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Chalder T, Landau S, Stone J, Carson A, Reuber M, Medford N, Robinson EJ, Goldstein LH. How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial. Psychol Med 2024:1-10. [PMID: 38197148 DOI: 10.1017/s0033291723003665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. METHODS We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression. RESULTS All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior. CONCLUSIONS Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.
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Affiliation(s)
- T Chalder
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Landau
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - A Carson
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, London, UK
- Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - L H Goldstein
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Goldstein LH, Robinson EJ, Chalder T, Stone J, Reuber M, Medford N, Carson A, Moore M, Landau S. Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
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Affiliation(s)
- L H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, UK; Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK.
| | - T Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.
| | - S Landau
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, UK.
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Rosmalen JGM, Burton C, Carson A, Cosci F, Frostholm L, Lehnen N, Olde Hartman TC, Rask CU, Rymaszewska J, Stone J, Tak LM, Witthöft M, Löwe B. The European Training Network ETUDE (Encompassing Training in fUnctional Disorders across Europe): a new research and training program of the EURONET-SOMA network recruiting 15 early stage researchers. J Psychosom Res 2021; 141:110345. [PMID: 33385705 DOI: 10.1016/j.jpsychores.2020.110345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dimence Group, Deventer, the Netherlands.
| | - C Burton
- University of Sheffield, Sheffield, UK
| | - A Carson
- University of Edinburgh, Edinburgh, UK
| | - F Cosci
- University of Florence, Florence, Italy
| | | | - N Lehnen
- Technical University Munich, Munich, Germany
| | | | - C U Rask
- Aarhus University Hospital, Aarhus, Denmark
| | | | - J Stone
- University of Edinburgh, Edinburgh, UK
| | - L M Tak
- Dimence Group, Deventer, the Netherlands
| | - M Witthöft
- Johannes Gutenberg-University, Mainz, Germany
| | - B Löwe
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vidaña B, Floyd T, Brena C, Lyle R, Carson A, Hamilton CM, Wessels M. First Case of Idiopathic Eosinophilic Meningoencephalitis in a Sheep. J Comp Pathol 2019; 174:58-62. [PMID: 31955804 DOI: 10.1016/j.jcpa.2019.10.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/03/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
A 1.5-year-old ewe was presented with neurological signs that had been observed from about 2 days prior to death. There had been no clinical response to anti-inflammatory and antibiotic treatment. Histopathological examination of the brain revealed a severe and widespread eosinophilic meningoencephalomyelitis of unknown aetiology. Defining histological features included diffuse angiocentric eosinophilic infiltrates in the neuroparenchyma and meninges, neuronal necrosis, astrocytosis, neuropil vacuolation and occasional glial scars. Differential diagnostics for eosinophilic meningoencephalitis were taken into account and investigated by means of special stains, immunohistochemistry, bacteriology and polymerase chain reaction. No pathological changes or ancillary tests were supportive or revealed a specific aetiology for the condition and therefore it was considered idiopathic. Idiopathic meningoencephalitis is a rare disease, mainly described in man and rarely in dogs, with no apparent aetiological cause or potential breed predisposition. To our knowledge this is the first case of idiopathic eosinophilic meningoencephalitis in a sheep and provides a histopathological guideline for prospective comparative pathology studies.
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Affiliation(s)
- B Vidaña
- Pathology Department, Animal and Plant Health Agency (APHA)-Weybridge, Addlestone, UK.
| | - T Floyd
- Pathology Department, Animal and Plant Health Agency (APHA)-Weybridge, Addlestone, UK
| | - C Brena
- Surveillance and Laboratory Services, APHA-Thirsk Veterinary Investigation Centre, West House, Station Road, Thirsk, UK
| | - R Lyle
- Bishopton Veterinary Group, Mill Farm, Studley Road, Ripon, UK
| | - A Carson
- Surveillance Intelligence Unit, APHA-Penrith Veterinary Investigation Centre, Merrythought Calthwaite, UK
| | - C M Hamilton
- Moredun Research Institute, Pentlands Science Park, Bush Loan, UK
| | - M Wessels
- Finn Pathologists, One Eyed Lane, Weybread, Diss, UK
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Stone J, Hoeritzauer I, Tesolin L, Carson A. Functional movement disorders of the face: A historical review and case series. J Neurol Sci 2018; 395:35-40. [DOI: 10.1016/j.jns.2018.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
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Chun HYY, Whiteley W, Dennis M, Mead G, Carson A. 81POST-TRAUMATIC STRESS DISORDER AFTER MILD STROKE AND TRANSIENT ISCHAEMIC ATTACK: PSYCHIATRIC CO-MORBIDITY AND SYMPTOM CLUSTER DISTRIBUTION. Age Ageing 2018. [DOI: 10.1093/ageing/afy135.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H -Y Y Chun
- Centre for Clinical Brain Sciences, University of Edinburgh
| | - W Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh
| | - M Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh
| | - G Mead
- Centre for Clinical Brain Sciences, University of Edinburgh
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh
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7
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Carson A. Treatment of functional disorders in neurology. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ji C, Lall R, Quinn T, Kaye C, Haywood K, Horton J, Gordon V, Deakin CD, Pocock H, Carson A, Smyth M, Rees N, Han K, Byers S, Brace-McDonnell S, Gates S, Perkins GD. Post-admission outcomes of participants in the PARAMEDIC trial: A cluster randomised trial of mechanical or manual chest compressions. Resuscitation 2017; 118:82-88. [PMID: 28689046 DOI: 10.1016/j.resuscitation.2017.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/31/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation. METHODS Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942. RESULTS 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4). CONCLUSION There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression.
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Affiliation(s)
- C Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Quinn
- Kingston University and St George's University of London Joint Faculty Health, Social Care and Education, London, UK
| | - C Kaye
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Haywood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Horton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - V Gordon
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - C D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - H Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - A Carson
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - N Rees
- Welsh Ambulance Services NHS Trust, Denbighshire, Wales, UK
| | - K Han
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Byers
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - S Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK.
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9
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Carson A. Midwifery around the World: A study in the role of midwives in local
communities and healthcare systems. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.617] [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: 11/26/2022] Open
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Abstract
The epidemiology of functional neurologic disorders (FND) is complex and has been hampered over the years by a lack of clear definition, with previous definitions struggling with an uneasy mix of both physical and psychologic components. The recent changes in DSM-5 to a definition based on positive identification of physical symptoms which are incongruent and inconsistent with neurologic disease and the lack of need for any associated psychopathology represent a significant step forward in clarifying the disorder. On this basis, FND account for approximately 6% of neurology outpatient contacts and putative community incidence rates of 4-12 per 100 000 per annum. Comorbid neurologic disease occurs in around 10% of cases. The diagnosis is reliable, with revision rates less than 5%. Of note, this revision rate was consistent prior to the widespread utilization of computed tomography and magnetic resonance imaging. FND symptoms are disabling and associated with significant distress. They are more common in women and have a peak incidence between the ages of 35 and 50; however the presentation is common in men and throughout the lifespan. The issues surrounding case definition, ascertainment, misdiagnosis, and risk factors are discussed in detail.
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Affiliation(s)
- A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - A Lehn
- Department of Neurology, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Australia
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Abstract
We describe an overall approach and structure to the clinical assessment of the patient with a functional neurologic disorder. Whilst the primary purpose of the assessment is to make a diagnosis and develop a treatment plan, we believe the assessment also plays a key role in treatment in its own right, as it sets a tone and context for future clinical interactions. We aim to set up an atmosphere of collaboration based on taking the patient's problems seriously, and emphasizing that all facets of the patient's presentation - physical, psychologic, and social - are of importance. Patients with functional disorders can be perceived as difficult to help and yet with the correct approaches we believe the consultation can be much more satisfying for both patient and doctor. Finally, we discuss and list some of the common diagnostic pitfalls in the assessment of functional neurologic disorders, looking at features that lead to erroneous diagnosis of neurologic disease (such as old age, la belle indifférence, and lack of psychiatric comorbidity) and an erroneous diagnosis of a functional disorder (such as "bizarre" gait in stiff-person syndrome).
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Affiliation(s)
- A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - J Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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12
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Abstract
Patients with functional neurologic disorders present to clinicians with a variety of symptomatic manifestations, with various levels of severity, chronicity, and comorbidity, as well as with various degrees of past adversity, intrinsic resilience, and available external support. Clearly, treatment must be individualized. For those patients who have been severely or chronically impaired, especially if adequate prior outpatient treatments have failed, inpatient treatment that integrates the various modalities outlined here provides a rational route of rescue from a course otherwise potentially characterized by protracted dependence and disability. Based on the data currently available, we believe this treatment approach is worthy of further study to refine the component treatment strategies and enhance the potentially most effective ingredients. For patients with severe levels of disability, who could be managed in a multimodal day-treatment program, that approach also warrants further consideration.
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Affiliation(s)
- D T Williams
- Movement Disorders Division, Columbia University Medical Center and Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY, USA.
| | - K Lafaver
- Movement Disorders Clinic, University of Louisville, Louisville, KY, USA
| | - A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S Fahn
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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13
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Abstract
There is widespread agreement that the way health professionals communicate the diagnosis of functional neurologic disorders (FND) has a central role in treatment, as it does arguably for most conditions. In this chapter we discuss barriers to effective diagnosis, different models of explanation and evidence regarding the importance of effective communication of the diagnosis in FND, especially movement disorders, and dissociative (nonepileptic) seizures. Debates and disagreements about how to go about this task often reflect different theoretic models held by health professionals rather than evidence. More evidence is required to know whether an initial emphasis on one model is more or less effective than another (e.g., a functional model vs. a psychologic model). We conclude, however, that there are a number of generic components to effective explanation shared by most authors on the topic that form the basis of a consensus. These include taking the patient seriously, giving the problem a diagnostic label, explaining the rationale for the diagnosis, some discussion of how the symptoms arise, emphasis on the potential for reversibility (rather than damage), and effective triage and referral for other treatment where appropriate. Although explanation can sometimes be therapeutic on its own, its role is probably more important as a facilitator to other therapy, including self-help, physical treatments, and psychotherapy.
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Affiliation(s)
- J Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Abstract
In this chapter we review key psychologic theories that have been mooted as possible explanations for the etiology of functional neurologic symptoms, conversion disorder, and hysteria. We cover Freudian psychoanalysis and later object relations and attachment theories, social theories, illness behavior, classic and operant conditioning, social learning theory, self-regulation theory, cognitive-behavioral theories, and mindfulness. Dissociation and modern cognitive neuroscience theories are covered in other chapters in this series and, although of central importance, are omitted from this chapter. Our aim is an overview with the emphasis on breadth of coverage rather than depth.
