CM, Wilkinson IB, Ben-Shlomo Y, Houston JG. Development and Validation of a Path Length Calculation for Carotid-Femoral Pulse Wave Velocity Measurement: A TASCFORCE, SUMMIT, and Caerphilly Collaborative Venture. Hypertension 2018; 71:937-945. [PMID: 29555666 PMCID: PMC5902134 DOI: 10.1161/hypertensionaha.117.10620] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/19/2022]
Abstract
Supplemental Digital Content is available in the text. Current distance measurement techniques for pulse wave velocity (PWV) calculation are susceptible to intercenter variability. The aim of this study was to derive and validate a formula for this distance measurement. Based on carotid femoral distance in 1183 whole-body magnetic resonance angiograms, a formula was derived for calculating distance. This was compared with distance measurements in 128 whole-body magnetic resonance angiograms from a second study. The effects of recalculation of PWV using the new formula on association with risk factors, disease discrimination, and prediction of major adverse cardiovascular events were examined within 1242 participants from the multicenter SUMMIT study (Surrogate Markers of Micro- and Macrovascular Hard End-Points for Innovative Diabetes Tools) and 825 participants from the Caerphilly Prospective Study. The distance formula yielded a mean error of 7.8 mm (limits of agreement =−41.1 to 56.7 mm; P<0.001) compared with the second whole-body magnetic resonance angiogram group. Compared with an external distance measurement, the distance formula did not change associations between PWV and age, blood pressure, or creatinine (P<0.01) but did remove significant associations between PWV and body mass index (BMI). After accounting for differences in age, sex, and mean arterial pressure, intercenter differences in PWV persisted using the external distance measurement (F=4.6; P=0.004), whereas there was a loss of between center difference using the distance formula (F=1.4; P=0.24). PWV odds ratios for cardiovascular mortality remained the same using both the external distance measurement (1.14; 95% confidence interval, 1.06–1.24; P=0.001) and the distance formula (1.17; 95% confidence interval, 1.08–1.28; P<0.001). A population-derived automatic distance calculation for PWV obtained from routinely collected clinical information is accurate and removes intercenter measurement variability without impacting the diagnostic utility of carotid–femoral PWV.
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Affiliation(s)
- Jonathan R Weir-McCall
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Liam Brown
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Jennifer Summersgill
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Piotr Talarczyk
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Michael Bonnici-Mallia
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Sook C Chin
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Faisel Khan
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Allan D Struthers
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Helen M Colhoun
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Angela C Shore
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Kunihiko Aizawa
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Leif Groop
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Jan Nilsson
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - John R Cockcroft
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Carmel M McEniery
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Ian B Wilkinson
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Yoav Ben-Shlomo
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - J Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.).
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174
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Ben-Shlomo Y, Hayward P. Letters to the Editor. J R Soc Med 2018. [DOI: 10.1177/014107688908201229] [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: 11/16/2022] Open
Affiliation(s)
- Y Ben-Shlomo
- Registrar in Public Health South West Thames Regional Health Authority
| | - P Hayward
- Department of Clinical Epidemiology & Social Medicine, St George's Hospital Medical School
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175
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Martin RM, Donovan JL, Turner EL, Metcalfe C, Young GJ, Walsh EI, Lane JA, Noble S, Oliver SE, Evans S, Sterne JAC, Holding P, Ben-Shlomo Y, Brindle P, Williams NJ, Hill EM, Ng SY, Toole J, Tazewell MK, Hughes LJ, Davies CF, Thorn JC, Down E, Davey Smith G, Neal DE, Hamdy FC. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial. JAMA 2018; 319:883-895. [PMID: 29509864 PMCID: PMC5885905 DOI: 10.1001/jama.2018.0154] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [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] [Received: 09/25/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer-specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practices across the United Kingdom. Randomization and recruitment of the practices occurred between 2001 and 2009; patient follow-up ended on March 31, 2016. Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs standard (unscreened) practice. Main Outcomes and Measures Primary outcome: prostate cancer-specific mortality at a median follow-up of 10 years. Prespecified secondary outcomes: diagnostic cancer stage and Gleason grade (range, 2-10; higher scores indicate a poorer prognosis) of prostate cancers identified, all-cause mortality, and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic. Results Among 415 357 randomized men (mean [SD] age, 59.0 [5.6] years), 189 386 in the intervention group and 219 439 in the control group were included in the analysis (n = 408 825; 98%). In the intervention group, 75 707 (40%) attended the PSA testing clinic and 67 313 (36%) underwent PSA testing. Of 64 436 with a valid PSA test result, 6857 (11%) had a PSA level between 3 ng/mL and 19.9 ng/mL, of whom 5850 (85%) had a prostate biopsy. After a median follow-up of 10 years, 549 (0.30 per 1000 person-years) died of prostate cancer in the intervention group vs 647 (0.31 per 1000 person-years) in the control group (rate difference, -0.013 per 1000 person-years [95% CI, -0.047 to 0.022]; rate ratio [RR], 0.96 [95% CI, 0.85 to 1.08]; P = .50). The number diagnosed with prostate cancer was higher in the intervention group (n = 8054; 4.3%) than in the control group (n = 7853; 3.6%) (RR, 1.19 [95% CI, 1.14 to 1.25]; P < .001). More prostate cancer tumors with a Gleason grade of 6 or lower were identified in the intervention group (n = 3263/189 386 [1.7%]) than in the control group (n = 2440/219 439 [1.1%]) (difference per 1000 men, 6.11 [95% CI, 5.38 to 6.84]; P < .001). In the analysis of all-cause mortality, there were 25 459 deaths in the intervention group vs 28 306 deaths in the control group (RR, 0.99 [95% CI, 0.94 to 1.03]; P = .49). In the instrumental variable analysis for prostate cancer mortality, the adherence-adjusted causal RR was 0.93 (95% CI, 0.67 to 1.29; P = .66). Conclusions and Relevance Among practices randomized to a single PSA screening intervention vs standard practice without screening, there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening. Trial Registration ISRCTN Identifier: ISRCTN92187251.
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Affiliation(s)
- Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
| | - Jenny L. Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Trust, Bristol, England
| | - Emma L. Turner
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Chris Metcalfe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Grace J. Young
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Eleanor I. Walsh
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - J. Athene Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Sian Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Steven E. Oliver
- Department of Health Sciences, University of York and Hull York Medical School, York, England
| | - Simon Evans
- Urology Department, Royal United Hospital, Bath, England
| | - Jonathan A. C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Trust, Bristol, England
| | - Peter Brindle
- Bristol, North Somerset, and South Gloucestershire Clinical Commissioning Group, Bristol, England
| | - Naomi J. Williams
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Elizabeth M. Hill
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Siaw Yein Ng
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jessica Toole
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Marta K. Tazewell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Laura J. Hughes
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
| | - Charlotte F. Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Joanna C. Thorn
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Elizabeth Down
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, England
| | - David E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
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176
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Plumb LA, Hamilton AJ, Inward CD, Ben-Shlomo Y, Caskey FJ. Continually improving standards of care: The UK Renal Registry as a translational public health tool. Pediatr Nephrol 2018; 33:373-380. [PMID: 28642999 PMCID: PMC5799353 DOI: 10.1007/s00467-017-3688-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 12/02/2022]
Abstract
A disease registry uses observational study methods to collect defined data on patients with a particular condition for a predetermined purpose. By providing comprehensive standardised data on patients with kidney disease, renal registries aim to provide a 'real world' representation of practice patterns, treatment and patient outcomes that may not be captured accurately by other methods, including randomised controlled trials. Additionally, using registries to measure variations in outcomes and audit care against standards is crucial to understanding how to improve quality of care for patients in an efficacious and cost-effective manner. Registries also have the potential to be a powerful scientific tool that can monitor and support the translational process between research and routine clinical practice, although their limitations must be borne in mind. In this review, we describe the role of the UK Renal Registry as a tool to support translational research. We describe its involvement across each stage of the translational pathway: from hypothesis generation, study design and data collection, to reporting of long-term outcomes and quality improvement initiatives. Furthermore we explore how this role may bring about improvements in care for adults and children with kidney disease.
