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McCleary N, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard M, Linklater S, Thavorn K, Dobell G, Mulhall CL, Lam JMC, Grimshaw JM, Ivers NM. Engagement is a necessary condition to test audit and feedback design features: results of a pragmatic, factorial, cluster-randomized trial with an embedded process evaluation. Implement Sci 2023; 18:13. [PMID: 37165413 PMCID: PMC10173488 DOI: 10.1186/s13012-023-01271-6] [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] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND While audit & feedback (A&F) is an effective implementation intervention, the design elements which maximize effectiveness are unclear. Partnering with a healthcare quality advisory organization already delivering feedback, we conducted a pragmatic, 2 × 2 factorial, cluster-randomized trial to test the impact of variations in two factors: (A) the benchmark used for comparison and (B) information framing. An embedded process evaluation explored hypothesized mechanisms of effect. METHODS Eligible physicians worked in nursing homes in Ontario, Canada, and had voluntarily signed up to receive the report. Groups of nursing homes sharing physicians were randomized to (A) physicians' individual prescribing rates compared to top-performing peers (the top quartile) or the provincial median and (B) risk-framed information (reporting the number of patients prescribed high-risk medication) or benefit-framed information (reporting the number of patients not prescribed). We hypothesized that the top quartile comparator and risk-framing would lead to greater practice improvements. The primary outcome was the mean number of central nervous system-active medications per resident per month. Primary analyses compared the four arms at 6 months post-intervention. Factorial analyses were secondary. The process evaluation comprised a follow-up questionnaire and semi-structured interviews. RESULTS Two hundred sixty-seven physicians (152 clusters) were randomized: 67 to arm 1 (median benchmark, benefit framing), 65 to arm 2 (top quartile benchmark, benefit framing), 75 to arm 3 (median benchmark, risk framing), and 60 to arm 4 (top quartile benchmark, risk framing). There were no significant differences in the primary outcome across arms or for each factor. However, engagement was low (27-31% of physicians across arms downloaded the report). The process evaluation indicated that both factors minimally impacted the proposed mechanisms. However, risk-framed feedback was perceived as more actionable and more compatible with current workflows, whilst a higher target might encourage behaviour change when physicians identified with the comparator. CONCLUSIONS Risk framing and a top quartile comparator have the potential to achieve change. Further work to establish the strategies most likely to enhance A&F engagement, particularly with physicians who may be most likely to benefit from feedback, is required to support meaningfully addressing intricate research questions concerning the design of A&F. TRIAL REGISTRATION ClinicalTrials.gov, NCT02979964 . Registered 29 November 2016.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- Department of Family and Emergency Medicine, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Gail Dobell
- Health System Performance, Ontario Health, Toronto, Canada
| | - Cara L Mulhall
- Health System Performance, Ontario Health, Toronto, Canada
| | | | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
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2
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Kushniruk A, Reis C, Ivers N, Desveaux L. Characterizing the Gaps Between Best-Practice Implementation Strategies and Real-world Implementation: Qualitative Study Among Family Physicians Who Engaged With Audit and Feedback Reports. JMIR Hum Factors 2023; 10:e38736. [PMID: 36607715 PMCID: PMC9947922 DOI: 10.2196/38736] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/28/2022] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Ontario, Canada, a government agency known as Ontario Health is responsible for making audit and feedback reports available to all family physicians to encourage ongoing quality improvement. The confidential report provides summary data on 3 key areas of practice: safe prescription, cancer screening, and diabetes management. OBJECTIVE This report was redesigned to improve its usability in line with evidence. The objective of this study was to explore how the redesign was perceived, with an emphasis on recipients' understanding of the report and their engagement with it. METHODS We conducted qualitative semistructured interviews with family physicians who had experience with both versions of the report recruited through purposeful and snowball sampling. We analyzed the transcripts following an emergent and iterative approach. RESULTS Saturation was reached after 17 family physicians participated. In total, 2 key themes emerged as factors that affected the perceived usability of the report: alignment between the report and the recipients' expectations and capacity to engage in quality improvement. Family physicians expected the report and its quality indicators to reflect best practices and to be valid and accurate. They also expected the report to offer feedback on the clinical activities they perceived to be within their control to change. Furthermore, family physicians expected the goal of the report to be aligned with their perspective on feasible quality improvement activities. Most of these expectations were not met, limiting the perceived usability of the report. The capacity to engage with audit and feedback was hindered by several organizational and physician-level barriers, including the lack of fit with the existing workflow, competing priorities, time constraints, and insufficient skills for bridging the gaps between their data and the corresponding desired actions. CONCLUSIONS Despite recognized improvements in the design of the report to better align with best practices, it was not perceived as highly usable. Improvements in the presentation of the data could not overcome misalignment with family physicians' expectations or the limited capacity to engage with the report. Integrating iterative evaluations informed by user-centered design can complement evidence-based guidance for implementation strategies. Creating a space for bringing together audit and feedback designers and recipients may help improve usability and effectiveness.