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Affiliation(s)
- A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - L Ludwig
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - K Welch
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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15
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Affiliation(s)
- A Carson
- A Carson, Robert Fergusson Unit, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK. Email
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Scott-Van Zeeland AA, Bloss CS, Tewhey R, Bansal V, Torkamani A, Libiger O, Duvvuri V, Wineinger N, Galvez L, Darst BF, Smith EN, Carson A, Pham P, Phillips T, Villarasa N, Tisch R, Zhang G, Levy S, Murray S, Chen W, Srinivasan S, Berenson G, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell JE, Strober M, Rotondo A, Treasure J, Woodside DB, Bulik CM, Keel P, Klump KL, Lilenfeld L, Plotnicov K, Topol EJ, Shih PB, Magistretti P, Bergen AW, Berrettini W, Kaye W, Schork NJ. Evidence for the role of EPHX2 gene variants in anorexia nervosa. Mol Psychiatry 2014; 19:724-32. [PMID: 23999524 PMCID: PMC3852189 DOI: 10.1038/mp.2013.91] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 01/08/2023]
Abstract
Anorexia nervosa (AN) and related eating disorders are complex, multifactorial neuropsychiatric conditions with likely rare and common genetic and environmental determinants. To identify genetic variants associated with AN, we pursued a series of sequencing and genotyping studies focusing on the coding regions and upstream sequence of 152 candidate genes in a total of 1205 AN cases and 1948 controls. We identified individual variant associations in the Estrogen Receptor-ß (ESR2) gene, as well as a set of rare and common variants in the Epoxide Hydrolase 2 (EPHX2) gene, in an initial sequencing study of 261 early-onset severe AN cases and 73 controls (P=0.0004). The association of EPHX2 variants was further delineated in: (1) a pooling-based replication study involving an additional 500 AN patients and 500 controls (replication set P=0.00000016); (2) single-locus studies in a cohort of 386 previously genotyped broadly defined AN cases and 295 female population controls from the Bogalusa Heart Study (BHS) and a cohort of 58 individuals with self-reported eating disturbances and 851 controls (combined smallest single locus P<0.01). As EPHX2 is known to influence cholesterol metabolism, and AN is often associated with elevated cholesterol levels, we also investigated the association of EPHX2 variants and longitudinal body mass index (BMI) and cholesterol in BHS female and male subjects (N=229) and found evidence for a modifying effect of a subset of variants on the relationship between cholesterol and BMI (P<0.01). These findings suggest a novel association of gene variants within EPHX2 to susceptibility to AN and provide a foundation for future study of this important yet poorly understood condition.
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Affiliation(s)
- A A Scott-Van Zeeland
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - C S Bloss
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - R Tewhey
- Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - V Bansal
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - A Torkamani
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - O Libiger
- The Scripps Translational Science Institute, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - V Duvvuri
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - N Wineinger
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - L Galvez
- The Scripps Translational Science Institute, La Jolla, CA, USA
| | - B F Darst
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - E N Smith
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - A Carson
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - P Pham
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - T Phillips
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - N Villarasa
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - R Tisch
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - G Zhang
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - S Levy
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - S Murray
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - W Chen
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - S Srinivasan
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - G Berenson
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - H Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - M M Fichter
- Roseneck Hospital for Behavioral Medicine, Prien, Germany
| | - K A Halmi
- Eating Disorder Research Program Weill Cornell Medical College, White Plains, NY, USA
| | - C Johnson
- Eating Recovery Center, Denver, CO, USA
| | - A S Kaplan
- Center for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - M Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - A Rotondo
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa, Italy
| | - J Treasure
- Department of Academic Psychiatry, Bermondsey Wing Guys Hospital, University of London, London, UK
| | - D B Woodside
- Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - C M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - K L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - L Lilenfeld
- Clinical Psychology Program, American School of Professional Psychology at Argosy University, Washington, DC, USA
| | - K Plotnicov
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - E J Topol
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - P B Shih
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - P Magistretti
- Laboratory of Neuroenergetics and Cellular Dynamics, The University of Lausanne, Lausanne, Switzerland
| | - A W Bergen
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - W Berrettini
- Department of Psychiatry, The University of Pennsylvania, Philadelphia, PA, USA
| | - W Kaye
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - N J Schork
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, 3344 N Torrey Pines Court, Room 306, La Jolla, CA 92037, USA. E-mail:
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Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS, Lin L, Amidei C, Lovely M, Arzbaecher J, Page M, Mogensen K, Lupica K, Maher ME, Armstrong TS, Won M, Wefel JS, Gilbert MR, Pugh S, Wendland MM, Brachman DG, Brown PD, Crocker IR, Robins HI, Lee RJ, Mehta M, Arvold N, Wang Y, Zigler C, Schrag D, Dominici F, Boele F, Douw L, de Groot M, van Thuijl H, Cleijne W, Heimans J, Taphoorn M, Reijneveld J, Klein M, Bunevicius A, Tamasauskas S, Tamasauskas A, Deltuva V, Bunevicius R, Cahill J, Lin L, Armstrong T, Acquaye A, Vera-Bolanos E, Gilbert M, Padhye N, Chan J, Clarke J, Lawton K, Rabbitt J, DeSilva A, Prados M, Rosen M, Cher L, Diamond E, Applebaum A, Corner G, DeRosa A, Breitbart W, DeAngelis L, Hoogendoorn P, Ikuta S, Muragaki Y, Maruyama T, Nitta M, Tamura M, Okamoto S, Iseki H, Okada Y, Lacouture M, Davis ME, Elzinga G, Butowski N, Tran D, Villano J, Wong E, Legge D, Cher L, Legge D, Cher L, Mills K, Lin L, Acquaye A, Vera-Bolanos E, Gilbert M, Armstrong T, Lovely M, Sullivan D, Mueller S, Fullerton H, Stratton K, Leisenring W, Armstrong G, Weathers R, Stovall M, Goldsby R, Sklar C, Robison L, Krull K, Pace A, Villani V, Focarelli S, Benincasa D, Benincasa A, Carapella CM, Pompili A, Peiffer AM, Burke A, Leyer CM, Shing E, Kearns WT, Hinson WH, Case D, Rapp SR, Shaw EG, Chan MD, Porensky E, Cavaliere R, Newton H, Shilds A, Burgess S, Ravelo A, Taylor F, Mazar I, Abrey L, Rooney A, Graham C, McKenzie H, Fraser M, MacKinnon M, McNamara S, Rampling R, Carson A, Grant R, Rooney A, Heimans L, Woltz S, Kerrigan S, McNamara S, Grant R, Seibl-Leven M, Wittenstein K, Rohn G, Goldbrunner R, Timmer M, Kennedy J, Sherman W, Sen-Gupta I, Garic I, Macken M, Gerard E, Raizer J, Schuele S, Grontoft M, Stragliotto G, Taphoorn MJ, Henriksson R, Bottomley A, Cloughesy T, Wick W, Mason W, Saran F, Nishikawa R, Ravelo A, Hilton M, Chinot OL, Trad W, Simpson T, Wright K, Tran T, Choong C, Barton M, Hovey E, Robinson K, Koh ES, Vera-Bolanos E, Acquaye AA, Brown PD, Chung C, Gilbert MR, Vardy J, Armstrong TS, Walbert T, Mendoza T, Vera-Bolanos E, Gilbert M, Acquaye A, Armstrong T, Walbert T, Glantz M, Schultz L, Puduvalli VK, Oudenhoven M, Farin C, Hoffman R, Armstrong T, Ewend M, Wu J. SYMPTOM MANAGEMENT/QUALITY OF LIFE. Neuro Oncol 2013; 15:iii226-iii234. [PMCID: PMC3823907 DOI: 10.1093/neuonc/not192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