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Affiliation(s)
- Lucy A Plumb
- The UK Renal Registry, Learning & Research Building, Southmead Hospital, Bristol, UK.
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Alexander J Hamilton
- The UK Renal Registry, Learning & Research Building, Southmead Hospital, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Carol D Inward
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- The UK Renal Registry, Learning & Research Building, Southmead Hospital, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Fergus J Caskey
- The UK Renal Registry, Learning & Research Building, Southmead Hospital, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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177
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Patterson CC, Blankenberg S, Ben-Shlomo Y, Heslop L, Bayer A, Lowe G, Zeller T, Gallacher J, Young I, Yarnell JWG. Troponin and BNP are markers for subsequent non-ischaemic congestive heart failure: the Caerphilly Prospective Study (CaPS). Open Heart 2018. [PMID: 29531757 PMCID: PMC5845403 DOI: 10.1136/openhrt-2017-000692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To examine the long-term predictive value of 28 biomarkers for subsequent non-ischaemic congestive heart failure (CHF) and separately for other cardiovascular outcomes (myocardial infarction (MI) and stroke). Methods The Caerphilly Prospective Study recruited 2171 men aged 55–69 years from the general population in 1989–1993; men were screened for evidence of cardiovascular disease (CVD) and followed for clinical cardiovascular events. Fasting blood samples were stored at −70°C until assayed for novel biomarkers in 2010–2013. A competing risks proportional hazards regression analysis was used to estimate subhazard ratios (SHRs) for each biomarker for each cardiovascular outcome. Results During follow-up (average 13 years), only new, initial events were evaluated in the whole cohort: 584 MIs, 313 strokes and 261 episodes of CHF (not associated with acute MI). In a subcohort of men who had no clinical history or evidence of CVD at baseline examination (n=1279) those in the top third of the distributions of troponin and B-type natriuretic peptide (BNP) showed a threefold increase in risk for subsequent CHF as a first event after adjustment for all conventional risk factors (SHRs 3.37, 95% CI 1.39 to 8.14 and 3.23, 95% CI 1.45 to 7.23), respectively, in contrast to moderate elevations in risk for acute MI (troponin SHR 1.63, 95% CI 1.10 to 2.41) and for stroke (BNP SHR 1.75 95% CI 1.06 to 2.88). Conclusion Troponin and BNP could be considered as potentially useful screening tools to detect subjects without prior CVD at increased risk of developing CHF in subsequent years in addition to having lesser roles for predicting subsequent MI (troponin) or stroke (BNP).
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Affiliation(s)
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,DZHK German Center for Cardiovascular Research, Partner Sites Hamburg, Lubeck, Kiel, Hamburg, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luke Heslop
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Anthony Bayer
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Gordon Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,DZHK German Center for Cardiovascular Research, Partner Sites Hamburg, Lubeck, Kiel, Hamburg, Germany
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Ian Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John W G Yarnell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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178
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Nüesch E, Dale C, Palmer TM, White J, Keating BJ, van Iperen EP, Goel A, Padmanabhan S, Asselbergs FW, Verschuren WM, Wijmenga C, Van der Schouw YT, Onland-Moret NC, Lange LA, Hovingh GK, Sivapalaratnam S, Morris RW, Whincup PH, Wannamethe GS, Gaunt TR, Ebrahim S, Steel L, Nair N, Reiner AP, Kooperberg C, Wilson JF, Bolton JL, McLachlan S, Price JF, Strachan MW, Robertson CM, Kleber ME, Delgado G, März W, Melander O, Dominiczak AF, Farrall M, Watkins H, Leusink M, Maitland-van der Zee AH, de Groot MC, Dudbridge F, Hingorani A, Ben-Shlomo Y, Lawlor DA, Amuzu A, Caufield M, Cavadino A, Cooper J, Davies TL, Drenos F, Engmann J, Finan C, Giambartolomei C, Hardy R, Humphries SE, Hypponen E, Kivimaki M, Kuh D, Kumari M, Ong K, Plagnol V, Power C, Richards M, Shah S, Shah T, Sofat R, Talmud PJ, Wareham N, Warren H, Whittaker JC, Wong A, Zabaneh D, Davey Smith G, Wells JC, Leon DA, Holmes MV, Casas JP. Adult height, coronary heart disease and stroke: a multi-locus Mendelian randomization meta-analysis. Int J Epidemiol 2018; 45:1927-1937. [PMID: 25979724 PMCID: PMC5841831 DOI: 10.1093/ije/dyv074] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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] [Accepted: 04/15/2015] [Indexed: 11/12/2022] Open
Abstract
Background: We investigated causal effect of completed growth, measured by adult height, on coronary heart disease (CHD), stroke and cardiovascular traits, using instrumental variable (IV) Mendelian randomization meta-analysis. Methods: We developed an allele score based on 69 single nucleotide polymorphisms (SNPs) associated with adult height, identified by the IBCCardioChip, and used it for IV analysis against cardiovascular risk factors and events in 21 studies and 60 028 participants. IV analysis on CHD was supplemented by summary data from 180 height-SNPs from the GIANT consortium and their corresponding CHD estimates derived from CARDIoGRAMplusC4D. Results: IV estimates from IBCCardioChip and GIANT-CARDIoGRAMplusC4D showed that a 6.5-cm increase in height reduced the odds of CHD by 10% [odds ratios 0.90; 95% confidence intervals (CIs): 0.78 to 1.03 and 0.85 to 0.95, respectively],which agrees with the estimate from the Emerging Risk Factors Collaboration (hazard ratio 0.93; 95% CI: 0.91 to 0.94). IV analysis revealed no association with stroke (odds ratio 0.97; 95% CI: 0.79 to 1.19). IV analysis showed that a 6.5-cm increase in height resulted in lower levels of body mass index (P < 0.001), triglycerides (P < 0.001), non high-density (non-HDL) cholesterol (P < 0.001), C-reactive protein (P = 0.042), and systolic blood pressure (P = 0.064) and higher levels of forced expiratory volume in 1 s and forced vital capacity (P < 0.001 for both). Conclusions: Taller individuals have a lower risk of CHD with potential explanations being that taller people have a better lung function and lower levels of body mass index, cholesterol and blood pressure.