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Affiliation(s)
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Noah Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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3
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Shuldiner J, Shah N, Reis C, Chalmers I, Ivers N, Nathan P. Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study. JMIR Hum Factors 2022; 9:e37606. [PMID: 36099013 PMCID: PMC9516377 DOI: 10.2196/37606] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of childhood cancer are at lifelong risk of morbidity (such as new cancers or heart failure) and premature mortality due to their cancer treatment. These are termed late effects. Therefore, they require lifelong, risk-tailored surveillance. However, most adult survivors of childhood cancer do not complete recommended surveillance tests such as mammograms or echocardiograms. Objective In partnership with survivors, family physicians, and health system partners, we are designing a provincial support system for high-priority tests informed by principles of implementation science, behavioral science, and design thinking. Methods Our multiphase process was structured as follows. Step 1 consisted of a qualitative study to explore intervention components essential to accessing surveillance tests. Step 2 comprised a workshop with childhood cancer survivors, family physicians, and health system stakeholders that used the Step 1 findings and “personas” (a series of fictional but data-informed characters) to develop and tailor the intervention for different survivor groups. Step 3 consisted of intervention prototype development, and Step 4 involved iterative user testing. Results The qualitative study of 30 survivors and 7 family physicians found a high desire for information on surveillance for late effects. Respondents indicated that the intervention should help patients book appointments when they are due in addition to providing personalized information. Insights from the workshop included the importance of partnering with both family physicians and survivorship clinics and providing emotional support for survivors who may experience distress upon learning of their risk for late effects. In our user-testing process, prototypes went through iterations that incorporated feedback from users regarding acceptability, usability, and functionality. We sought to address the needs of survivors and physicians while balancing the capacity and infrastructure available for a lifelong intervention via our health system partners. Conclusions In partnership with childhood cancer survivors, family physicians, and health system partners, we elucidated the barriers and enablers to accessing guideline-recommended surveillance tests and designed a multifaceted solution that will support survivors and their family physicians. The next step is to evaluate the intervention in a pragmatic randomized controlled trial.
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Affiliation(s)
- Jennifer Shuldiner
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Nida Shah
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Noah Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Nathan
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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4
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Pais A, Laranjo M, Reis C, Reis S, Sousa A, Silva F, Jorge J, Gonçalves C, Botelho F, Almeida-Santos T. 454 Angiogenesis stimulation of cryopreserved ovarian tissue. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.375] [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: 11/28/2022]
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Gomes D, Lopes P, Freitas P, Albuquerque F, Horta E, Reis C, Guerreiro S, Abecassis J, Trabulo M, Ferreira A, Ferreira J, Ribeiras R, Mendes M, Andrade MJ. Prognostic significance of peak atrial longitudinal strain in patients with functional mitral regurgitation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Chronic mitral regurgitation has been shown to promote left atrial (LA) dysfunction and remodeling. However, the significance of LA dysfunction in this setting has not been fully investigated. The aim of our study was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in a cohort of patients with LV systolic dysfunction and functional mitral regurgitation (FMR).
Methods
Patients with at least mild FMR and reduced LVEF (< 50%) under optimized medical therapy who underwent transthoracic echocardiography between 2010 and 2018 were retrospectively identified at a single-centre. FMR grading was undertaken according to the new 2021 valvular guidelines. PALS was assessed by 2D speckle tracking in apical 4-chamber view (as per EACVI current recommendations). Cox proportional hazards regression was applied for univariable and multivariable analysis to investigate the association between clinical and echocardiographic parameters, namely PALS, and all-cause mortality.
Results
A total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median mitral regurgitant volume was 25mL (IQR: 14 – 34mL). According to the new ESC 2021 valvular guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. Median PALS was 14% (IQR 8 – 20%). The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS (figure 1). On ROC curve analysis, the best PALS cut-off value associated with mortality was < 15%. Kaplan-Meier survival curves according to FMR severity and PALS > or < 15% are depicted in figure 2. PALS remained independently associated with all-cause mortality on multivariable analysis (adjusted hazard ratio [aHR]: 0.94; 95%CI: 0.90 – 0.98; p = 0.004) even after adjustment for several (n = 14) clinical and echocardiographic confounders.