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Parke E, Hart J, Baldock D, Barchard K, Etcoff L, Allen D, Stolberg P, Nardi N, Cohen J, Jones W, Loe S, Etcoff L, Delgaty L, Tan A, Bunner M, Delgaty L, Tan A, Bunner M, Tan A, Delgaty L, Bunner M, Tan A, Delgaty L, Bunner M, Goodman G, Kim W, Nolty A, Marion S, Davis A, Finch W, Piehl J, Moss L, Nogin R, Dean R, Davis J, Lindstrom W, Poon M, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fields K, Hill B, Corley E, Russ K, Boettcher A, Musso M, Rohling M, Rowden A, Downing K, Benners M, Miller D, Maricle D, Dugbartey T, Anum A, Anderson J, Daniel M, Hoskins L, Gillis K, Khen S, Carter K, Ayers C, Neeland I, Cullum M, Weiner M, Rossetti H, Buddin W, Mahal S, Schroeder R, Baade L, Macaluso M, Phelps K, Evans C, Clark J, Vickery C, Chow J, Stokic D, Phelps K, Evans C, Watson S, Odom R, Clark J, Clark J, Odom R, Evans C, Vickery C, Thompson J, Noggle C, Kane C, Kecala N, Lane E, Raymond M, Woods S, Iudicello J, Dawson M, Ghias A, Choe M, Yudovin S, McArthur D, Asarnow R, Giza C, Babikian T, Tun S, O'Neil M, Ensley M, Storzbach D, Ellis R, O'Neil M, Carlson K, Storzbach D, Brenner L, Freeman M, Quinones A, Motu'apuaka M, Ensley M, Kansagara D, Brickell T, Grant I, Lange R, Kennedy J, Ivins B, Marshall K, Prokhorenko O, French L, Brickell T, Lange R, Bhagwat A, French L, Weber E, Nemeth D, Songy C, Gremillion A, Lange R, Brubacher J, Shewchuk J, Heran M, Jarrett M, Rauscher A, Iverson G, Woods S, Ukueberuwa D, Medaglia J, Hillary F, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Levan A, Gale S, Atkinson J, Boettcher A, Hill B, Rohling M, Stolberg P, Hart J, Allen D, Mayfield J, Ellis M, Marion SD, Houshyarnejad A, Grant I, Akarakian R, Kernan C, Babikian T, Asarnow R, Bens M, Fisher M, Garrett C, Vinogradov S, Walker K, Torstrick A, Uderman J, Wellington R, Zhao L, Fromm N, Dahdah M, Salisbury D, Monden K, Lande E, Wanlass R, Fong G, Smith K, Miele A, Novakovic-Agopian T, Chen A, Rome S, Rossi A, Abrams G, Murphy M, Binder D, Muir J, Carlin G, Loya F, Rabinovitz B, Bruhns M, Adler M, Schleicher-Dilks S, Messerly J, Babika C, Ukpabi C, Golden C, Schleicher-Dilks S, Coad S, Messerly J, Schaffer S, Babika C, Golden C, Cowad S, Paisley S, Fontanetta R, Messerly J, Golden C, Holder C, Kloezeman K, Henry B, Burns W, Patt V, Minassian A, Perry W, Cooper L, Allen D, Vogel S, Woolery H, Ciobanu C, Simone A, Bedard A, Olivier T, O'Neill S, Rajendran K, Halperin J, Rudd-Barnard A, Steenari M, Murry J, Le M, Becker T, Mucci G, Zupanc M, Shapiro E, Santos O, Cadavid N, Giese E, Londono N, Osmon D, Zamzow J, Culnan E, D'Argenio D, Mosti C, Spiers M, Schleicher-Dilks S, Kloss J, Curiel A, Miller K, Olmstead R, Gottuso A, Saucier C, Miller J, Dye R, Small G, Kent A, Andrews P, Puente N, Terry D, Faraco C, Brown C, Patel A, Siegel J, Miller L, Lee B, Joan M, Thaler N, Fontanetta R, Carla F, Allen D, Nguyen T, Glass L, Coles C, Julie K, May P, Sowell E, Jones K, Riley E, Demsky Y, Mattson S, Allart A, Freer B, Tiersky L, Sunderaraman P, Sylvester P, Ang J, Schultheis M, Newton S, Holland A, Burns K, Bunting J, Taylor J, Muetze H, Coe M, Harrison D, Putnam M, Tiersky L, Freer B, Holland A, Newton S, Sakamoto M, Bunting J, Taylor J, Coe M, Harrison D, Musso M, Hill B, Barker A, Pella R, Gouvier W, Davis J, Woods S, Wall J, Etherton J, Brand T, Hummer B, O'Shea C, Segovia J, Thomlinson S, Schulze E, Roskos P, Gfeller J, Loftis J, Fogel T, Barrera K, Sherzai A, Chappell A, Harrison A, Armstrong I, Flaro L, Pedersen H, Shultz LS, Roper B, Huckans M, Basso M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Silk-Eglit G, Stenclik J, Miele A, Lynch J, Musso M, McCaffrey R, Martin P, VonDran E, Baade L, Heinrichs R, Schroeder R, Hunter B, Calloway J, Rolin S, Akeson S, Westervelt H, Mohammed S, An K, Jeffay E, Zakzanis K, Lynch A, Drasnin D, Ikanga J, Graham O, Reid M, Cooper D, Long J, Lange R, Kennedy J, Hopewell C, Lukaszewska B, Pachalska M, Bidzan M, Lipowska M, McCutcheon L, Kaup A, Park J, Morgan E, Kenton J, Norman M, Martin P, Netson K, Woods S, Smith M, Paulsen J, Hahn-Ketter A, Paxton J, Fink J, Kelley K, Lee R, Pliskin N, Segala L, Vasilev G, Bozgunov K, Naslednikova R, Raynov I, Gonzalez R, Vassileva J, Bonilla X, Fedio A, Johnson K, Sexton J, Blackstone K, Weber E, Moore D, Grant I, Woods S, Pimental P, Welch M, Ring M, Stranks E, Crowe S, Jaehnert S, Ellis C, Prince C, Wheaton V, Schwartz D, Loftis J, Fuller B, Hoffman W, Huckans M, Turecka S, McKeever J, Morse C, Schultheis M, Dinishak D, Dasher N, Vik P, Hachey D, Bowman B, Van Ness E, Williams C, Zamzow J, Sunderaraman P, Kloss J, Spiers M, Swirsky-Sacchetti T, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stricker N, Kimmel C, Grant I, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stephan R, Stricker N, Grant I, Hertza J, Tyson K, Northington S, Loughan A, Perna R, Davis A, Collier M, Schroeder R, Buddin W, Schroeder R, Moore C, Andrew W, Ghelani A, Kim J, Curri M, Patel S, Denney D, Taylor S, Huberman S, Greenberg B, Lacritz L, Brown D, Hughes S, Greenberg B, Lacritz L, Vargas V, Upshaw N, Whigham K, Peery S, Casto B, Barker L, Otero T, La D, Nunan-Saah J, Phoong M, Gill S, Melville T, Harley A, Gomez R, Adler M, Tsou J, Schleicher-Dilks S, Golden C, Tsou J, Schleicher-Dilks S, Adler M, Golden C, Cowad S, Link J, Barker T, Gulliver K, Golden C, Young K, Moses J, Lum J, Vik P, Legarreta M, Van Ness E, Williams C, Dasher N, Williams C, Vik P, Dasher N, Van Ness E, Bowman B, Nakhutina L, Margolis S, Baek R, Gonzalez J, Hill F, England H, Horne-Moyer L, Stringer A, DeFilippis N, Lyon A, Giovannetti T, Fanning M, Heverly-Fitt S, Stambrook E, Price C, Selnes O, Floyd T, Vogt E, Thiruselvam I, Quasney E, Hoelzle J, Grant N, Moses J, Matevosyan A, Delano-Wood L, Alhassoon O, Hanson K, Lanni E, Luc N, Kim R, Schiehser D, Benners M, Downing K, Rowden A, Miller D, Maricle D, Kaminetskaya M, Moses J, Tai C, Kaminetskaya M, Melville T, Poole J, Scott R, Hays F, Walsh B, Mihailescu C, Douangratdy M, Scott B, Draffkorn C, Andrews P, Schmitt A, Waksmunski C, Brady K, Andrews A, Golden C, Olivier T, Espinoza K, Sterk V, Spengler K, Golden C, Olivier T, Spengler K, Sterk V, Espinoza K, Golden C, Gross J, DeFilippis N, Neiman-Kimel J, Romers C, Isaacs C, Soper H, Sordahl J, Tai C, Moses J, D'Orio V, Glukhovsky L, Beier M, Shuman M, Spat J, Foley F, Guatney L, Bott N, Moses J, Miranda C, Renteria MA, Rosario A, Sheynin J, Fuentes A, Byrd D, Mindt MR, Batchelor E, Meyers J, Patt V, Thomas M, Minassian A, Geyer M, Brown G, Perry W, Smith C, Kiefel J, Rooney A, Gouaux B, Ellis R, Grant I, Moore D, Graefe A, Wyman-Chick K, Daniel M, Beene K, Jaehnert S, Choi A, Moses J, Iudicello J, Henry B, Minassian A, Perry W, Marquine M, Morgan E, Letendre S, Ellis R, Woods S, Grant I, Heaton R, Constantine K, Fine J, Palewjala M, Macher R, Guatney L, Earleywine M, Draffkorn C, Scott B, Andrews P, Schmitt A, Dudley M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Scharaga E, Gomes W, McGinley J, Miles-Mason E, Colvin M, Carrion L, Romers C, Soper H, Zec R, Kohlrus S, Fritz S, Robbs R, Ala T, Zec R, Fritz S, Kohlrus S, Robbs R, Ala T, Edwards M, Hall J, O'Bryant S, Miller J, Dye R, Miller K, Baerresen K, Small G, Moskowitz J, Puente A, Ahmed F, Faraco C, Brown C, Evans S, Chu K, Miller L, Young-Bernier M, Tanguay A, Tremblay F, Davidson P, Duda B, Puente A, Terry D, Kent A, Patel A, Miller L, Junod A, Marion SD, Harrington M, Fonteh A, Gurnani A, John S, Gavett B, Diaz-Santos M, Mauro S, Beaute J, Cronin-Golomb A, Fazeli P, Gouaux B, Rosario D, Heaton R, Moore D, Puente A, Lindbergh C, Chu K, Evans S, Terry D, Duda B, Mackillop J, Miller S, Greco S, Klimik L, Cohen J, Robbins J, Lashley L, Schleicher-Dilks S, Golden C, Kunkes I, Culotta V, Kunkes I, Griffits K, Loughan A, Perna R, Hertza J, Cohen M, Northington S, Tyson K, Musielak K, Fine J, Kaczorowski J, Doty N, Braaten E, Shah S, Nemanim N, Singer E, Hinkin C, Levine A, Gold A, Evankovich K, Lotze T, Yoshida H, O'Bryan S, Roberg B, Glusman M, Ness A, Thelen J, Wilson L, Feaster T, Bruce J, Lobue C, Brown D, Hughes S, Greenberg B, Lacritz L, Bristow-Murray B, Andrews A, Bermudez C, Golden C, Moore R, Pulver A, Patterson T, Bowie C, Harvey P, Jeste D, Mausbach B, Wingo J, Fink J, Lee R, Pliskin N, Legenkaya A, Henry B, Minassian A, Perry W, McKeever J, Morse C, Thomas F, Schultheis M, Ruocco A, Daros A, Gill S, Grimm D, Saini G, Relova R, Hoblyn J, Lee T, Stasio C, Mahncke H, Drag L, Grimm D, Gill S, Saini G, Relova R, Hoblyn J, Lee T, Stasio C, Mahncke H, Drag L, Verbiest R, Ringdahl E, Thaler N, Sutton G, Vogel S, Reyes A, Ringdahl E, Vogel S, Freeman A, Call E, Allen D, March E, Salzberg M, Vogel S, Ringdahl E, Freeman A, Dadis F, Allen D, Sisk S, Ringdahl E, Vogel S, Freeman A, Allen D, DiGangi J, Silva L, Pliskin N, Thieme B, Daniel M, Jaehnert S, Noggle C, Thompson J, Kecala N, Lane E, Kane C, Noggle C, Thompson J, Lane E, Kecala N, Kane C, Palmer G, Happe M, Paxson J, Jurek B, Graca J, Olson S, Melville T, Harley A, La D, Phoong M, Gill S, Jocson VA, Nunan-Saah J, Keller J, Gomez R, Melville T, Kaminetskaya M, Poole J, Vernon A, Van Vleet T, DeGutis J, Chen A, Marini C, Dabit S, Gallegos J, Zomet A, Merzenich M, Thaler N, Linck J, Heyanka D, Pastorek N, Miller B, Romesser J, Sim A, Allen D, Zimmer A, Marcinak J, Hibyan S, Webbe F, Rainwater B, Francis J, Baum L, Sautter S, Donders J, Hui E, Barnes K, Walls G, Erikson S, Bailie J, Schwab K, Ivins B, Boyd C, Neff J, Cole W, Lewis S, Bailie J, Schwab K, Ivins B, Boyd C, Neff J, Cole W, Lewis S, Ramirez C, Oganes M, Gold S, Tanner S, Pina D, Merritt V, Arnett P, Heyanka D, Linck J, Thaler N, Pastorek N, Miller B, Romesser J, Sim A, Parks A, Roskos P, Gfeller J, Clark A, Isham K, Carter J, McLeod J, Romero R, Dahdah M, Barisa M, Schmidt K, Barnes S, Dubiel R, Dunklin C, Harper C, Callender L, Wilson A, Diaz-Arrastia R, Shafi S, Jacquin K, Bolshin L, Jacquin K, Romers C, Gutierrez E, Messerly J, Tsou J, Adler M, Golden C, Harmell A, Mausbach B, Moore R, Depp C, Jeste D, Palmer B, Hoadley R, Hill B, Rohling M, Mahdavi S, Fine J, daCruz K, Dinishak D, Richardson G, Vertinski M, Allen D, Mayfield J, Margolis S, Miele A, Rabinovitz B, Schaffer S, Kline J, Boettcher A, Hill B, Hoadley R, Rohling M, Eichstaedt K, Vale F, Benbadis S, Bozorg A, Rodgers-Neame N, Rinehardt E, Mattingly M, Schoenberg M, Fares R, Fares R, Carrasco R, Grups J, Evans B, Simco E, Mittenberg W, Carrasco R, Grups J, Evans B, Simco E, Mittenberg W, Rach A, Baughman B, Young C, Bene E, Irwin C, Li Y, Poulin R, Jerram M, Susmaras T, Gansler D, Ashendorf L, Miarmi L, Fazio R, Cantor J, Fernandez A, Godoy-Garcete G, Marchetti P, Harrison A, Armstrong I, Harrison L, Iverson G, Brinckman D, Ayaz H, Schultheis M, Heinly M, Vitelli K, Russler K, Sanchez I, Jones W, Loe S, Raines T, Hart J, Bene E, Li Y, Irwin C, Baughman B, Rach A, Bravo J, Schilling B, Weiss L, Lange R, Shewchuk J, Heran M, Rauscher A, Jarrett M, Brubacher J, Iverson G, Zink D, Barney S, Gilbert G, Allen D, Martin P, Schroeder R, Klas P, Jeffay E, Zakzanis K, Iverson G, Lanting S, Saffer B, Koehle M, Palmer B, Barrio C, Vergara R, Muniz