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Affiliation(s)
- Eveline Nüesch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Caroline Dale
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom M Palmer
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Jon White
- UCL Genetics Institute, Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Brendan J Keating
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Surgery.,Division of Genetics, University of Pennsylvania, Philadelphia
| | - Erik Pa van Iperen
- Department of Biostatistics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anuj Goel
- Wellcome Trust Centre for Human Genetics and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | | | | | | | | | | | - Leslie A Lange
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G K Hovingh
- Department of Vascular Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Suthesh Sivapalaratnam
- Department of Vascular Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Richard W Morris
- Department of Primary Care & Population Health, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Goya S Wannamethe
- Department of Primary Care & Population Health, University College London, London, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shah Ebrahim
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Steel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil Nair
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA / Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - James F Wilson
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jennifer L Bolton
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Stela McLachlan
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jacqueline F Price
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Christine M Robertson
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Marcus E Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Graciela Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Winfried März
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Germany, Synlab Academy, Synlab Services GmbH, Mannheim and Augsburg, Germany, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | | | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Farrall
- Wellcome Trust Centre for Human Genetics and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Wellcome Trust Centre for Human Genetics and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Maarten Leusink
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mark Ch de Groot
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Dudbridge
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aroon Hingorani
- Department of Epidemiology and Public Health, University College London Medical School, London, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - D Zabaneh
- UCLEB, London, Edinburgh and Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Community Medicine, Arctic University of Norway, UiT
| | - Michael V Holmes
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Department of Surgery and Clinical Epidemiology Unit, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Juan P Casas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
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179
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Tilling K, Lawton M, Robertson N, Tremlett H, Zhu F, Harding K, Oger J, Ben-Shlomo Y. Modelling disease progression in relapsing-remitting onset multiple sclerosis using multilevel models applied to longitudinal data from two natural history cohorts and one treated cohort. Health Technol Assess 2018; 20:1-48. [PMID: 27817792 DOI: 10.3310/hta20810] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The ability to better predict disease progression represents a major unmet need in multiple sclerosis (MS), and would help to inform therapeutic and management choices. OBJECTIVES To develop multilevel models using longitudinal data on disease progression in patients with relapsing-remitting MS (RRMS) or secondary-progressive MS (SPMS); and to use these models to estimate the association of disease-modifying therapy (DMT) with progression. DESIGN Secondary analysis of three MS cohorts. SETTING Two natural history cohorts: University of Wales Multiple Sclerosis (UoWMS) cohort, UK, and British Columbia Multiple Sclerosis (BCMS) cohort, Canada. One observational DMT-treated cohort: UK MS risk-sharing scheme (RSS). PARTICIPANTS The UoWMS database has > 2000 MS patients and the BCMS database (as of 2009) has > 5900 MS patients. All participants who had definite MS (RRMS/SPMS), who reached the criteria set out by the Association of British Neurologists (ABN) for eligibility for DMT [i.e. age ≥ 18 years, Expanded Disability Status Scale (EDSS) score of ≤ 6.5, occurrence of two or more relapses in the previous 2 years] and who had at least two repeated outcome measures were included: 404 patients for the UoWMS cohort and 978 patients for the BCMS cohort. Through the UK MS RSS scheme, 5583 DMT-treated patients were recruited, with the analysis sample being the 4137 who had RRMS and were eligible and treated at baseline, with at least one valid EDSS score post baseline. MAIN OUTCOME MEASURES EDSS score observations post ABN eligibility. METHODS We used multilevel models in the development cohort (UoWMS) to develop a model for EDSS score with time since ABN eligibility, allowing for covariates and appropriate transformation of outcome and/or time. These methods were then applied to the BCMS cohort to obtain a 'natural history' model for changes in the EDSS score with time. We then used this natural history model to predict the trajectories of EDSS score in treated patients in the UK MS RSS database. Differences between the progression predicted by the natural history model and the progression observed at 6 years' follow-up for the UK MS RSS cohort were used as indicators of the effectiveness of the DMTs. Previously developed utility scores were assigned to each EDSS score, and differences in utility also examined. RESULTS The model best fitting the UoWMS data showed a non-linear increase in EDSS score over time since ABN eligibility. This model fitted the BCMS cohort data well, with similar coefficients, and the BCMS model predicted EDSS score in UoWMS data with little evidence of bias. Using the natural history model predicts EDSS score in a treated cohort (UK MS RSS) higher than that observed [by 0.59 points (95% confidence interval 0.54 to 0.64 points)] at 6 years post treatment. LIMITATIONS Only two natural history cohorts were compared, limiting generalisability. The comparison of a treated cohort with untreated cohorts is observational, thus limiting conclusions about causality. CONCLUSIONS EDSS score progression in two natural history cohorts of MS patients showed a similar pattern. Progression in the natural history cohorts was slightly faster than EDSS score progression in the DMT-treated cohort, up to 6 years post treatment. FUTURE WORK Long-term follow-up of randomised controlled trials is needed to replicate these findings and examine duration of any treatment effect. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Kate Tilling
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Michael Lawton
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Neil Robertson
- Department of Neurology, Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Helen Tremlett
- Faculty of Medicine, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Feng Zhu
- Faculty of Medicine, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Katharine Harding
- Department of Neurology, Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Joel Oger
- Faculty of Medicine, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, Bristol University, Bristol, UK
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180
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Bailey PK, Hamilton AJ, Clissold RL, Inward CD, Caskey FJ, Ben-Shlomo Y, Owen-Smith A. Young adults' perspectives on living with kidney failure: a systematic review and thematic synthesis of qualitative studies. BMJ Open 2018; 8:e019926. [PMID: 29326196 PMCID: PMC5781019 DOI: 10.1136/bmjopen-2017-019926] [Citation(s) in RCA: 31] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Young adults fare worse than younger adolescents or older adults on a broad range of health indicators. Those with a chronic illness such as renal failure are a particularly vulnerable group, who experience poor outcomes compared with both children and older adults. Understanding how being in receipt of renal replacement therapy (RRT) affects the lives of young adults might help us to better prepare and support these individuals for and on RRT, and improve outcomes. This study aimed to synthesise research describing young adults' experiences of the psychosocial impact of kidney failure and RRT. DESIGN A systematic literature review identified qualitative research reporting the perspectives of people aged 16-30 years receiving RRT on the psychosocial impact of renal failure. Electronic databases (including Medline/EMBASE/PsycINFO/ASSIA) were searched to November 2017 for full-text papers. The transparency of reporting of each study was assessed using the Consolidated Criteria for Reporting Qualitative Health Research (COREQ) framework. Quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. An inductive thematic synthesis was undertaken. PARTICIPANTS Seven studies from five different countries were included, comprising 123 young adults receiving RRT. RESULTS Comprehensiveness of reporting was variable: studies reported 9-22 of the 32 COREQ-checklist items.Three global themes about the impact of kidney failure on young adults were identified: (1) difference desiring normality, (2) thwarted or moderated dreams and ambitions, and (3) uncertainty and liminality. These reflected five organising themes: (1) physical appearance and body image, (2) activity and participation, (3) educational disruption and underachievement, (4) career ambitions and employment difficulties, and (5) social isolation and intimate relationships. CONCLUSIONS Across different countries and different healthcare settings, young adults on RRT experience difference and liminality, even after transplantation. Tailored social and psychological support is required to allow young adults to experience wellness while in receipt of RRT, and not have life on hold.