Conclusion
In a cohort of patients with reduced LVEF and functional mitral regurgitation, peak atrial longitudinal strain was associated with all-cause mortality. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- D Gomes
- Hospital Santa Cruz, Lisbon, Portugal
| | - P Lopes
- Hospital Santa Cruz, Lisbon, Portugal
| | - P Freitas
- Hospital Santa Cruz, Lisbon, Portugal
| | | | - E Horta
- Hospital Santa Cruz, Lisbon, Portugal
| | - C Reis
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - M Trabulo
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | | | - M Mendes
- Hospital Santa Cruz, Lisbon, Portugal
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Silva MR, Paiva T, Reis C, Feliciano A, Gaspar T, Canhão H, Matos MG, Pereira C, Carreiro A, Lino A, Moreira S, Bernarda A, Gaspar S, Ramiro L, Fonseca J, Videira G. Effects of Covid-19 confinement on portuguese adults’ nutrition, physical activity and sleep. Clin Nutr ESPEN 2021. [PMCID: PMC8674507 DOI: 10.1016/j.clnesp.2021.09.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Thavorn K, Kumar S, Reis C, Lam J, Dobell G, Mulhall C, Grimshaw JM, Ivers N. Audit feedback interventions to address high-risk prescriptions in long-term care homes: a costing study and return on investment analysis. Implement Sci Commun 2021; 2:125. [PMID: 34711294 PMCID: PMC8554856 DOI: 10.1186/s43058-021-00225-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Audit and feedback is a common implementation strategy, but few studies describe its costs. ‘MyPractice’ is a province-wide audit and feedback initiative to improve prescribing in nursing homes. This study sought to estimate the costs of ‘MyPractice’ and assess whether the financial benefit of ‘MyPractice’ offsets those costs. Methods We conducted a costing study from the perspective of the Ontario government. Total cost of ‘MyPractice’ was calculated as the sum of the costs of producing and disseminating the reports (covering three report releases) which were obtained from Ontario Health staff interviews and document reviews. Return on investment (ROI) was calculated as the ratio of net cost-savings and the intervention cost. Cost savings were based on the effectiveness of ‘MyPractice’ derived from a published cohort study. Cost-savings attributable to ‘MyPractice’ were estimated from the changes in the rates of antipsychotics over time between physicians who signed up and viewed the reports and those who did not sign up to the reports. Results Total intervention costs were C$223,691 (C$838 per physician and C$74,564 per release). Costs incurred during the development phase accounted for 74% of the total cost (C$166,117), while implementation costs for three report releases were responsible for 26% of the total costs (C$57,575). The ROI for every C$1 spent on the ‘MyPractice’ intervention was 1.02 (95% CI 0.51, 1.93) for three report releases. Conclusion ‘MyPractice’ report offers a good return on investment and the value for money could improve with greater number of report releases. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00225-7.
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Affiliation(s)
- Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. .,ICES, Toronto, Ontario, Canada.
| | - Srishti Kumar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catherine Reis
- Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Jonathan Lam
- Ontario Health (Quality), Toronto, Ontario, Canada
| | - Gail Dobell
- Ontario Health (Quality), Toronto, Ontario, Canada
| | - Cara Mulhall
- Ontario Health (Quality), Toronto, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Noah Ivers
- ICES, Toronto, Ontario, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Maltes S, Abecasis J, Mendes GSM, Padrao C, Reis C, Guerreiro S, Freitas P, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M. Prevalence and determinants of right ventricular dysfunction in patients with severe symptomatic high gradient aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function in aortic stenosis (AS) has been largely neglected. Recently it was demonstrated that right ventricular impairment may be influenced by left ventricular (LV) function and afterload, well before overt pulmonary hypertension development.
Aim
To describe the prevalence of RV dysfunction in a group of patients with severe symptomatic aortic stenosis (AS) and its relation to LV function parameters and afterload.
Methods
We prospectively studied 93 consecutive patients (age: 73 years [IQR 68–77] years, 55% women) with pure severe symptomatic high gradient aortic stenosis: mean transaortic pressure gradient: 57.0mmHg [IQR 46.9–71.1]; aortic valve area: 0.72cm2 [IQR 0.61–0.88]; indexed stroke volume: 48.8±1.5 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance (CMR) for LV myocardium tissue characterization (late gadolinium enhancement and extracellular volume). Normal RV function was defined according to TAPSE ≥17mm, tricuspid annular systolic velocity ≥12cm/s, mean free wall longitudinal strain ≤−20%. Patients were divided into four groups: (0) – all three RV parameters below normal (1.1%), (1) – 1 normal parameter (12.9%), (2) – 2 normal parameters (44.1%), (3) – 3 normal parameters (41.9%). Indexes of LV systolic and diastolic function, CMR derived LV geometric remodeling, hypertrophy and tissue characterization, aortic valve disease severity and afterload were compared across the 4 groups of patients. We tried to identify predictors of RV dysfunction (group 0, 1, 2 vs. group 3) at multivariate regression analysis.