M, Pinto L, Jeste D, Stenclik J, Lynch J, McCaffrey R, Shultz LS, Pedersen H, Roper B, Crouse E, Crucian G, Dezhkam N, Mulligan K, Singer R, Psihogios A, Davis A, Stephens B, Love C, Mulligan K, Webbe F, West S, McCue R, Goldin Y, Cicerone K, Ruchinskas R, Seidl JT, Massman P, Tam J, Schmitter-Edgecombe M, Baerresen K, Hanson E, Miller K, Miller J, Yeh D, Kim J, Ercoli L, Siddarth P, Small G, Noback M, Noback M, Baldock D, Mahmoud S, Munic-Miller D, Bonner-Jackson A, Banks S, Rabin L, Emerson J, Smith C, Roberts R, Hass S, Duhig A, Pankratz V, Petersen R, Leibson C, Harley A, Melville T, Phoong M, Gill S, Nunan-Saah J, La D, Gomez R, Lindbergh C, Puente A, Gray J, Chu K, Evans S, Sweet L, MacKillop J, Miller L, McAlister C, Schmitter-Edgecombe M, Baldassarre M, Kamm J, Wolff D, Dombrowski C, Bullard S, Edwards M, Hall J, Parsons T, O'Bryant S, Lawson R, Papadakis A, Higginson C, Barnett J, Wills M, Strang J, Dominska A, Wallace G, Kenworthy L, Bott N, Kletter H, Carrion V, Ward C, Getz G, Peer J, Baum C, Edner B, Mannarino A, Casnar C, Janke K, van der Fluit F, Natalie B, Haberman D, Solomon M, Hunter S, Klein-Tasman B, Starza-Smith A, Talbot E, Hart A, Hall M, Baker J, Kral M, Lally M, Zisk A, Lo T, Ross P, Cuevas M, Patel S, Lebby P, Mouanoutoua A, Harrison J, Pollock M, Mathiowetz C, Romero R, Boys C, Vekaria P, Vasserman M, MacAllister W, Stevens S, Van Hecke A, Carson A, Karst J, Schohl K, Dolan B, McKindles R, Remel R, Reveles A, Fritz N, McDonald G, Wasisco J, Kahne J, Hertza J, Tyson K, Northington S, Loughan A, Perna R, Newman A, Garmoe W, Clark J, Loughan A, Perna R, Hertza J, Cohen M, Northington S, Tyson K, Whithers K, Puente A, Dedmon A, Capps J, Lindsey H, Francis M, Weigand L, Steed A, Puente A, Edmed S, Sullivan K, Puente A, Lindsey H, Dedmon A, Capps J, Whithers K, Weigand L, Steed A, Kark S, Lafleche G, Brown T, Bogdanova Y, Strongin E, Spickler C, Drasnin D, Strongin C, Poreh A, Houshyarnejad A, Ellis M, Babikian T, Kernan C, Asarnow R, Didehbani N, Cullum M, Loneman L, Mansinghani S, Hart J, Fischer J. POSTER SESSIONS SCHEDULE. Arch Clin Neuropsychol 2013. [DOI: 10.1093/arclin/act054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Panaretto KS, Gardner KL, Button S, Carson A, Schibasaki R, Wason G, Baker D, Mein J, Dellit A, Lewis D, Wenitong M, Ring I. Prevention and management of chronic disease in Aboriginal and Islander Community Controlled Health Services in Queensland: a quality improvement study assessing change in selected clinical performance indicators over time in a cohort of services. BMJ Open 2013; 3:bmjopen-2012-002083. [PMID: 23585385 PMCID: PMC3641421 DOI: 10.1136/bmjopen-2012-002083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate clinical healthcare performance in Aboriginal Medical Services in Queensland and to consider future directions in supporting improvement through measurement, target setting and standards development. DESIGN Longitudinal study assessing baseline performance and improvements in service delivery, clinical care and selected outcomes against key performance indicators 2009-2010. SETTING 27 Aboriginal and Islander Community Controlled Health Services (AICCHSs) in Queensland, who are members of the Queensland Aboriginal and Islander Health Council (QAIHC). PARTICIPANTS 22 AICCHS with medical clinics. INTERVENTION Implementation and use of an electronic clinical information system that integrates with electronic health records supported by the QAIHC quality improvement programme-the Close the Gap Collaborative. MAIN OUTCOME MEASURES Proportion of patients with current recording of key healthcare activities and the prevalence of risk factors and chronic disease. RESULTS Aggregated performance was high on a number of key risk factors and healthcare activities including assessment of tobacco use and management of hypertension but low for others. Performance between services showed greatest variation for care planning and health check activity. CONCLUSIONS Data collected by the QAIHC health information system highlight the risk factor workload facing the AICCHS in Queensland, demonstrating the need for ongoing support and workforce planning. Development of targets and weighting models is necessary to enable robust between-service comparisons of performance, which has implications for health reform initiatives in Australia. The limited information available suggests that although performance on key activities in the AICCHS sector has potential for improvement in some areas, it is nonetheless at a higher level than for mainstream providers. IMPLICATIONS The work demonstrates the role that the Community Controlled sector can play in closing the gap in Aboriginal and Torres Strait Islander health outcomes by leading the use of clinical data to record and assess the quality of services and health outcome.
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Affiliation(s)
- K S Panaretto
- Preventative Health Unit, Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - K L Gardner
- Australian Primary Health Care Research Institute, ANU, Canberra, Australian Capital Territory, Australia
| | - S Button
- Preventative Health Unit, Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - A Carson
- Institute for Urban Indigenous Health, Brisbane, Queensland, Australia
| | - R Schibasaki
- Preventative Health Unit, Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - G Wason
- Mulungu Corporation for Medical Corporation, Mareeba, Queensland, Australia
| | - D Baker
- Mulungu Corporation for Medical Corporation, Mareeba, Queensland, Australia
| | - J Mein
- Apunipima Cape York Health Council, Cairns, Queensland, Australia
| | - A Dellit
- Preventative Health Unit, Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
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- Preventative Health Unit, Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - M Wenitong
- Apunipima Cape York Health Council, Cairns, Queensland, Australia
| | - I Ring
- Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Carson A. MP 7 Conversion disorder. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303538.11] [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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Ammoun S, Zhou L, Barczyk M, Hilton D, Hafizi S, Hanemann C, Lehnus KS, Donovan LK, Pilkington GJ, An Q, Anderson IA, Thomson S, Bailey M, Lekka E, Law J, Davis C, Banfill K, Loughrey C, Hatfield P, Bax D, Elliott R, Bishop R, Taylor K, Marshall L, Gaspar N, Viana-Pereira M, Reis R, Renshaw J, Ashworth A, Lord C, Jones C, Bellamy C, Shaw L, Alder J, Shorrocks A, Lea R, Birks S, Burnet M, Pilkington G, Bruch JD, Ho J, Watts C, Price SJ, Camp S, Apostolopoulos V, Mehta A, Roncaroli F, Nandi D, Clark B, Mackinnon M, MacLeod N, Stewart W, Chalmers A, Cole A, Hanna G, Bailie K, Conkey D, Harney J, Darlow C, Chapman S, Mohsen L, Price S, Donovan L, Birks S, Pilkington G, Dyer H, Lord H, Fletcher K, das Nair R, MacNiven J, Basu S, Byrne P, Glancz L, Critchley G, Grech-Sollars M, Saunders D, Phipps K, Clayden J, Clark C, Greco A, Acquati S, Marino S, Hammouche S, Wilkins SP, Smith T, Brodbelt A, Hammouche S, Clark S, Wong AHL, Eldridge P, Farah JO, Ho J, Bruch J, Watts C, Price S, Lamb G, Smith S, James A, Glegg M, Jeffcote T, Boulos S, Robbins P, Knuckey N, Banigo A, Brodbelt AR, Jenkinson MD, Jeyapalan JN, Mumin MA, Forshew T, Lawson AR, Tatevossian RG, Jacques TS, Sheer D, Kilday J, Wright K, Leavy S, Lowe J, Schwalbe E, Clifford S, Gilbertson R, Coyle B, Grundy R, Kinsella P, Clynes M, Amberger-Murphy V, Barron N, Lambert SR, Jones D, Pearson D, Ichimura I, Collins V, Steele L, Sinha P, Chumas P, Tyler J, Ogawa D, Chiocca E, DeLay M, Bronisz A, Nowicki M, Godlewski J, Lawler S, Lee MK, Javadpour M, Jenkinson MD, Lekka E, Abel P, Dawson T, Lea B, Davis C, Lim CSK, Grundy PL, Pendleton M, Lord H, Mackinnon M, Williamson A, James A, Stewart W, Clark B, Chalmers A, Merve A, Zhang X, Marino S, Miller S, Rogers HA, Lyon P, Rand V, Adamowicz-Brice M, Clifford SC, Hayden JT, Dyer S, Pfister S, Korshunov A, Brundler MA, Lowe J, Coyle B, Grundy RG, Nankivell M, Mulvenna P, Barton R, Wilson P, Faivre-Finn C, Pugh C, Langley R, Ngoga D, Tennant D, Williams A, Moss P, Cruickshank G, Owusu-Agyemang K, Bell S, Stewart W, St.George J, Piccirillo SG, Watts C, Qadri S, Pirola E, Jenkinson M, Brodbelt A, Rahman R, Rahman C, Smith S, MacArthur D, Rose F, Shakesheff K, Grundy R, Carroll C, Watson P, Hawkins M, Spoudeas H, Walker D, Holland T, Ring H, Rooney A, McNamara S, Mackinnon M, Fraser M, Rampling R, Carson A, Grant R, Royds J, Al Nadaf S, Ahn A, Chen YJ, Wiles A, Jellinek D, Braithwaite A, Baguley B, MacFarlane M, Hung N, Slatter T, Rusbridge S, Walmsley N, Griffiths S, Wilford P, Rees J, Ryan D, Watts C, Liu P, Galavotti S, Shaked-Rabi M, Tulchinsky E, Brandner S, Jones C, Salomoni P, Schulte A, Gunther HS, Zapf S, Riethdorf S, Westphal M, Lamszus K, Selvanathan SK, Hammouche S, Salminen HJ, Jenkinson MD, Setua S, Watts C, Welland ME, Shevtsov M, Khachatryan W, Kim A, Samochernych K, Pozdnyakov A, Guzhova IV, Romanova IV, Margulis B, Smith S, Rahman R, Rahman C, Barrow J, Macarthur D, Rose F, Grundy R, Smith S, Long A, Barrow J, Macarthur D, Coyle B, Grundy R, Maherally Z, Smith JR, Dickson L, Pilkington GJ, Prabhu S, Harris F, Lea R, Snape TJ, Sussman M, Wilne S, Whitehouse W, Chow G, Liu JF, Walker D, Snape T, Karakoula A, Rowther F, Warr T, Williamson A, Mackinnon M, Zisakis A, Varsos V, Panteli A, Karypidou O, Zampethanis A, Fotovati A, Abu-Ali S, Wang PS, Deleyrolle L, Lee C, Triscott J, Chen JY, Franciosi S, Nakamura Y, Sugita Y, Uchiumi T, Kuwano M, Leavitt BR, Singh SK, Jury A, Jones C, Wakimoto H, Reynolds BA, Pallen CJ, Dunn SE, Shepherd S, Scott S, Bowyer D, Wallace L, Hacking B, Mohsen L, Jena R, Gillard J, Price S, Lee C, Fotovati A, Verraeult M, Wakimoto H, Reynolds B, Dunham C, Bally M, Hukin J, Singhal S, Singh S, Dunn S. Abstracts from the 2011 BNOS Conference, June 29 - July 1, 2011, Homerton College, Cambridge. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sharpe M, Walker J, Williams C, Stone J, Cavanagh J, Murray G, Butcher I, Duncan R, Smith S, Carson A. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology 2011; 77:564-72. [PMID: 21795652 DOI: 10.1212/wnl.0b013e318228c0c7] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Functional (psychogenic or somatoform) symptoms are common in neurology clinics. Cognitive-behavioral therapy (CBT) can be an effective treatment, but there are major obstacles to its provision in practice. We tested the hypothesis that adding CBT-based guided self-help (GSH) to the usual care (UC) received by patients improves outcomes. METHODS We conducted a randomized trial in 2 neurology services in the United Kingdom. Outpatients with functional symptoms (rated by the neurologist as "not at all" or only "somewhat" explained by organic disease) were randomly allocated to UC or UC plus GSH. GSH comprised a self-help manual and 4 half-hour guidance sessions. The primary outcome was self-rated health on a 5-point clinical global improvement scale (CGI) at 3 months. Secondary outcomes were measured at 3 and 6 months. RESULTS In this trial, 127 participants were enrolled, and primary outcome data were collected for 125. Participants allocated to GSH reported greater improvement on the primary outcome (adjusted common odds ratio on the CGI 2.36 [95% confidence interval 1.17-4.74; p = 0.016]). The absolute difference in proportion "better" or "much better" was 13% (number needed to treat was 8). At 6 months the treatment effect was no longer statistically significant on the CGI but was apparent in symptom improvement and in physical functioning. CONCLUSIONS CBT-based GSH is feasible to implement and efficacious. Further evaluation is indicated. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that CBT-based GSH therapy improves self-reported general health, as measured by the CGI, in patients with functional neurologic symptoms.
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Affiliation(s)
- M Sharpe
- University of Edinburgh, Edinburgh, Scotland, UK.
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Carson A, Stone J, Hibberd C, Murray G, Duncan R, Coleman R, Warlow C, Roberts R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Hansen C, Sharpe M. Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by organic disease'. J Neurol Neurosurg Psychiatry 2011; 82:810-3. [PMID: 21257981 DOI: 10.1136/jnnp.2010.220640] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by organic disease and to compare them with patients with symptoms explained by organic disease. METHODS As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient's symptoms were explained by organic disease. Patients whose symptoms were rated as 'not at all' or only 'somewhat' explained by disease were considered cases, and those whose symptoms were 'largely' or 'completely' explained by disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status. RESULTS 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI -2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means -3.5 (95% CI -4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)). CONCLUSIONS New neurology patients with symptoms unexplained by organic disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by disease.
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Affiliation(s)
- A Carson
- School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK.
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Stone J, Carson A, Duncan R, Roberts R, Warlow C, Hibberd C, Coleman R, Cull R, Murray G, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, Sharpe M. Who is referred to neurology clinics?—The diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112:747-51. [DOI: 10.1016/j.clineuro.2010.05.011] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 05/17/2010] [Accepted: 05/23/2010] [Indexed: 10/19/2022]
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Stone J, Carson A. 020 Psychogenic/dissociative/functional facial symptoms--a case report. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.217554.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Sharpe M, Stone J, Hibberd C, Warlow C, Duncan R, Coleman R, Roberts R, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker A, Walker J, MacMahon A, Murray G, Carson A. Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome. Psychol Med 2010; 40:689-698. [PMID: 19627646 DOI: 10.1017/s0033291709990717] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients whose symptoms are 'unexplained by disease' often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation. METHOD The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as 'not at all' or only 'somewhat explained' by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale ('much better' to 'much worse') 1 year later. RESULTS The 12-month outcome data were available on 716 of 1144 patients (63%). Poor outcome on the CGI ('unchanged', 'worse' or 'much worse') was reported by 482 (67%) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95% CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30, 95% CI 1.37-3.86). Together, these factors predicted 13% of the variance in outcome. CONCLUSIONS Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.
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Affiliation(s)
- M Sharpe
- Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK.
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Phillips M, Haines M, Peck E, Lee H, Phillips B, Wein B, Bekenstein J, O'Grady J, Schoenberg M, Ogrocki P, Maddux B, Whitney C, Gould D, Riley D, Maciunas R, Espe-Pfeifer P, Arguello J, Taber S, Duff K, Fields A, Newby R, Weissgerber K, Epping A, Panepinto J, Scott P, Reesman J, Zabel A, Wodka E, Ferenc L, Comi A, Cohen N, Bigelow S, McCrea Jones L, Sandoval R, Vilar-Lopez R, Puente N, Hidalgo-Ruzante N, Bure A, Ojeda C, Puente A, Zolten A, Mallory L, Heyanka D, Golden C, McCue R, Heyanka D, Mackelprang J, Reuther B, Golden C, Odland A, Scarisbrick D, Heyanka D, Martin P, Golden C, Mazur-Mosiewicz A, Holcomb M, Dean R, Schneider J, Morgan D, Scott J, Leber W, Adams R, Marceaux J, Triebel K, Griffith H, Gifford K, Potter E, Webbe F, Barker W, Loewenstein D, Duara R, Gifford K, Mahaney T, Srinivasan V, Cummings T, Frankl M, Bayan R, Webbe F, Mulligan K, Duncan N, Greenaway M, Sakamoto M, Spiers M, Libon D, Pimontel M, Gavett B, Jefferson A, Nair A, Green R, Stern R, Mahaney T, Frankl M, Cummings T, Mulligan K, Webbe F, Lou K, Gavett B, Jefferson A, Nair A, Green R, Morere D, Gifford K, Ferro J, Ezrine G, Kiefel J, Hinton V, Greco S, Corradino G, Pantone J, MacLeod R, Stern R, Hart J, Lavach J, Pick L, Szymanski C, Ilardi D, Marcus D, Burns T, Mahle W, Jenkins P, Davis A, McDermott A, Pierson E, Freeman Floyd E, McIntosh D, Dixon F, Davis A, Boseck J, Berry K, Whited A, Gelder B, Davis A, Dodd J, Berry K, Boseck J, Koehn E, Gelder B, Riccio C, Kahn D, Perez E, Reynolds C, Scott M, Nguyen-Driver M, Ruchinskas R, Lennen D, Steiner R, Sikora D, Freeman K, Carboni J, Fong G, Fong G, Carboni J, Whigham K, O'Toole K, Schneider B, Burns T, Olivier T, Nemeth D, Whittington L, Moreau A, Webb N, Weimer M, Gontier J, Labrana J, Rioseco F, Lichtenberg P, Puente A, Puente A, Bure A, Buddin H, Teichner G, Golden C, Pacheco E, Chong J, Gold S, Mittenberg W, Miller A, Bruce J, Hancock L, Peterson S, Jacobson J, Guse E, Tyrer J, Lasater J, Fritz J, Lynch S, Yarger L, Bryant K, Zychowski L, Nippoldt-Baca L, Lehman C, Arffa S, Marceaux J, Dilks L, Arthur A, Myers B, Levy J, Blancett S, Martincin K, Thrasher A, Koushik N, McArthur S, Baird A, Foster P, Drago V, Yung R, Crucian G, Heilman K, Castellon S, Livers E, Oppenheim A, Carter C, Ganz P, San Miguel-Montes L, Escabi-Quiles Y, Allen D, Gavett B, Stern R, Nowinski C, Cantu R, Martukovich R, McKee A, Davis A, Roberds E, Lutz J, Williams R, Gupta A, Schoenberg M, Werz M, Maciunas R, Koubeissi M, Poreh A, Luders H, Barwick F, Arnett P, Morse C, Gonzalez-Heydrich J, Luna L, Rao S, McClendon J, Rotelle P, Waber D, Holland A, Boyer K, Faraone S, Whitney J, Guild D, Biederman J, Baerwald J, Ryan G, Baerwald J, Ryan G, Guerrero J, Carmona J, Parsons T, Rizzo A, Lance B, Courtney C, Baerwald J, Ryan G, Perna R, Jackson A, Luton L, O'Toole K, Harrison D, Alosco M, Emerson K, Hill B, Bauer L, Tremont G, Zychowski L, Yarger L, Kegel N, Arffa S, Crockett D, Hunt S, Parks R, Vernon-Wilkinsion R, Hietpas-Wilson T, Zartman A, Gordon S, Krueger K, VanBuren K, Yates A, Hilsabeck R, Campbell J, Riner B, Crowe S, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Latham K, Thompson J, Barisa M, Maulucci A, Sumowski J, Chiaravalloti N, Lengenfelder J, DeLuca J, Iturriaga L, Henry G, Heilbronner R, Carmona J, Mittenberg W, Enders C, Stevens A, Dux M, Henry G, Heilbronner R, Mittenberg W, Enders C, Myers A, Arffa S, Holland A, Nippoldt-Baca L, Yarger L, Acocella-Stollerman J, Lee E, Peck E, Lee H, Khawaja S, Phillips B, Crockett A, Greve K, Comer C, Ord J, Etherton J, Bianchini K, Curtis K, Harrison A, Edwards M, Harrison A, Edwards M, Cottingham M, Goldberg H, Harrison D, Victor T, Perry L, Pazienza S, Boone K, Bowers T, Triebel K, Denney R, Halfaker D, Tussey C, Barber A, Martin P, Denney R, Deal W, Bailey C, Denney R, Marcopulos B, Schaefer L, Rabin L, Kakkanatt T, Popalzai A, Chantasi K, Heyanka D, Magyar Y, Cruz R, Weiss L, Schatz P, Gibney B, Lietner D, Koushik N, Brooks B, Iverson G, Horton A, Odland A, Reynolds C, Horton A, Reynolds C, Davis A, Finch W, Skierkiewicz A, Rothlisberg B, McIntosh D, Davis A, Finch W, Golden C, Chang M, McIntosh D, Rothlisberg B, Paulson S, Davis A, Starling J, Whited A, Chang M, Roberds