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Affiliation(s)
- Phillippa K Bailey
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Translational Health Sciences, Bristol Medical School, Bristol, UK
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alexander J Hamilton
- Population Health Sciences, Bristol Medical School, Bristol, UK
- UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Rhian L Clissold
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Carol D Inward
- Paediatric Nephrology Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, Bristol, UK
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
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181
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Bhimjiyani A, Neuburger J, Jones T, Ben-Shlomo Y, Gregson CL. The effect of social deprivation on hip fracture incidence in England has not changed over 14 years: an analysis of the English Hospital Episodes Statistics (2001-2015). Osteoporos Int 2018; 29:115-124. [PMID: 28965213 DOI: 10.1007/s00198-017-4238-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/21/2017] [Indexed: 01/23/2023]
Abstract
Deprivation predicts increased hip fracture risk. Over 14 years, hip fracture incidence increased among men with persisting inequalities. Among women, inequalities in incidence were less pronounced; whilst incidence decreased overall, this improvement was seen marginally less in women from the most deprived areas. Hip fracture prevention programmes have not reduced inequalities. PURPOSE Deprivation is associated with increased hip fracture risk. We examined the effect of area-level deprivation on hip fracture incidence in England over 14 years to determine whether inequalities have changed over time. METHODS We used English Hospital Episodes Statistics (2001/2002-2014/2015) to identify hip fractures in adults aged 50+ years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation measured local area deprivation. We calculated age-adjusted incidence rate ratios (IRR) for hip fracture, stratified by gender and deprivation quintiles. RESULTS Over 14 years, we identified 747,369 hospital admissions with an index hip fracture; the number increased from 50,640 in 2001 to 55,092 in 2014; the proportion of men increased from 22.2% to 29.6%. Whereas incidence rates decreased in women (annual reduction 1.1%), they increased in men (annual increase 0.6%) (interaction p < 0.001). Incidence was higher in more deprived areas, particularly among men: IRR most vs. least deprived quintile 1.50 [95% CI 1.48, 1.52] in men, 1.17 [1.16, 1.18] in women. Age-standardised incidence increased for men across all deprivation quintiles from 2001 to 2014. Among women, incidence fell more among those least compared to most deprived (year by deprivation interaction p < 0.001). CONCLUSIONS Deprivation is a stronger relative predictor of hip fracture incidence in men than in women. However, given their higher hip fracture incidence, the absolute burden of deprivation on hip fractures is greater in women. Despite public health efforts to prevent hip fractures, the health inequality gap for hip fracture incidence has not narrowed for men, and marginally widened among women.
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Affiliation(s)
- A Bhimjiyani
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - J Neuburger
- Nuffield Trust, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - T Jones
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
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182
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Kehoe PG, Blair PS, Howden B, Thomas DL, Malone IB, Horwood J, Clement C, Selman LE, Baber H, Lane A, Coulthard E, Passmore AP, Fox NC, Wilkinson IB, Ben-Shlomo Y. The Rationale and Design of the Reducing Pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR) Trial. J Alzheimers Dis 2018; 61:803-814. [PMID: 29226862 DOI: 10.3233/jad-170101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anti-hypertensives that modify the renin angiotensin system may reduce Alzheimer's disease (AD) pathology and reduce the rate of disease progression. OBJECTIVE To conduct a phase II, two arm, double-blind, placebo-controlled, randomized trial of losartan to test the efficacy of Reducing pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR). METHODS Men and women aged at least 55 years with mild-to-moderate AD will be randomly allocated 100 mg encapsulated generic losartan or placebo once daily for 12 months after successful completion of a 2-week open-label phase and 2-week placebo washout to establish drug tolerability. 228 participants will provide at least 182 subjects with final assessments to provide 84% power to detect a 25% difference in atrophy rate (therapeutic benefit) change over 12 months at an alpha level of 0.05. We will use intention-to-treat analysis, estimating between-group differences in outcomes derived from appropriate (linear or logistic) multivariable regression models adjusting for minimization variables. RESULTS The primary outcome will be rate of whole brain atrophy as a surrogate measure of disease progression. Secondary outcomes will include changes to 1) white matter hyperintensity volume and cerebral blood flow; 2) performance on a standard series of assessments of memory, cognitive function, activities of daily living, and quality of life. Major assessments (for all outcomes) and relevant safety monitoring of blood pressure and bloods will be at baseline and 12 months. Additional cognitive assessment will also be conducted at 6 months along with safety blood pressure and blood monitoring. Monitoring of blood pressure, bloods, and self-reported side effects will occur during the open-label phase and during the majority of the post-randomization dispensing visits. CONCLUSION This study will identify whether losartan is efficacious in the treatment of AD and whether definitive Phase III trials are warranted.
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Affiliation(s)
- Patrick G Kehoe
- Dementia Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Faculty of Health Sciences, Level 1 Learning and Research>, Southmead Hospital, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Beth Howden
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David L Thomas
- Leonard Wolfson Experimental Neurology Centre, UCL Institute of Neurology, Queen Square, London, UK
- Dementia Research Centre (DRC), Institute of Neurology, University College London, Queen Square, London, UK
| | - Ian B Malone
- Dementia Research Centre (DRC), Institute of Neurology, University College London, Queen Square, London, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy E Selman
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Baber
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- ReMemBr Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Faculty of Health Sciences, Brain Centre, Southmead Hospital, Bristol, UK
| | - Anthony Peter Passmore
- Institute of Clinical Sciences, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Nick C Fox
- Dementia Research Centre (DRC), Institute of Neurology, University College London, Queen Square, London, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, School of Clinical Medicine, University of Cambridge, and Clinical Trials Unit, Addenbrookes Hospital, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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183
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Hamilton AJ, Clissold RL, Inward CD, Caskey FJ, Ben-Shlomo Y. Sociodemographic, Psychologic Health, and Lifestyle Outcomes in Young Adults on Renal Replacement Therapy. Clin J Am Soc Nephrol 2017; 12:1951-1961. [PMID: 29051144 PMCID: PMC5718271 DOI: 10.2215/cjn.04760517] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Young adults receiving RRT face additional challenges in life. The effect of established kidney failure on young adulthood is uncertain. We aimed to establish the psychosocial and lifestyle status of young adults receiving RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study was a systematic review and meta-analysis of 16-30-year olds receiving RRT compared with the general population. We selected randomized, controlled trials; cohort studies; or cross-sectional studies without language restriction and extracted proportions of sociodemographic and lifestyle outcomes or validated psychologic health tests producing quality of life, wellbeing, and self-esteem scores. We undertook random effects meta-analysis. RESULTS There were 60 studies with a total of 15,575 participants. Studies were largely single-center cross-sectional studies of those transplanted in childhood. Compared with healthy peers, young adults on RRT had lower quality of life, which was worse for patients on dialysis (seven studies: standardized mean difference, -1.01; 95% confidence interval [95% CI], -1.32 to -0.70) compared with patients with transplants (nine studies: standardized mean difference, -0.42; 95% CI, -0.64 to -0.20). They were more likely to be unemployed (seven studies: relative risk, 1.89; 95% CI, 1.47 to 2.44) and live in the family home (two studies: relative risk, 1.84; 95% CI, 1.40 to 2.43). They were less likely to be married or have a partner (four studies: relative risk, 0.71; 95% CI, 0.53 to 0.95). Higher education (three studies: relative risk, 1.05; 95% CI, 0.73 to 1.51), alcohol abstinence (three studies: relative risk, 1.96; 95% CI, 0.84 to 4.67), and smoking status (two studies: relative risk, 0.72; 95% CI, 0.36 to 1.44) did not differ. Results were limited by high heterogeneity and a small evidence base, biased toward surviving patients. CONCLUSIONS Established kidney failure is associated with lower quality of life in young people and limited employment, independence, and relationships compared with healthy peers. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_10_19_CJASNPodcast_17_12_.mp3.