Results
Left ventricular performance parameters, diastolic and myocardial work indexes were significantly different across the groups (Figure). Neither AV severity indexes nor LV tissue characterization were distinct. At multivariate analysis only global constructive work was an independent predictor of RV dysfunction.
Conclusion
RV dysfunction is common in this group of patients with severe high gradient aortic stenosis and preserved ejection fraction. RV impairment is significantly related to several LV systolic and diastolic parameters and also to LV afterload, probably accounting for RV-LV interdependence.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Maltes
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - C Padrao
- Hospital Santa Cruz, Lisbon, Portugal
| | - C Reis
- Hospital Santa Cruz, Lisbon, Portugal
| | | | - P Freitas
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - N Cardim
- Hospital da Luz, SA, Lisbon, Portugal
| | - V Gil
- Hospital da Luz, SA, Lisbon, Portugal
| | - M Mendes
- Hospital Santa Cruz, Lisbon, Portugal
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Abreu V, Vaz R, Chamadoira C, Rebelo V, Reis C, Costa F, Martins J, Gillies MJ, Aziz TZ, Pereira EAC. Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years' follow-up and effective volume of activated brain tissue. Neurochirurgie 2021; 68:52-60. [PMID: 34166646 DOI: 10.1016/j.neuchi.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/24/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p=0.0001), on UW-NPS of 35.2% (p=0.3582), on BPI of 65.1% (p=0.0505) and on SF-36 of 5% (p=0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p=0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p=0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.
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Affiliation(s)
- V Abreu
- Department of Neuroradiology. Centro Hospitalar Universitário do Porto, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal.
| | - R Vaz
- Faculdade de Medicina da Universidade do Porto, Portugal; Department of Neurosurgery. Centro Hospitalar Universitário São João, Porto, Portugal; Neurociences Unity Hospital Cuf, Porto, Portugal
| | - C Chamadoira
- Department of Neurosurgery. Centro Hospitalar Universitário São João, Porto, Portugal
| | - V Rebelo
- Pain Unit. Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Reis
- Department of Neuroradiology. Centro Hospitalar Universitário São João, Porto, Portugal
| | - F Costa
- Department of Neuroradiology. Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - M J Gillies
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | - T Z Aziz
- Faculdade de Medicina da Universidade do Porto, Portugal; Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | - E A C Pereira
- Faculdade de Medicina da Universidade do Porto, Portugal; Neurosciences Research Centre, Institute of Molecular and Clinical Neurosciences, St. George's, University of London, London, United Kingdom
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Gamboa Madeira S, Reis C, Paiva T, Roenneberg T. Circadian misalignment is associated with a high cardiovascular risk among shift workers: is this an opportunity for prevention in occupational settings? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT) and Fundo Social Europeu (FSE)
Introduction
Atypical work schedules encompass more than 20% of the European workforce. The link between shift work and cardiovascular disease (CVD) has been extensively studied being lifestyle behaviours, sleep disruption and circadian misalignment the key mechanisms involved. Social Jetlag (SJL) has been proposed as a proxy for circadian misalignment in epidemiological studies, once it takes into account individual’s chronotype and working schedules. Therefore we hypothesize that, among workers under fixed atypical work schedules, those with a greater SJL have a higher CVD risk.
Methods
A cross-sectional observational study was conducted among blue-collar workers of one retail company. Fixed working schedules were early morning, late evening, and night work. Sociodemographic, occupational, lifestyle and sleep data were collected through questionnaire. SJL was quantified by the difference for mid-sleep points on work- and free-days. Even though SJL is a continuous variable, 3 categories have been used (≤2h; 2-4h; ≥4h). Blood pressure (BP) and the total cholesterol (TC) were assessed. The CVD risk was estimated according to the relative risk SCORE chart. A relative risk≥3 was considered "high CVD risk". Descriptive statistics and bivariate analysis according to the CVD risk (high vs other) was performed. The relationship between SJL and high CVD risk was analysed through logistic binary regression using generalized linear models adjusted for age, sex, education, Body Mass Index, consumptions, sleep duration and quality plus work schedule and seniority.