E, Dodd J, Martin P, Goldstein G, DeFilippis N, Carlozzi N, Tulsky D, Kurkowski R, Browne K, Wortman K, Gershon R, Heyanka D, Odland A, Golden C, Rodriguez M, Myers A, West S, Golden C, Holster J, Bolanos J, Corsun-Ascher C, Golden C, Robbins J, Restrepo L, Prinzi L, Garcia J, Golden C, Holster J, Bolanos J, Garcia J, Golden C, Osgood J, Trice A, Ernst W, Mahaney T, Gifford K, Oelschlager J, Gurrea J, Tourgeman I, Odland A, Golden C, Tourgeman I, Gurrea J, Stack M, Boddy R, Demsky Y, Golden C, Judd T, Jurecska D, Holmes J, Aguerrevere L, Greve K, Capps D, Izquierdo R, Feldman C, Boddy R, Scarisbrick D, Rice J, Tourgeman I, Golden C, Scarisbrick D, Boddy R, Corsun-Ascher C, Heyanka D, Golden C, Woon F, Hedges D, Odland A, Heyanka D, Martin P, Golden C, Yamout K, Heinrichs R, Baade L, Soetaert D, Perle J, Odland A, Martin P, Golden C, Armstrong C, Bello D, Randall C, Allen D, McLaren T, Konopacki K, Peery S, Miranda F, Saleh M, Moise F, Mendoza J, Mak E, Gomez R, Mihaila E, Parrella M, White L, Harvey P, Marshall D, Gomez R, Keller J, Rogers E, Misa J, Che A, Tennakoon L, Schatzberg A, Sutton G, Allen D, Strauss G, Bello D, Armstrong C, Randall C, Duke L, Ross S, Randall C, Bello D, Armstrong C, Sutton G, Ringdahl E, Thaler N, McMurray J, Sanders L, Isaac H, Allen D, Rumble S, Klonoff P, Wilken J, Sullivan C, Fratto T, Sullivan A, McKenzie T, Ensley M, Saunders C, Quig M, Kane R, Simsarian J, Restrepo L, Rodriguez M, Robbins J, Morrow J, Golden C, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Lanting S, Brooks B, Iverson G, Horton A, Reynolds C, Scarisbrick D, Odland A, Perle J, Golden C, West S, Collins K, Frisch D, Golden C, Guerrero J, Baerwald J, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Mackelprang J, Heyanka D, Lennertz L, Morin I, Marker C, Collins M, Dodd J, Goldstein G, DeFilippis N, Holcomb M, Kimball T, Luther E, Belsher B, Botelho V, Reed R, Hernandez B, Noda A, Yesavage J, Kinoshita L, Kakos L, Gunstad J, Hughes J, Spitznagel M, Potter V, Stanek K, Szabo A, Waechter D, Josephson R, Rosneck J, Schofield H, Getz G, Magnuson S, Bryant K, Miller A, Martincin K, Pastel D, Poreh A, Davis J, Ramos C, Sherer C, Bertram D, Wall J, Bryant K, Poreh A, Magnuson S, Miller A, Martincin K, Pastel D, Gow C, Francis J, Olson L, Sautter S, Ord J, Capps D, Greve K, Bianchini K, Stettler T, Daniel M, Kleman V, Etchells M, Rabinowitz A, Barwick F, Arnett P, Proto D, Barker A, Gouvier W, Jones K, Williams J, Lockwood C, Mansoor Y, Homer-Smith E, Moses J, Stolberg P, Jones W, Krach S, Loe S, Mortimer J, Avirett E, Maricle D, Miller D, Avirett E, Mortimer J, Maricle D, Miller D, Avirett E, Mortimer J, Miller D, Maricle D, McGill C, Moneta L, Gioia G, Isquith P, Lazarus G, Puente A, Ahern D, Faust D, Bridges A, Ahern D, Faust D, Bridges A, Hobson V, Hall J, Harvey M, Spering C, Cullum M, Lacritz L, Massman P, Waring S, O'Bryant S, Frisch D, Morrow J, West S, Golden C, West S, Dougherty M, Rice J, Golden C, Morrow J, Frisch D, Pearlson J, Golden C, Thorgusen S, Watson J, Miller A, Kesner R, Levy J, Lambert A, Fazeli P, Marceaux J, Vance D, Marceaux J, Fazeli P, Vance D, Frankl M, Cummings T, Mahaney T, Webbe F, Spering C, Cooper J, Hobson V, O'Bryant S, Bolanos J, Holster J, Metoyer K, Garcia J, Golden C, Brown C, O'Toole K, Brown C, O'Toole K, Granader Y, Keller S, Bender H, Rathi S, Nass R, MacAllister W, Maehr A, Kiefel J, Bigras C, Slick D, Dewey L, Tao R, Motes M, Emslie G, Rypma B, Kahn D, Riccio C, Reynolds C, Eberle N, Mucci G, Chase A, Boyle M, Gallaway M, Bowyer S, Lajiness-O'Neill R, Gifford K, Mahaney T, Cohen R, Gorman P, Levin Allen S, O'Hara E, LeGoff D, Chute D, Barakat L, Laboy G, San Miguel-Montes L, Rios-Motta M, Pita-Garcia I, Van Horn H, Cuevas M, Ross P, Kinjo C, Basanez T, Patel S, Dinishak D, Zhou W, Ortega M, Zareie R, Lane B, Rosen A, Myers A, Domboski K, Ireland S, Mittenberg W, Mazur-Mosiewicz A, Holcomb M, Dean R, Myerson C, Katzen H, Mittel A, McClendon M, Guevara A, Nahab F, Gallo B, Levin B, Fay T, Brooks B, Sherman E, Szabo A, Gunstad J, Spitznagel M, McCaffery J, McGeary J, Paul R, Sweet L, Cohen R, Hancock L, Bruce J, Peterson S, Jacobson J, Tyrer J, Guse E, Lasater J, Fritz J, Lynch S, O'Rourke J, Queller S, Whitlock K, Beglinger L, Stout J, Duff K, Paulsen J, Kim M, Jang J, Chung J, Zukerman J, Miller S, Waterman G, Sadek J, Singer E, Heaton R, van Gorp W, Castellon S, Hinkin C, Yamout K, Baade L, Panos S, Becker B, Kim M, Foley J, Jang J, Chung J, Castellon S, Hinkin C, Kim M, Jang J, Foley J, Chung J, Miller S, Castellon S, Marcotte T, Hinkin C, Merrick E, Kazakov D, Duke L, Field R, Allen D, Mayfield J, Barney S, Thaler N, Allen D, Donohue B, Mayfield J, Mauro C, Shope C, Riber L, Dhami S, Citrome L, Tremeau F, Heyanka D, Corsun-Ascher C, Englebert N, Golden C, Block C, Sautter S, Stolberg P, Terranova J, Jones W, Allen D, Mayfield J, Ramanathan D, Medaglia J, Chiou K, Wardecker B, Slocomb J, Vesek J, Wang J, Hills E, Good D, Hillary F, Kimpton T, Kirshenbaum A, Madathil R, Trontel H, Hall S, Chiou K, Slocomb J, Ramanathan D, Medaglia J, Wardecker B, Vesek J, Wang J, Hills E, Good D, Hillary F, Salinas C, Tiedemann S, Webbe F, Williams C, Wood R, Ringdahl E, Thaler N, Hodges T, Mayfield J, Allen D, Kazakov D, Haderlie M, Terranova J, Martinez A, Allen D, Mayfield J, Medaglia J, Ramanathan D, Chiou K, Wardecker B, Franklin R, Genova H, Deluca J, Hillary F, Pastrana F, Wurst L, Zeiner H, Garcia A, Bender H, Rice J, West S, Dougherty M, Boddy R, Golden C, Tyrer J, Bruce J, Hancock L, Guse E, Jacobson J, Lynch S, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Scarisbrick D, Heyanka D, Frisch D, Golden C, Prinzi L, Morrow J, Robbins J, Golden C, Fallows R, Amin K, Virden T, Borgaro S, Hubel K, Miles G, Gomez R, Nazarian S, Mucci G, Moreno-Torres M, San Miguel-Montes L, Otero-Zeno T, Rios M, Douglas K, McGhee R, Sakamoto M, Spiers M, Vanderslice-Barr J, Elbin R, Covassin T, Kontos A, Larson E, Stiller-Ostrowski J, McLain M, Serina N, John S, Rautiola M, Waldstein S, Che A, Gomez R, Keller J, Tennakoon L, Marshall D, Rogers E, Misa J, Schatzberg A, Stiles M, Ericson R, Earleywine M, Ericson R, Earleywine M, Tourgeman I, Boddy R, Gurrea J, Buddin H, Golden C, Holcomb M, Mazur-Mosiewicz A, Dean R, Miele A, Lynch J, McCaffrey R, Miele A, Vanderslice-Barr J, Lynch J, McCaffrey R, Wershba R, Stevenson M, Thomas M, Sturgeon J, Youngjohn J, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Heinrichs R, Baade L, Soetaert D, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Pimental P, Riedl K, Kimsey M, Sartori A, Griffith H, Okonkwo O, Marson D, Bertisch H, Schaefer L, McKenzie S, Mittelman M, Hibbard M, Sherr R, Diller L, McTaggart A, Williams R, Troster A, Clark J, Owens T, O'Jile J, Schmitt A, Livingston R, Smernoff E, Galusha J, Piazza J, Gutierrez M, Yeager C, Hyer L, Vaughn E, LaPorte D, Schoenberg M, Werz M, Pedigo T, Lavach J, Hart J, Vyas S, Dorta N, Granader Y, Roberts E, Hill B, Musso M, Pella R, Barker A, Proto D, Gouvier W, Gibson K, Bowers T, Bowers T, Gibson K, Hinkle S, Barisa M, Noggle C, Thompson J, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Benitez A, Gunstad J, Spitznagel M, Szabo A, Rogers E, Gomez R, Keller J, Marshall D, Tennakoon L, Che A, Misa J, Schatzber A, Strauss G, Ringdahl E, Barney S, Jetha S, Duke L, Ross S, Watrous B, Allen D, Maucieri L, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Getz G, Dandridge A, Klein R, La Point S, Holcomb M, Mazur-Mosiewicz A, Dean R, Bailey C, Samples H, Broshek D, Barth J, Freeman J, Schatz P, Neidzwski K, Moser R, Reesman J, Suli-Moci E, Wells C, Moneta L, Dean P, Gioia G, Belsher B, Hutson L, Greenberg L, Sullivan C, Hull A, Poole J, Schatz P, Pardini J, Lovell M, Strauser E, Parish R, Carr W, Paggi M, Anderson-Barnes V, Kelly M, Hutson L, Loughlin J, Sullivan C, Kelley E, Poole J, Hutson L, Loughlin J, Sullivan C, Belsher B, Hull A, Greenberg L, Poole J, Carr W, Parish R, Paggi M, Anderson-Barnes V, Ahlers S, Roebuck Spencer T, O'Neill D, Carter J, Bleiberg J, Lange R, Brubacher J, Iverson G, Madler B, Heran M, MacKay A, Andolfatto G, Krol A, Mrazik M, Lebby P, Johnson W, Sweatt J, Turitz M, Greenawald K, Lesser S, Ormonde A, Lavach J, Hart J, Demakis G, Rimland C, Lengenfelder J, Sumowski J, Smith A, Chiaravalloti N, DeLuca J, Pierson E, Koehn E, Lajiness-O'Neill R, Hyer L, Yeager C, Manatan K, Sherman S, Atkinson M, Massey-Connolly S, Gugnani M, Stack R, Carson A, Mirza N, Johnson E, Lovell M, Perna R, Jackson A, Roy S, Zebeigly A, Larochette A, Bowie C, Harrison A, Nippoldt-Baca L, Bleil J, Arffa S, Thompson J, Noggle C, Mark B, Maulucci A, Umaki T, Denney R, Greenberg L, Hull A, Belsher B, Lee H, Sullivan C, Poole J, Abrigo E, Hurewitz F, Kounios J, Noggle C, Barisa M, Thompson J, Maulucci A, Greve K, Aguerrevere L, Bianchini K, Etherton J, Heinly M, Kontos A, Covassin T, Elbin R, Larson E, Stearne D, Johnson D, Gilliland K, Vincent A, Chafetz M, Herkov M, Morais H, Schwait A, Mangiameli L, Greenhill T. Grand Rounds. Arch Clin Neuropsychol 2009. [DOI: 10.1093/arclin/acp045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, Hibberd C, Murray G, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, MacMahon A, Sharpe M. Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain 2009; 132:2878-88. [DOI: 10.1093/brain/awp220] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pauluhn J, Carson A, Costa DL, Gordon T, Kodavanti U, Last JA, Matthay MA, Pinkerton KE, Sciuto AM. Workshop Summary: Phosgene-Induced Pulmonary Toxicity Revisited: Appraisal of Early and Late Markers of Pulmonary Injury From Animal Models With Emphasis on Human Significance. Inhal Toxicol 2008; 19:789-810. [PMID: 17687713 DOI: 10.1080/08958370701479133] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A workshop was held February 14, 2007, in Arlington, VA, under the auspices of the Phosgene Panel of the American Chemistry Council. The objective of this workshop was to convene inhalation toxicologists and medical experts from academia, industry and regulatory authorities to critically discuss past and recent inhalation studies of phosgene in controlled animal models. This included presentations addressing the benefits and limitations of rodent (mice, rats) and nonrodent (dogs) species to study concentration x time (C x t) relationships of acute and chronic types of pulmonary changes. Toxicological endpoints focused on the primary pulmonary effects associated with the acute inhalation exposure to phosgene gas and responses secondary to injury. A consensus was reached that the phosgene-induced increased pulmonary extravasation of fluid and protein can suitably be probed by bronchoalveolar lavage (BAL) techniques. BAL fluid analyses rank among the most sensitive methods to detect phosgene-induced noncardiogenic, pulmonary high-permeability edema following acute inhalation exposure. Maximum protein concentrations in BAL fluid occurred within 1 day after exposure, typically followed by a latency period up to about 15 h, which is reciprocal to the C x t exposure relationship. The C x t relationship was constant over a wide range of concentrations and single exposure durations. Following intermittent, repeated exposures of fixed duration, increased tolerance to recurrent exposures occurred. For such exposure regimens, chronic effects appear to be clearly dependent on the concentration rather than the cumulative concentration x time relationship. The threshold C x t product based on an increased BAL fluid protein following single exposure was essentially identical to the respective C x t product following subchronic exposure of rats based on increased pulmonary collagen and influx of inflammatory cells. Thus, the chronic outcome appears to be contingent upon the acute pulmonary threshold dose. Exposure concentrations high enough to elicit an increased acute extravasation of plasma constituents into the alveolus may also be associated with surfactant dysfunction, intra-alveolar accumulation of fibrin and collagen, and increased recruitment and activation of inflammatory cells. Although the exact mechanisms of toxicity have not yet been completely elucidated, consensus was reached that the acute pulmonary toxicity of phosgene gas is consistent with a simple, irritant mode of action at the site of its initial deposition/retention. The acute concentration x time mortality relationship of phosgene gas in rats is extremely steep, which is typical for a local, directly acting pulmonary irritant gas. Due to the high lipophilicity of phosgene gas, it efficiently penetrates the lower respiratory tract. Indeed, more recent published evidence from animals or humans has not revealed appreciable irritant responses in central and upper airways, unless exposure was to almost lethal concentrations. The comparison of acute inhalation studies in rats and dogs with focus on changes in BAL fluid constituents demonstrates that dogs are approximately three to four times less susceptible to phosgene than rats under methodologically similar conditions. There are data to suggest that the dog may be useful particularly for the study of mechanisms associated with the acute extravasation of plasma constituents because of its size and general morphology and physiology of the lung as well as its oronasal breathing patterns. However, the study of the long-term sequelae of acute effects is experimentally markedly more demanding in dogs as compared to rats, precluding the dog model to be applied on a routine base. The striking similarity of threshold concentrations from single exposure (increased protein in BAL fluid) and repeated-exposure 3-mo inhalation studies (increased pulmonary collagen deposition) in rats supports the notion that chronic changes depend on acute threshold mechanisms.
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Affiliation(s)
- J Pauluhn
- Bayer Schering Pharma, Wuppertal, Germany.
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Moguillansky D, Carson A, Leng X, Lavery L, Chen X, Schwartz A, Gretton J, Fischer D, Pacella J, Villanueva F. Quantification of adventitial neovascularization during atherosclerosis progression with contrast ultrasound: a histologic validation. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Delclos GL, Arif AA, Aday L, Carson A, Lai D, Lusk C, Stock T, Symanski E, Whitehead LW, Benavides FG, Antó JM. Validation of an asthma questionnaire for use in healthcare workers. Occup Environ Med 2006; 63:173-9. [PMID: 16497858 PMCID: PMC2078145 DOI: 10.1136/oem.2005.021634] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. AIMS To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. METHODS An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. RESULTS The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or = 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. CONCLUSIONS Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.
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Affiliation(s)
- G L Delclos
- The University of Texas School of Public Health, Houston, Texas 77030, USA.
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Abstract
Government policy has directed local services to address the needs of carers as a way of maintaining care in the community. This study was initiated to enable carers to develop an information pack based upon their identified needs. Cooperative inquiry was the method used to ensure full participation of the carers. Group meetings were already in existence through a charity organization who provides a carers support network. The first author participated in a number of carers group meetings. Cooperative inquiry was used to clarify a number of themes identified and reflective cycles ensured that those themes remained relevant. It was found that carers did want to be involved in their relative's care, not as passive recipients but as collaborative care providers. To do this they need to be fully informed of the processes of care provision. Carers need information that is relevant, easily accessible and obtainable in varying degrees of comprehension. This study suggests that a culture shift within mental health nursing is necessary if professionals are to recognize that a perceived lack of support may lead to a breakdown in relationships between the carer, the person being cared for and the professionals.
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Affiliation(s)
- M Lloyd
- North East Wales Institute of Higher Education, Plas Coch Campus, Wrexham, UK.
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Abstract
At present, no treatments exist that effectively target and eliminate papillomaviruses (PVs) from infected cells or prevent its replication. We are employing a strategy to prevent virus replication in PV-infected cells through the conditional expression of the herpes simplex virus type 1 thymidine kinase (TK) gene. Expression of TK in this system is expected to be triggered by a homologous recombination event between the endogenous PV genome and a nonexpressing TK gene cassette. Recombination between these two DNAs is expected to change the nonexpressing cassette into a form that expresses TK. Various constructs were generated to express the TK in the above manner. Transfection of cell lines with a TK nonexpressing plasmid did not result in TK production due to alternative splicing and polyadenylation site selection. However, cotransfection of cell lines with PV plasmids along with the above TK construct containing short segments of PV sequences resulted in a recombination event that led to TK expression as shown by Northern and Western blot analyses. We also developed a TK expression cassette utilizing an adeno-associated virus (AAV) vector. Delivery of the cassette by AAV to PV-infected cells resulted in TK expression, and ganciclovir treatment resulted in efficient killing of these cells.
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Affiliation(s)
- A Carson
- Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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Affiliation(s)
- J Stone
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Affiliation(s)
- J Stone
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Stone J, Durrance D, Wojcik W, Carson A, Sharpe M. What do medical outpatients attending a neurology clinic think about antidepressants? J Psychosom Res 2004; 56:293-5. [PMID: 15046965 DOI: 10.1016/s0022-3999(03)00075-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2002] [Accepted: 02/04/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine how medical outpatients attending a neurology clinic view antidepressant medication and whether those who present with medically unexplained symptoms have different views than those whose symptoms are explained by neurological disease. METHODS A total of 89 consecutive outpatients attending a medical neurology clinic were interviewed. RESULTS Those who believed that antidepressants were addictive comprised 74% and those who thought that they could cause physical harm comprised 47%. Only 49% were aware that antidepressants could be used to treat symptoms other than depression. The views of patients whose symptoms were rated by the doctor as being 'not at all' only 'somewhat' unexplained by neurological disease (37% of the total) were neither substantially nor statistically different those whose symptoms were rated as 'largely' or 'completely' explained by neurological disease. CONCLUSION The majority of medical patients attending a neurology clinic, and not just those with medically unexplained symptoms, have largely negative beliefs about antidepressant drugs. The implications for patient adherence to these agents and for medical practice are discussed.