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Affiliation(s)
- Alexander J. Hamilton
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom
| | - Rhian L. Clissold
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom; and
| | - Carol D. Inward
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Fergus J. Caskey
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Baig F, Lawton M, Rolinski M, Ruffmann C, Klein J, Nithi K, Okai D, Ben-Shlomo Y, Hu M. PO075 Personality and addictive behaviours in prodromal and early parkinson’s disease. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kelly MJ, Baig F, Ben-Shlomo Y, Okai D, Hu M. PO083 Severity of impulsive compulsive behaviours in early parkinson’s disease. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Borges MC, Barros AJD, Ferreira DLS, Casas JP, Horta BL, Kivimaki M, Kumari M, Menon U, Gaunt TR, Ben-Shlomo Y, Freitas DF, Oliveira IO, Gentry-Maharaj A, Fourkala E, Lawlor DA, Hingorani AD. Metabolic Profiling of Adiponectin Levels in Adults: Mendelian Randomization Analysis. Circ Cardiovasc Genet 2017; 10:e001837. [PMID: 29237687 PMCID: PMC5736126 DOI: 10.1161/circgenetics.117.001837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 09/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adiponectin, a circulating adipocyte-derived protein, has insulin-sensitizing, anti-inflammatory, antiatherogenic, and cardiomyocyte-protective properties in animal models. However, the systemic effects of adiponectin in humans are unknown. Our aims were to define the metabolic profile associated with higher blood adiponectin concentration and investigate whether variation in adiponectin concentration affects the systemic metabolic profile. METHODS AND RESULTS We applied multivariable regression in ≤5909 adults and Mendelian randomization (using cis-acting genetic variants in the vicinity of the adiponectin gene as instrumental variables) for analyzing the causal effect of adiponectin in the metabolic profile of ≤37 545 adults. Participants were largely European from 6 longitudinal studies and 1 genome-wide association consortium. In the multivariable regression analyses, higher circulating adiponectin was associated with higher high-density lipoprotein lipids and lower very-low-density lipoprotein lipids, glucose levels, branched-chain amino acids, and inflammatory markers. However, these findings were not supported by Mendelian randomization analyses for most metabolites. Findings were consistent between sexes and after excluding high-risk groups (defined by age and occurrence of previous cardiovascular event) and 1 study with admixed population. CONCLUSIONS Our findings indicate that blood adiponectin concentration is more likely to be an epiphenomenon in the context of metabolic disease than a key determinant.
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Affiliation(s)
- Maria Carolina Borges
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.).
| | - Aluísio J D Barros
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Diana L Santos Ferreira
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Juan Pablo Casas
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Bernardo Lessa Horta
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Mika Kivimaki
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Meena Kumari
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Usha Menon
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Tom R Gaunt
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Yoav Ben-Shlomo
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Deise F Freitas
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Isabel O Oliveira
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Aleksandra Gentry-Maharaj
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Evangelia Fourkala
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Debbie A Lawlor
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
| | - Aroon D Hingorani
- From the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil (M.C.B., A.J.D.B., B.L.H., D.F.F., I.O.O.); MRC Integrative Epidemiology Unit (M.C.B., D.L.S.F., T.R.G., D.A.L.) and Population Health Sciences, Bristol Medical School (M.C.B., D.L.S.F., T.R.G., Y.B.-S., D.A.L.), University of Bristol, United Kingdom; Farr Institute of Health Informatics (J.P.C., A.D.H.), Department of Epidemiology and Public Health (M. Kivimaki, M. Kumari), Department of Women's Cancer, Institute for Women's Health, Faculty of Population Health Sciences (U.M., A.G.-M., E.F.), and Institute of Cardiovascular Science (A.D.H.), University College London, United Kingdom; Institute for Social and Economic Research, University of Essex, United Kingdom (M. Kumari); and Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Brazil (I.O.O.)
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Rees RN, Tan MMX, Pittman AM, Ben-Shlomo Y, Williams NM, Grosset DG, Morris HR. PO103 Impulse control disorders in familial parkinson’s disease. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.133] [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: 11/04/2022]
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188
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Chen MH, Yanek LR, Backman JD, Eicher JD, Huffman JE, Ben-Shlomo Y, Beswick AD, Yerges-Armstrong LM, Shuldiner AR, O'Connell JR, Mathias RA, Becker DM, Becker LC, Lewis JP, Johnson AD, Faraday N. Exome-chip meta-analysis identifies association between variation in ANKRD26 and platelet aggregation. Platelets 2017; 30:164-173. [PMID: 29185836 DOI: 10.1080/09537104.2017.1384538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Previous genome-wide association studies (GWAS) have identified several variants associated with platelet function phenotypes; however, the proportion of variance explained by the identified variants is mostly small. Rare coding variants, particularly those with high potential for impact on protein structure/function, may have substantial impact on phenotype but are difficult to detect by GWAS. The main purpose of this study was to identify low frequency or rare variants associated with platelet function using genotype data from the Illumina HumanExome Bead Chip. Three family-based cohorts of European ancestry, including ~4,000 total subjects, comprised the discovery cohort and two independent cohorts, one of European and one of African American ancestry, were used for replication. Optical aggregometry in platelet-rich plasma was performed in all the discovery cohorts in response to adenosine diphosphate (ADP), epinephrine, and collagen. Meta-analyses were performed using both gene-based and single nucleotide variant association methods. The gene-based meta-analysis identified a significant association (P = 7.13 × 10-7) between rare genetic variants in ANKRD26 and ADP-induced platelet aggregation. One of the ANKRD26 SNVs - rs191015656, encoding a threonine to isoleucine substitution predicted to alter protein structure/function, was replicated in Europeans. Aggregation increases of ~20-50% were observed in heterozygotes in all cohorts. Novel genetic signals in ABCG1 and HCP5 were also associated with platelet aggregation to ADP in meta-analyses, although only results for HCP5 could be replicated. The SNV in HCP5 intersects epigenetic signatures in CD41+ megakaryocytes suggesting a new functional role in platelet biology for HCP5. This is the first study to use gene-based association methods from SNV array genotypes to identify rare variants related to platelet function. The molecular mechanisms and pathophysiological relevance for the identified genetic associations requires further study.