Results
Of the 301 workers, 56.1% were male with a mean age of 33.0 ± 9.4years. Average SJL was 1:57 ± 1:38hours with the majority of workers experiencing ≤2h (59.4%) and 8% (n = 24) more than 4h. Less than a half had hypercholesterolemia (48.8%), overweight (37.9%)or hypertensive values (10.6%), however 50.5% were currently smokers. We found a significant trend for hypertension (p = 0.006) and smoking prevalence (p = 0.043) among ordinal SJL categories. A relative "high CVD risk" was found in 20.3% of the sample (n = 61). These workers were significantly older (p < 0.001), less educated (p = 0.003) and slept less hours on workdays (p = 0.021). In the multiple regression analysis, SJL was an independent risk factor for a "high CVD risk" (p = 0.029).The odds of having a "high CVD risk" increased almost thirty per cent per each additional hour of SJL (OR = 1.29; 95% CI:1.03-1.63), even after adjusting for sociodemographic, lifestyle, sleep and working features.
Conclusions
We found compelling evidence that a greater SJL was associated with a bigger chance of high CVD risk. From this innovative perspective, the focus is not just on the working schedule itself but also on the worker’s chronotype. These findings suggest that interventions aimed to reduce Social Jetlag, especially in extreme chronotypes and working schedules, poses a great opportunity to minimize the cardiovascular health impact of shift work.
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Affiliation(s)
- S Gamboa Madeira
- Faculdade de Medicina, Universidade de Lisboa, Instituto de Saúde Ambiental (ISAMB), Lisbon, Portugal
| | - C Reis
- Universidade Católica Portuguesa, Católica Research Centre for Psychological (CRC-W), Lisbon, Portugal
| | - T Paiva
- CENC - Sleep Medicine Center, Lisbon, Portugal
| | - T Roenneberg
- Ludwig-Maximilians University, Institute for Medical Psychology, Munich, Germany
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11
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Araujo A, Pereira A, Reis C, Nascimento L, Pina C, Avó J, Feijão A, Macedo A. Impulsivity and compulsivity aggregate in alcohol use disorder and explain comorbidity with impulse-control and related disorders. Eur Psychiatry 2021. [PMCID: PMC9475920 DOI: 10.1192/j.eurpsy.2021.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The conceptualization of impulsivity and compulsiveness has fluctuated between two different perspectives: they are (1) distinct and orthogonal dimensions, (2) extreme poles of the same dimension/ spectrum. We favor this latter, accepting that these dimensions contribute to the etiopathogenesis of impulsive-compulsive disorders, namely alcohol use disorder/AUD. Objectives To analyze: Differences of impulsivity and compulsivity levels between AUD patients vs. participants from the community; prevalence of impulsive-compulsive disorders/ICD in AUD; if impulsivity/compulsivity predict the severity of alcohol use and ICD in AUD. Methods 32 AUD patients (21% women, mean age 46±10) answered the Portuguese versions of: Alcohol-Use-Disorders-Identification-Test, Questionnaire-for-Impulsive-Compulsive-Disorders-in-Parkinson’s-Disease, Barrat-Impulsiveness-Scale, Obsessive-Compulsive-Inventory and Depression-Anxiety-Stress-Scales; 50 adults from the community (68% women, mean age 29±14) answered the former three. Mann-Whitney-U, Spearman and regression tests were performed using SPSS. Results AUD individuals vs. subjects from the community presented higher levels of impulsivity and compulsivity (p<.001). AUD-group: AUDIT median score was 25 (>8 harmful use); 81% reported ICD-symptoms; impulsivity and compulsivity highly correlated (r=.639; p<.001); impulsivity levels explained the presence of certain ICD (gambling, compulsive buying, eating disorders) and depression/anxiety/stress (OR=.152; p<.05); compulsivity levels also explained the occurrence of specific ICD (compulsive buying and other repetitive automatic behaviours) and depression/anxiety/stress (OR=.131 p<.05). Conclusions Our results indicate that impulsivity and compulsivity co-occur and contribute to the explanation of AUD, and related comorbidity and psychological distress. This highlights the utility of considering impulsivity and compulsivity when subtyping, stratifying, and treating AUD patients. Finally, we assert that disorders of impulsivity and compulsivity (eg.: AUD and ICD) co-occur. Conflict of interest No significant relationships.
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12
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Lopes P, Albuquerque F, Freitas P, Gama F, Horta E, Reis C, Abecasis J, Trabulo M, Ferreira A, Canada M, Ribeiras R, Mendes M, Andrade MJ. Adapting the concepts of proportionate and disproportionate functional mitral regurgitation to clinical practice. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite its theoretical appeal, the concept of Proportionate and Disproportionate FMR has been limited by the lack of a simple way to assess it and by the paucity of data showing its prognostic superiority over currently established ways of grading FMR.