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Affiliation(s)
- J Stone
- Division of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Stone J, Sharpe M, Carson A, Lewis SC, Thomas B, Goldbeck R, Warlow CP. Are functional motor and sensory symptoms really more frequent on the left? A systematic review. J Neurol Neurosurg Psychiatry 2002; 73:578-81. [PMID: 12397155 PMCID: PMC1738113 DOI: 10.1136/jnnp.73.5.578] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the hypothesis that unilateral motor and sensory symptoms unexplained by identifiable disease are more common on the left side of the body than the right. METHODS Systematic review of the literature published since 1965. RESULTS 121 eligible studies, involving 1139 patients, were analysed. The pooled proportion of functional left sided weakness and sensory symptoms in adults was 58% (95% confidence interval (CI) 55 to 61%). A much higher proportion of left sided symptoms (66%, 95% CI 61 to 71%) was found in studies where laterality featured in the title of the paper. However, when laterality was not mentioned in the title, no significant difference between left and right was observed (53% on the left, 95% CI 48 to 57%). This difference could not be explained on the basis of sex differences between the groups or the date of the study. Functional or "psychogenic" movement disorder was right sided in 68% (95% CI 61 to 75%). Handedness did not influence symptom lateralisation. CONCLUSIONS The findings of this systematic review question whether functional weakness and sensory symptoms do in fact occur more commonly on the left side of the body. A type of outcome variable reporting bias in combination with non-blinding of investigators may be responsible for this long held but erroneous belief.
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Affiliation(s)
- J Stone
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, UK.
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Abstract
Medically unexplained functional or somatization symptoms are somatic disorders that are not adequately explained by physical disease processes. The way in which these disorders have been understood and managed has varied over the history of medicine. However, only in the past 100 years has the "mental" explanation predominated. A benefit of this trend has been the development of effective treatments in the form of "antidepressant" drugs and cognitive-behavioral therapies; a cost has been limited integration of these treatments into medical practice and lack of acceptability to patients. We suggest that there is much to learn from physicians of the pre-Freudian era. Their etiologic theories are now supported by new scientific evidence, and their clinical practice provided ways of making psychological treatment acceptable to patients. We propose a paradigm shift in which unexplained symptoms are remedicalized around the notion of a functional disturbance of the nervous system and treatments currently considered "psychiatric" are integrated into general medical care.
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Affiliation(s)
- M Sharpe
- University Department of Psychiatry, Kennedy Tower Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom
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Adesiyun A, Carson A, McAdoo K, Bailey C. Molecular analysis of Salmonella enteritidis isolates from the Caribbean by pulsed-field gel electrophoresis. Rev Panam Salud Publica 2000; 8:342-7. [PMID: 11190971 DOI: 10.1590/s1020-49892000001000004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Using pulsed-field gel electrophoresis (PFGE), between 1987 and 1996 we analyzed Salmonella enteritidis isolates from gastroenteritis cases in four Caribbean countries: Barbados, Saint Kitts and Nevis, Saint Lucia, and Trinidad and Tobago. We also determined the resistance of the isolates to 12 antimicrobial agents. Of the 129 isolates of S. enteritidis available for testing, DNA digested by XbaI revealed 13 distinctive PFGE patterns. The most prevalent XbaI PFGE patterns were group 1 (88 of 129 isolates, 68.2%) and group 2 (26 of 129, 20.2%). The patterns found among S. enteritidis isolates correlated with the geographical origin of the isolates. Of the 28 isolates from Barbados, 20 of them (71.4%) belonged to XbaI PFGE group 2, and of the 93 isolates from Trinidad and Tobago, 78 of them (83.9%) belonged to group 1. SpeI digestion of S. enteritidis genome was not as discriminatory as XbaI. Overall, of the 129 isolates, 67 of them (51.9%) exhibited resistance to one or more of the 12 antimicrobial agents that we tested. The prevalence of resistance was 53.8% for the S. enteritidis isolates tested from Trinidad and Tobago, 50.0% for those from Barbados, 28.6% for those from Saint Lucia, and 100.0% for one isolate from the island of Saint Kitts. Resistance was highest to triple sulfur (59 of 129 isolates, 45.7%), followed by furadantoin (10 of 129, 7.8%), ampicillin (7 of 129, 5.4%), and carbamycin (5 of 129, 3.9%).
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Affiliation(s)
- A Adesiyun
- University of the West Indies, Faculty of Medical Sciences, School of Veterinary Medicine, St. Augustine, Trinidad and Tobago.
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Bashford C, Carson A. Reimbursement: what every nurse needs to know. Ohio Nurses Rev 2000; 75:11-4; quiz 15. [PMID: 12017716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Johnson P, Johnson J, Heurich S, Curl C, Carson A, Hill S, Sanders-Jones C, Washington R, Russell C. The Africentric Transtheoretical model in a school-based pregnancy prevention program. ABNF J 1998; 9:40-4. [PMID: 9677866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article describes the use of a socio-culturally specific framework for a pregnancy prevention program for low income 10 to 12 year old African American middle school girls. The framework expands earlier (Johnson, 1995) conceptualizations by combining African and African American frames of reference with behavior change processes to influence sexual decision-making among young adolescents.
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Affiliation(s)
- P Johnson
- School of Nursing, Georgia State University, Atlanta 30302, USA.
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Carson A, Isles C. A patient's guide to kidney failure. EDTNA ERCA J 1996; 22:43-5. [PMID: 10723335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Imagine how bewildered you would feel if you had just been told by a doctor or a nurse that your kidneys had failed and that you would shortly require dialysis. This news is broken to 80 per million of the population or approximately 4000 people in the United Kingdom each year, and must come as a dreadful blow to each and every patient, their family, carers and friends.
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Affiliation(s)
- A Carson
- Renal Unit, Dumfries Infirmary, Scotland, UK
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Abstract
OBJECTIVES This study aimed to assess the uptake and effect in primary care of a computerized decision support system (DSS) for the management of hyperlipidaemia. METHOD A prospective controlled trial was conducted in 25 practices covering a population of 150,000 in the city of Birmingham. The Primed system, a specialist developed, rule based DSS for general practice, was introduced prospectively after a 3-month baseline data collection. The main outcome measures were nine months' data on prescribing of lipid lowering agents; use of laboratory tests; and referrals to secondary care for the investigation of hyperlipidaemia. RESULTS System use was lower than expected. A shift was observed towards requests for appropriate follow-up of previously abnormal lipid results and a greater emphasis on full lipid profiles, in line with the DSS guidelines. Referrals showed a 55% decrease on those expected (NS). The prescribing evaluation revealed a large variation between practices, but no significant alteration following system use. Views of users favoured decision support as a concept, but criticised technical problems with the system. CONCLUSIONS Greater integration of DSS software and practice based data handling systems is needed. The mode of data capture, and hence both the content and form of knowledge representation, in DSS must take greater account of the primary care consultation process if such systems are to be of use to practitioners.
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Affiliation(s)
- F D Hobbs
- Department of General Practice, University of Birmingham, Medical School, Edgbaston, UK
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Abstract
As Information Technology enters its second era, it's encountering a paradigm shift that mirrors changes in the corporation itself. With no respect for traditional boundaries, it's breaking down walls and hierarchies--and, in the process, becoming an increasingly valuable strategic tool.
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Lemasters GK, Carson A, Samuels SJ. Occupational styrene exposure for twelve product categories in the reinforced-plastics industry. Am Ind Hyg Assoc J 1985; 46:434-41. [PMID: 4050680 DOI: 10.1080/15298668591395120] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Approximately 1500 occupational styrene exposure values from 28 reinforced-plastic manufacturers were collected retrospectively from companies and state and federal agencies. This report describes the major types of manufacturing processes within the reinforced-plastics industry and reports on the availability, collection and analysis of historical exposure information. Average exposure to styrene in most open-mold companies (24-82 ppm) was generally 2-3 times the exposure in press-mold companies (11-26 ppm). Manufacturers of smaller boats had mean styrene exposures of 82 ppm as compared to 37 ppm for yacht companies. There was considerable overlap in styrene exposure among job titles classified as directly exposed within open- and press-mold processing.
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Abstract
An important step in studies relating worker health to industrial exposure is the estimation of mean exposure levels. The investigator frequently has to rely on industrial hygiene measurements collected for other purposes. Samples may have been taken at several companies on different dates, and on each occasion multiple individual samplers may have been employed. Often it is not recognized that readings from such a hierarchical arrangement are correlated; for example, samples taken at the same time and location are more alike than samples taken on different days. This correlation invalidates the commonly used standard errors of sample means and the usual sample standard deviation. A component of variance analysis is suggested which quantifies within-day, between-day and between-company variation. Estimators of mean exposure are presented with correct standard errors. The techniques are illustrated by a small set of data and by a recent study of exposures to styrene in 36 companies manufacturing reinforced plastics.
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Lockey JE, Brooks SM, Jarabek AM, Khoury PR, McKay RT, Carson A, Morrison JA, Wiot JF, Spitz HB. Pulmonary changes after exposure to vermiculite contaminated with fibrous tremolite. Am Rev Respir Dis 1984; 129:952-958. [PMID: 6329050 DOI: 10.1164/arrd.1984.129.6.952] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Workers exposed to vermiculite contaminated with fibrous tremolite were surveyed for the presence of respiratory symptoms by questionnaire, and for pneumoconiosis by chest radiograph. Pulmonary function was measured by spirometry and single-breath carbon monoxide diffusing capacity ( DLCOsb ). Fiber exposure indexes, expressed as fiber/ml-yr, were derived for each worker from available industrial hygiene data and work histories. The estimated cumulative exposure for the work force ranged from 0.01 to 39 fiber/ml-yr. Discriminant analysis demonstrated significant correlates with shortness of breath and pleuritic chest pain to cumulative fiber exposure. The radiographic changes were limited to pleural changes and involved 4.4% of the population. Parametric and discriminant analysis demonstrated a significant correlation with radiographic changes and cumulative fiber exposure. There were no correlations between spirometry or DLCOsb and fiber exposure. Exposure to vermiculite contaminated with fibrous tremolite can cause pleural changes in occupationally exposed workers. This is supported by the previously identified 12 cases of benign pleural effusions in this working population and the association of pleural radiographic changes and pleuritic chest symptoms with cumulative fiber exposure. The lack of significant parenchymal radiographic, spirometric, and DLCOsb changes most likely reflects the low cumulative fiber exposure.
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Carson A, Weiss M, Riggio RR. The use of human gamma globulin in renal transplantation. AANNT J 1982; 9:35-7. [PMID: 6173409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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