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Affiliation(s)
- Ming-Huei Chen
- a National Heart, Lung and Blood Institute's The Framingham Heart Study, Population Sciences Branch, Division of Intramural Research , National Heart, Lung and Blood Institute , Framingham , MA , USA
| | - Lisa R Yanek
- b GeneSTAR Research Program, Department of Medicine, Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Joshua D Backman
- c School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - John D Eicher
- a National Heart, Lung and Blood Institute's The Framingham Heart Study, Population Sciences Branch, Division of Intramural Research , National Heart, Lung and Blood Institute , Framingham , MA , USA
| | - Jennifer E Huffman
- a National Heart, Lung and Blood Institute's The Framingham Heart Study, Population Sciences Branch, Division of Intramural Research , National Heart, Lung and Blood Institute , Framingham , MA , USA
| | - Yoav Ben-Shlomo
- d School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Andrew D Beswick
- e School of Clinical Sciences , University of Bristol , Bristol , UK
| | - Laura M Yerges-Armstrong
- c School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Alan R Shuldiner
- c School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Jeffrey R O'Connell
- c School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Rasika A Mathias
- f GeneSTAR Research Program, Department of Medicine, Divisions of Allergy and Clinical Immunology and General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Diane M Becker
- b GeneSTAR Research Program, Department of Medicine, Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Lewis C Becker
- g GeneSTAR Research Program, Department of Medicine, Divisions of Cardiology and General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Joshua P Lewis
- c School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Andrew D Johnson
- a National Heart, Lung and Blood Institute's The Framingham Heart Study, Population Sciences Branch, Division of Intramural Research , National Heart, Lung and Blood Institute , Framingham , MA , USA
| | - Nauder Faraday
- h GeneSTAR Research Program, Department of Anesthesiology & Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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189
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Jordan H, Hidajat M, Payne N, Adams J, White M, Ben-Shlomo Y. What are older smokers' attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study. BMJ Open 2017; 7:e018150. [PMID: 29146649 PMCID: PMC5695521 DOI: 10.1136/bmjopen-2017-018150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/07/2017] [Accepted: 10/11/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To investigate whether age is associated with access to smoking cessation services. DESIGN Data from the Smoking Toolkit Study 2006-2015, a repeated multiwave cross-sectional household survey (n=181 157). SETTING England. PARTICIPANTS Past-year smokers who participated in any of the 102 waves stratified into age groups. OUTCOME MEASURES Amount smoked and nicotine dependency, self-reported quit attempts and use of smoking cessation interventions. Self-report of whether the general practitioner (GP) raised the topic of smoking and made referrals for pharmacological support (prescription of nicotine replacement therapies (NRTs)) or other support (counselling or support groups). RESULTS Older smokers (75+ years) were less likely to report that they were attempting to quit smoking or seek help from a GP, despite being less nicotine-dependent. GPs raised smoking as a topic equally across all age groups, but smokers aged 70+ were more likely not to be referred for NRT or other support (ORs relative to 16-54 years; 70-74 years 1.27, 95% CI 1.03 to 1.55; 75-79 years 1.87, 95% CI 1.43 to 2.44; 80+ years 3.16, 95% CI 2.20 to 4.55; p value for trend <0.001). CONCLUSIONS Our findings suggest that there are potential missed opportunities in facilitating smoking cessation in older smokers. In this large population-based study, older smokers appeared less interested in quitting and were less likely to be offered support, despite being less addicted to nicotine than younger smokers. It is unclear whether this constitutes inequitable access to services or reflects informed choices by older smokers and their GPs. Future research is needed to understand why older smokers and GPs do not pursue smoking cessation. Service provision should consider how best to reduce these variations, and a stronger effectiveness evidence base is required to support commissioning for this older population so that, where appropriate, older smokers are not missing out on smoking cessation therapies and the health benefits of cessation at older ages.
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Affiliation(s)
- Hannah Jordan
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Mira Hidajat
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nick Payne
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jean Adams
- MRC Epidemiology Unit & CEDAR, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit & CEDAR, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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190
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Salami B, Yaskina M, Hegadoren K, Diaz E, Meherali S, Rammohan A, Ben-Shlomo Y. Migration and social determinants of mental health: Results from the Canadian Health Measures Survey. Can J Public Health 2017; 108:e362-e367. [PMID: 29120306 DOI: 10.17269/cjph.108.6105] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/02/2017] [Accepted: 04/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Studies worldwide point to increased risk of mental health problems among immigrants. However, the data on Canadian immigrants' mental health are ambiguous. To address this, we examined the relationship of both self-perceived mental health and reported diagnosis of mood disorders with age, gender, migration status, time since migration, and social determinants of health factors. METHODS We analyzed three cycles of the Canadian Health Measures Survey. Our outcome variables were self-perceived mental health and reported diagnosis of mood disorders. We used weighted logistic regression to model time since migration conditional on age, gender, income, community belonging, education, and employment status for 12 160 participants aged 15-79 years. RESULTS Recent (within 5 years) migrants reported better self-perceived mental health (odds ratio 3.98, 95% confidence interval [CI]: 2.06-7.70) but this effect disappeared with longer time since immigration. Other predictors were older age, higher income, better sense of community belonging, and being employed. Similarly, diagnosis of mood disorders was less likely to be reported in recent migrants (odds ratio 0.23, 95% CI: 0.10-0.53) with some weak evidence that this was also seen among longer-term migrant residents (>10 years). Diagnosis was also associated with older age, being a woman, lower income, weak sense of community belonging, and being unemployed. DISCUSSION Our findings indicate that migrants to Canada do not have worse mental health in general, though health and social policies need to attend to the socio-economic determinants, such as low income, unemployment, and a poor sense of community belonging, which contribute to population health outcomes.
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Affiliation(s)
- Bukola Salami
- Assistant Professor, Faculty of Nursing, University of Alberta, Edmonton, AB.
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191
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Barber TR, Lawton M, Rolinski M, Evetts S, Baig F, Ruffmann C, Gornall A, Klein JC, Lo C, Dennis G, Bandmann O, Quinnell T, Zaiwalla Z, Ben-Shlomo Y, Hu MTM. Prodromal Parkinsonism and Neurodegenerative Risk Stratification in REM Sleep Behavior Disorder. Sleep 2017; 40:3796343. [PMID: 28472425 PMCID: PMC5806544 DOI: 10.1093/sleep/zsx071] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [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] [Indexed: 11/14/2022] Open
Abstract
Objectives Rapid eye movement (REM) sleep behavior disorder (RBD) is the most specific marker of prodromal alpha-synucleinopathies. We sought to delineate the baseline clinical characteristics of RBD and evaluate risk stratification models. Methods Clinical assessments were performed in 171 RBD, 296 control, and 119 untreated Parkinson's (PD) participants. Putative risk measures were assessed as predictors of prodromal neurodegeneration, and Movement Disorders Society (MDS) criteria for prodromal PD were applied. Participants were screened for common leucine-rich repeat kinase 2 (LRRK2)/glucocerebrosidase gene (GBA) gene mutations. Results Compared to controls, participants with RBD had higher rates of solvent exposure, head injury, smoking, obesity, and antidepressant use. GBA mutations were more common in RBD, but no LRRK2 mutations were found. RBD participants performed significantly worse than controls on Unified Parkinson's Disease Rating Scale (UPDRS)-III, timed "get-up-and-go", Flamingo test, Sniffin Sticks, and cognitive tests and had worse measures of constipation, quality of life (QOL), and orthostatic hypotension. For all these measures except UPDRS-III, RBD and PD participants were equally impaired. Depression, anxiety, and apathy were worse in RBD compared to PD participants. Stratification of people with RBD according to antidepressant use, obesity, and age altered the odds ratio (OR) of hyposmia compared to controls from 3.4 to 45.5. 74% (95% confidence interval [CI] 66%, 80%) of RBD participants met the MDS criteria for probable prodromal Parkinson's compared to 0.3% (95% CI 0.009%, 2%) of controls. Conclusions RBD are impaired across a range of clinical measures consistent with prodromal PD and suggestive of a more severe nonmotor subtype. Clinical risk stratification has the potential to select higher risk patients for neuroprotective interventions.