Objectives
This study sought to evaluate the prognostic value of a new and individualized method of assessing Functional Mitral Regurgitation (FMR) Proportionality.
Methods
Patients with at least mild FMR and reduced left ventricular ejection fraction (< 50%) under optimal guideline-directed medical therapy were retrospectively identified at a single-center. To determine FMR proportionality status, we used a novel approach where two simple equations establish an individual cut-off of regurgitant volume/effective regurgitant orifice area, categorizing the study population into non-severe, proportionate and disproportionate FMR (Figure 1). The primary endpoint was all-cause mortality.
Results
A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Disproportionate FMR was present in 109 patients (19%) with a median EROA of 26 mm2 (IQR 22-31) and a median RegVol of 40 ml (IQR 34-48), proportionate FMR in 148 patients (26%) with a median EROA of 16mm2 (IQR 12-21) and a median RegVol of 26 ml (IQR 19-32). During a median follow-up of 3.8 years (interquartile range: 1.8 to 6.2 years) there were 254 deaths (44%). The unadjusted mortality incidence per 100 persons-year rose as the degree of FMR disproportionality worsened. On multivariable analysis, disproportionate FMR remained independently associated with all-cause mortality (adjusted hazard ratio: 1.785; 95% confidence interval [CI]: 1.249 to 2.550; P = 0.001). The FMR proportionality concept showed greater discriminative power (C-statistic 0.639; 95% CI: 0.597 to 0.680) than the American (C-statistic 0.588; 95% CI: 0.550 to 0.626; P for comparison = .001) and European guidelines (C-statistic 0.563; 95% CI: 0.534 to 0.591; P for comparison < .001). It was also able to increase the net reclassification index (0.167 [P < 0.001] and 0.084 [P = 0.001], respectively).
Conclusions
A new, simplified and individualized method of assessing FMR Proportionality showed that disproportionate FMR is independently associated with all-cause mortality. This approach seems to outperform the risk stratification of current guidelines.
Abstract Figure 1
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Affiliation(s)
- P Lopes
- Hospital Santa Cruz, Carnaxide, Portugal
| | | | - P Freitas
- Hospital Santa Cruz, Carnaxide, Portugal
| | - F Gama
- Hospital Santa Cruz, Carnaxide, Portugal
| | - E Horta
- Hospital Santa Cruz, Carnaxide, Portugal
| | - C Reis
- Hospital Santa Cruz, Carnaxide, Portugal
| | - J Abecasis
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Trabulo
- Hospital Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Canada
- Hospital Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital Santa Cruz, Carnaxide, Portugal
| | - MJ Andrade
- Hospital Santa Cruz, Carnaxide, Portugal
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13
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Lopes P, Albuquerque F, Freitas P, Horta E, Reis C, Abecasis J, Trabulo M, Ferreira A, Canada M, Ribeiras R, Mendes M, Andrade MJ. Regurgitant volume to left ventricular end-diastolic volume ratio: another step to risk stratification in patients with secondary mitral regurgitation? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Quantitative evaluation of secondary mitral valve regurgitation (MR) remains an important yet challenging step in the evaluation of this entity. Its severity can be underestimated when using the proximal isovelocity surface area (PISA) method, which does not take left ventricular (LV) volume into account. Normalizing mitral regurgitant volume (Rvol) for the LV end-diastolic volume (EDV) might overcome this key limitation. This study aimed to investigate the prognostic implication of Rvol/EDV ratio in patients with secondary MR.
Methods
Patients with at least mild secondary MR and reduced left ventricular ejection fraction (<50%) under optimal guidelines-directed medical therapy were retrospectively identified at a single-center. The cohort was divided into terciles according to the RVol/EDV ratio. The primary endpoint was all-cause mortality.
Results
A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Median measures of secondary MR were EROA 14 mm2 (IQR 8-22) and RegVol 23 ml (12-34). During a median follow-up of 3.8 years (interquartile range 1.8 to 6.2 years) there were 254 deaths (44%). The unadjusted mortality incidence increases across terciles distribution. Patients at the 2nd and 3rd terciles of the RVol/EDV ratio showed significantly higher mortality when compared to those at the 1st one (baseline reference) (figure 1). After multivariable analysis, terciles of the Rvol/EDV ratio remained independently associated with increased all-cause mortality (considering the 1st tercile as the reference; adjusted HR for the 2nd tercile 1.46 [95% CI 1.05- 2.02] p = 0.023; adjusted HR for 3rd tercile 1.56 [95% CI 1.09 – 2.22], p = 0.015).