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Affiliation(s)
- Thomas R Barber
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, UK
| | - Michal Rolinski
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK.,Institute of Clinical Neurosciences, University of Bristol, UK
| | - Samuel Evetts
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Fahd Baig
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Claudio Ruffmann
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Aimie Gornall
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Department of Psychiatry, University of Oxford, UK
| | - Johannes C Klein
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Christine Lo
- Sheffield Institute of Translational Neuroscience, University of Sheffield, UK.,Department of Neurology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Gary Dennis
- Department of Neurology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Oliver Bandmann
- Sheffield Institute of Translational Neuroscience, University of Sheffield, UK.,Department of Neurology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Timothy Quinnell
- Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
| | - Zenobia Zaiwalla
- Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, UK
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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192
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Young GJ, Harrison S, Turner EL, Walsh EI, Oliver SE, Ben-Shlomo Y, Evans S, Lane JA, Neal DE, Hamdy FC, Donovan JL, Martin RM, Metcalfe C. Prostate-specific antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study. BMJ Open 2017; 7:e017729. [PMID: 29084797 PMCID: PMC5665300 DOI: 10.1136/bmjopen-2017-017729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/25/2017] [Accepted: 09/14/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Cross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa). SETTING, PARTICIPANTS AND OUTCOME MEASURES Patient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man's age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study. RESULTS The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45-49 years to 53.0% for men aged 65-69 years (p for trend <0.001). For those with a PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively). CONCLUSION A high proportion of men aged 45-69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa. TRIAL REGISTRATION NUMBER ISRCTN20141297,NCT02044172.
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Affiliation(s)
- Grace J Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Sean Harrison
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eleanor I Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steven E Oliver
- Health Sciences, Hull York Medical School, University of York, York, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Evans
- Urology Department, Royal United Hospital, Bath, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - David E Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
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193
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Swallow DMA, Lawton MA, Grosset KA, Malek N, Smith CR, Bajaj NP, Barker RA, Ben-Shlomo Y, Burn DJ, Foltynie T, Hardy J, Morris HR, Williams N, Wood NW, Grosset DG. Variation in Recent Onset Parkinson's Disease: Implications for Prodromal Detection. J Parkinsons Dis 2017; 6:289-300. [PMID: 27003780 PMCID: PMC4927926 DOI: 10.3233/jpd-150741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The detection of prodromal Parkinson's disease (PD) is desirable to test drugs with neuroprotective potential, but will be affected by known disease variations. OBJECTIVE To assess the prevalence of four key non-motor prodromal PD markers, and evaluate the sensitivity of case detection when non-motor screening tools for prodromal PD are implemented in an early clinical PD cohort. METHODS Hyposmia (University of Pennsylvania smell identification test ≤15th centile or Sniffin' Sticks at or ≤10th centile corrected for age and sex), rapid-eye movement sleep behaviour disorder (RBD questionnaire >4), constipation (<1 daily spontaneous bowel motion) and depression (Leeds >6) were recorded in recent onset PD cases, and proposed non-motor screening criteria applied. RESULTS In 1,719 PD cases, mean age 68.6 years (SD 8.1), 65.5% male, mean disease duration 1.3 years (SD 0.9), 72.2% were hyposmic, 43.3% had RBD, 22.1% depression, and 21.5% constipation. 11.6% of cases had no key non-motor features, 38.8% one, 32.1% two, 15.5% three, and 2.0% all four. Increasing numbers of non-motor features were associated with younger age (p = 0.019), higher motor scores (p < 0.001), more postural instability gait difficulty (PIGD) (p < 0.001), greater cognitive impairment (p < 0.001) and higher total non-motor burden (p < 0.001). Cases with hyposmia alone were younger (p < 0.001), had less severe cognitive (p = 0.006) and other non-motor features (p < 0.001). All screening criteria selected younger patients (p = 0.001, p < 0.001), three of four greater overall non-motor burden (p = 0.005, p < 0.001), and inclusion of RBD more cognitive impairment (p = 0.003, p = 0.001) and PIGD (p = 0.004, p = 0.001). CONCLUSIONS Varying sensitivity levels, and age and phenotype selectivity, are found when different non-motor screening methods to detect prodromal PD are applied to an early clinical PD cohort.
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Affiliation(s)
- Diane M A Swallow
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Michael A Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Naveed Malek
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Callum R Smith
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Nin P Bajaj
- Department of Neurology, Queen's Medical Centre, Nottingham, UK
| | - Roger A Barker
- Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David J Burn
- Institute of Neuroscience, University of Newcastle, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - John Hardy
- Reta Lila Weston Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Huw R Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Nigel Williams
- Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Nicholas W Wood
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
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194
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Skrobot OA, Black SE, Chen C, DeCarli C, Erkinjuntti T, Ford GA, Kalaria RN, O'Brien J, Pantoni L, Pasquier F, Roman GC, Wallin A, Sachdev P, Skoog I, Ben-Shlomo Y, Passmore AP, Love S, Kehoe PG. Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study. Alzheimers Dement 2017; 14:280-292. [PMID: 29055812 DOI: 10.1016/j.jalz.2017.09.007] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2. METHODS We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI. RESULTS Six survey rounds comprising 65-79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders-Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging. DISCUSSION The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders-Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration.
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Affiliation(s)
- Olivia A Skrobot
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Sandra E Black
- Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, California, USA
| | - Timo Erkinjuntti
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Gary A Ford
- Divison of Medical Sciences, Oxford University, Oxford, UK
| | | | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | - Anders Wallin
- Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Perminder Sachdev
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Anthony P Passmore
- Institute of Clinical Sciences, Block B, Queens University Belfast, Belfast, UK
| | - Seth Love
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Patrick G Kehoe
- Translational Health Sciences, University of Bristol, Bristol, UK.
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195
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Stafford M, Ben-Shlomo Y, Cooper C, Gale C, Gardner MP, Geoffroy MC, Power C, Kuh D, Cooper R. Diurnal cortisol and mental well-being in middle and older age: evidence from four cohort studies. BMJ Open 2017; 7:e016085. [PMID: 29025828 PMCID: PMC5652457 DOI: 10.1136/bmjopen-2017-016085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We conducted an individual participant meta-analysis to test the hypothesis that cortisol patterns indicative of dysregulated hypothalamic-pituitary-adrenal axis functioning would be prospectively associated with poorer well-being at follow-up. SETTING Four large UK-based cohort studies. PARTICIPANTS Those providing valid salivary or serum cortisol samples (n=7515 for morning cortisol; n=1612 for cortisol awakening response) at baseline (age 44-82) and well-being data on the Warwick Edinburgh Mental Wellbeing Scale at follow-up (0-8 years) were included. RESULTS Well-being was not associated with morning cortisol, diurnal slope or awakening response though a borderline association with evening cortisol was found. Adjusting for sex and follow-up time, each 1 SD increase in evening cortisol was associated with a -0.47 (95% CI -1.00 to 0.05) point lower well-being. This was attenuated by adjustment for body mass index, smoking and socioeconomic position. Between-study heterogeneity was low. CONCLUSIONS This study does not support the hypothesis that diurnal cortisol is prospectively associated with well-being up to 8 years later. However, replication in prospective studies with cortisol samples over multiple days is required.