Conclusion
In patients with secondary MR, Rvol/EDV ratio is independently associated with all-cause mortality. However, the appropriate cut-off to determine any kind of clinical decision remains to be determined.
Abstract Figure.
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Affiliation(s)
- P Lopes
- Hospital Santa Cruz, Carnaxide, Portugal
| | | | - P Freitas
- Hospital Santa Cruz, Carnaxide, Portugal
| | - E Horta
- Hospital Santa Cruz, Carnaxide, Portugal
| | - C Reis
- Hospital Santa Cruz, Carnaxide, Portugal
| | - J Abecasis
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Trabulo
- Hospital Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Canada
- Hospital Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital Santa Cruz, Carnaxide, Portugal
| | - MJ Andrade
- Hospital Santa Cruz, Carnaxide, Portugal
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14
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Albuquerque F, Lopes P, Freitas P, Horta E, Reis C, Abecassis J, Trabulo M, Ferreira A, Canada M, Ribeiras R, Mendes M, Joao Andrade M. External validation of the unifying concept for the quantitative assessment of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A Unifying Concept for the Quantitative Assessment of Secondary Mitral Regurgitation (SMR) was recently proposed in order to provide a solution for the ongoing guideline controversy. However, these data were derived from a single center cohort and lacks external validation. We aimed to validate the proposed algorithm in a different patient population.
Methods
Patients with at least mild SMR and reduced left ventricular ejection fraction (< 50%) under optimal guideline-directed medical therapy were retrospectively identified at a single-center. The cohort was stratified in low-risk (effective regurgitant orifice area [EROA] < 20 mm2 and regurgitant volume [RegVol] < 30 ml), intermediate-risk (EROA 20 to 29 mm2 and RegVol 30 to 44 ml) and high-risk (EROA ≥ 30 mm2 and RegVol ≥ 45ml) according to the defined risk-based thresholds tailored to the pathophysiological concept of SMR. In the intermediate-risk group, patients were further stratified on the basis of the hemodynamic severity of SMR, into intermediate low-risk and intermediate high-risk (regurgitant fraction < 50% or ≥ 50%, respectively). The primary endpoint was all-cause mortality.
Results
A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Median measures of SMR severity were EROA of 14 mm2 (IQR 8-22) and RegVol of 23 ml (12-34). During a median follow-up of 3.8 years (interquartile range: 1.8 to 6.2 years) there were 254 deaths (44%). The mortality at 6-years was 38.9% for the low-risk group, 30.7% for the intermediate low-risk, 64.9% in the intermediate high-risk and 63.2% in the high-risk group. On multivariable analysis, the defined thresholds of risk for SMR severity remained independently associated with all-cause mortality (adjusted hazard ratio: 1.164; 95% confidence interval [CI]: 1.020 to 1.327; P = 0.024). The unifying concept showed similar discriminative power (C-statistic 0.588; 95% CI: 0.540 to 0.635) to the American (C-statistic 0.588; 95% CI: 0.541 to 0.635; P for comparison = 1) and European guidelines (C-statistic 0.563; 95% CI: 0.515 to 0.610; P for comparison = 0.458), but it was able to increase the net reclassification index (0.143 [P < .001] and 0.026 [P = .025], respectively).
Conclusions
In this cohort of patients with SMR and LVEF <50%, the proposed unifying concept based on combined assessment of the EROA, the RegVol, and the RegFrac proved to be associated with an increased risk of all-cause mortality and could improve risk prediction of current guidelines.
Abstract Figure.
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Affiliation(s)
| | - P Lopes
- Hospital Santa Cruz, Carnaxide, Portugal
| | - P Freitas
- Hospital Santa Cruz, Carnaxide, Portugal
| | - E Horta
- Hospital Santa Cruz, Carnaxide, Portugal
| | - C Reis
- Hospital Santa Cruz, Carnaxide, Portugal
| | | | - M Trabulo
- Hospital Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Canada
- Hospital Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital Santa Cruz, Carnaxide, Portugal
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15
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De Sousa Bispo J, Azevedo P, Freitas P, Marques N, Reis C, Horta E, Trabulo M, Abecasis J, Canada M, Ribeiras R, Andrade M. Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation.
Objectives
To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI
Methods
Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint.
Results
377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF <40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102)
Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint.
We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001.
Conclusion
PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge.