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Affiliation(s)
- Mai Stafford
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Catharine Gale
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Michael P Gardner
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies at Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Chris Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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196
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Bennett-Britton I, Teyhan A, Macleod J, Sattar N, Davey Smith G, Ben-Shlomo Y. Changes in marital quality over 6 years and its association with cardiovascular disease risk factors in men: findings from the ALSPAC prospective cohort study. J Epidemiol Community Health 2017; 71:1094-1100. [PMID: 28993473 PMCID: PMC5847094 DOI: 10.1136/jech-2017-209178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Marital relationship quality has been suggested to have independent effects on cardiovascular health outcomes. This study investigates the association between changes in marital relationship quality and cardiovascular disease (CVD) risk factors in men. METHODS We used data from The Avon Longitudinal Study of Parents and Children, a prospective birth cohort study (Bristol, UK). Our baseline sample was restricted to married study fathers with baseline relationship and covariate data (n=2496). We restricted final analysis (n=620) to those with complete outcome, exposure and covariate data, who were married and confirmed the study child's father at 6.4 years and 18.8 years after baseline. Relationship quality was measured at baseline and 6.4 years and operationalised as consistently good, improving, deteriorating or consistently poor relationship. We measured CVD risk factors of blood pressure, resting heart rate, body mass index, lipid profile and fasting glucose at 18.8 years after baseline. RESULTS Improving relationships were associated with lower levels of low-density lipoprotein (-0.25 mmol/L, 95% CI -0.46 to -0.03) and relative reduction of body mass index (-1.07 kg/m2, 95% CI -1.73 to -0.42) compared with consistently good relationships, adjusting for confounders. Weaker associations were found between improving relationships and total cholesterol (-0.24 mmol/L, 95% CI -0.48 to 0.00) and diastolic blood pressure (-2.24 mm Hg, 95% CI -4.59 to +0.11). Deteriorating relationships were associated with worsening diastolic blood pressure (+2.74 mm Hg, 95% CI 0.50 to 4.98). CONCLUSIONS Improvement and deterioration of longitudinal relationship quality appears associated with respectively positive and negative associations with a range of CVD risk factors.
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Affiliation(s)
| | - Alison Teyhan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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197
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Barber TR, Lawton M, Ben-Shlomo Y, Hu MTM. Considerations in the Use of MDS Research Criteria for Prodromal Parkinson's in Rapid Eye Movement Sleep Behaviour Disorder and Population Cohorts. Sleep 2017; 40:4320224. [PMID: 29029243 DOI: 10.1093/sleep/zsx169] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
Affiliation(s)
- Thomas R Barber
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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198
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Oakley L, Baker CP, Addanki S, Gupta V, Walia GK, Aggarwal A, Bhogadi S, Kulkarni B, Wilson RT, Prabhakaran D, Ben-Shlomo Y, Davey Smith G, Radha Krishna KV, Kinra S. Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study. BMJ Open 2017; 7:e016331. [PMID: 28939576 PMCID: PMC5623574 DOI: 10.1136/bmjopen-2017-016331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate whether village-level urbanicity and lower level socioeconomic factors are associated with breastfeeding practices in transitioning rural communities in India. SETTING 29 villages in Ranga Reddy district, southern India between 2011 and 2014. PARTICIPANTS 7848 children under 6 years identified via a cross-sectional household survey conducted as part of the Andhra Pradesh Children and Parents Study. OUTCOME MEASURES Two key indicators of optimal breastfeeding: termination of exclusive breastfeeding before 6 months and discontinuation of breastfeeding by 24 months. Village urbanicity was classified as low, medium or high according to satellite assessed night-light intensity. RESULTS Breastfeeding initiation was almost universal, and approximately two in three children were exclusively breastfed to 6 months and a similar proportion breastfed to 24 months. Using multilevel logistic regression, increasing urbanicity was associated with breastfeeding discontinuation before 24 months (medium urbanicity OR 1.45, 95% CI 0.71 to 2.96; high urbanicity OR 2.96, 95% CI 1.45 to 6.05) but not with early (<6 months) termination of exclusive breastfeeding. Increased maternal education was independently associated with both measures of suboptimal breastfeeding, and higher household socioeconomic position was associated with early termination of exclusive breastfeeding. CONCLUSION In this transitional Indian rural community, early stage urbanicity was associated with a shorter duration of breastfeeding. Closer surveillance of changes in breastfeeding practices alongside appropriate intervention strategies are recommended for emerging economies.
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Affiliation(s)
- Laura Oakley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene, London, UK
| | - Christopher P Baker
- Department of Non-communicable Disease Epidemiology, London School of Hygiene, London, UK
| | | | - Vipin Gupta
- Department of Anthropology, University of Delhi, New Delhi, India
| | - Gagandeep Kaur Walia
- Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
| | - Aastha Aggarwal
- Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
| | | | | | - Robin T Wilson
- Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Dorairaj Prabhakaran
- Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene, London, UK
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199
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Salami B, Yaskina M, Hegadoren K, Diaz E, Meherali S, Rammohan A, Ben-Shlomo Y. Erratum to: Migration and social determinants of mental health: Results from the Canadian Health Measures Survey. Can J Public Health 2017; 108:e650. [PMID: 30592013 DOI: 10.17269/cjph.108.6560] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There was an error in Tables 2 and 3 of the article "Migration and social determinants of mental health: Results from the Canadian Health Measures Survey". In both Tables 2 and 3, the compared variables (immigrants vs. Canadians) were reported in the reversed order. Comparison of the health of immigrants to Canadians should read: "Migrants 0-5 years vs. Canadians"; "Migrants 6-10 years vs. Canadians"; "Migrants >10 years vs. Canadians". We apologize for this error. The corrected tables appear below.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Anu Rammohan
- Department of Economics, University of Western Australia, Perth, Australia
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Anderson EL, Heron J, Ben-Shlomo Y, Kuh D, Cooper R, Lawlor DA, Fraser A, Howe LD. Adversity in childhood and measures of aging in midlife: Findings from a cohort of british women. Psychol Aging 2017; 32:521-530. [PMID: 28891666 PMCID: PMC5592847 DOI: 10.1037/pag0000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Very few studies have assessed whether socioeconomic and psychosocial adversity during childhood are associated with objective measures of aging later in life. We assessed associations of socioeconomic position (SEP) and total psychosocial adversity during childhood, with objectively measured cognitive and physical capability in women during midlife. Adverse childhood experiences were retrospectively reported at mean ages 28-30 years in women from the Avon Longitudinal Study of Parents And Children (N = 2,221). We investigated associations of childhood SEP and total psychosocial adversity, with composite measures of cognitive and physical capability at mean age 51 years. There was evidence that, compared with participants whose fathers had professional occupations, participants whose fathers had managerial/technical, skilled nonmanual, skilled manual, and partly or unskilled manual occupations had, on average, lower physical and cognitive capability. There was a clear trend for increasing magnitudes of association with lowering childhood SEP. There was also evidence that greater total psychosocial adversity in childhood was associated with lower physical capability. Total psychosocial adversity in childhood was not associated with cognitive capability. Lower SEP in childhood is detrimental to cognitive and physical capability in midlife, at least in part, independently of subsequent SEP in adulthood. Greater psychosocial adversity in childhood is associated with poorer physical capability, independently of social disadvantage in childhood. Our findings highlight the need for interventions to both identify and support children experiencing socioeconomic or psychosocial of adversity as early as possible. (PsycINFO Database Record
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Affiliation(s)
- Emma L Anderson
- Medical Research Council Integrative Epidemiology Unit, University of Bristol
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing, University College London
| | - Rachel Cooper
- Medical Research Council Unit for Lifelong Health and Ageing, University College London
| | - Debbie A Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol
| | - Abigail Fraser
- Medical Research Council Integrative Epidemiology Unit, University of Bristol
| | - Laura D Howe
- School of Social and Community Medicine, University of Bristol
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