Kaplan-Meier Survival Curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - C Reis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - E Horta
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Trabulo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Canada
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M.J Andrade
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
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16
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Lopes P, Albuquerque F, Freitas P, Gama F, Rocha B, Cunha G, Horta E, Reis C, Ferreira A, Abecasis J, Trabulo M, Canada M, Ribeiras R, Mendes M, Andrade M. Disproportionate functional mitral regurgitation: clinical validation of a new conceptual framework. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Disproportionate functional mitral regurgitation (FMR) is a novel concept that tries to identify hemodynamically significant FMR by readjusting the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) cut-offs according to left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF). However, this theoretical concept lacks clinical validation. The aim of this study was to assess the clinical significance of disproportionate FMR.
Methods
Patients with at least mild FMR and reduced LVEF (<50%) who underwent transthoracic echocardiography between 2010 and 2014 were retrospectively identified in our laboratory database. Optimal medical therapy (including cardiac resynchronization when indicated) for ≥3 months was a prerequisite for inclusion. Hemodynamically significant FMR was defined as regurgitant fraction >50% and the patient-specific theoretical RegVol cut-off was calculated according to the formula presented in Fig. 1a. The difference between the estimated RegVol by the PISA method and the theoretical RegVol cut-off was considered to represent the haemodynamic burden of MR. The primary endpoint was all-cause death. Patients were censured if mitral intervention or heart transplant was undertaken. Survival analysis was used to assess the effect of disproportionate FMR on mortality in 2 subgroups (LVEF <30% and 30–49%).
Results
A total of 289 patients (median age 69 years [IQR 60–77], 75% male, 53% of ischemic aetiology) were included. More than 90% were on beta-blockers and renin-angiotensin inhibitors, 44% on aldosterone receptor antagonists, and 73% had implanted devices. The median LVEF and LVEDV were 34% (IQR 27–41) and 170mL (IQR 128–220), respectively. Median EROA was 10mm2 (IQR 3–21) and RegVol was 15 mL (IQR 4–30). RegVol distribution across the cohort was: <10mL: 41%; 10–20mL: 18%; 20–30mL: 15% and >30mL: 26%. Disproportionate FMR was present in 83 patients (29%). These patients had significantly higher SPAP values (41mmHg [IQR 33–50] vs. 33mmHg [IQR 29–40]; p<0.001).
During a median follow-up of 44 months (IQR 19–73), 106 patients died. In the LVEF <30% subgroup, age (HR 1.05 per year [1.02–1.08]; p<0.001), LVEF (HR 0.94 per 1% [0.89–0.99]; p=0.042) and TAPSE (HR 0.92 per mm [0.86–0.99]; p=0.030) were independent predictors of mortality. In the LVEF 30–49% subgroup, age (HR 1.05 per year [1.02–1.08]; p=0.003), LVEF (HR 0.94 per 1% [0.89–0.99]; p=0.020) and disproportionate FMR (HR 1.02 per mL [1.01–1.03]; p=0.01) were independently associated with increased mortality.
Conclusions
Disproportionate FMR proved to be an important independent predictor of mortality in patients with LVEF between 30–49%. These findings were not replicated in those with LVEF<30%, where the degree of biventricular dysfunction seems to outweigh all other echocardiographic parameters, leaving FMR as a bystander.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Lopes
- Hospital Santa Cruz, Carnaxide, Portugal
| | | | - P Freitas
- Hospital Santa Cruz, Carnaxide, Portugal
| | - F Gama
- Hospital Santa Cruz, Carnaxide, Portugal
| | - B Rocha
- Hospital Santa Cruz, Carnaxide, Portugal
| | - G Cunha
- Hospital Santa Cruz, Carnaxide, Portugal
| | - E Horta
- Hospital Santa Cruz, Carnaxide, Portugal
| | - C Reis
- Hospital Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital Santa Cruz, Carnaxide, Portugal
| | - J Abecasis
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Trabulo
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Canada
- Hospital Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital Santa Cruz, Carnaxide, Portugal
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17
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McCleary N, Desveaux L, Reis C, Linklater S, Witteman HO, Taljaard M, Thavorn K, Grimshaw JM, Ivers NM, Presseau J. A multiple-behaviour investigation of goal prioritisation in physicians receiving audit and feedback to address high-risk prescribing in nursing homes. Implement Sci Commun 2020; 1:33. [PMID: 32885191 PMCID: PMC7427855 DOI: 10.1186/s43058-020-00019-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background As part of their professional role, healthcare providers enact multiple competing goal-directed behaviours in time-constrained environments. Better understanding healthcare providers’ motivation to engage in the pursuit of particular goals may help inform the development of implementation interventions. We investigated healthcare providers’ pursuit of multiple goals as part of a trial evaluating the effectiveness of an audit and feedback intervention in supporting appropriate adjustment of high-risk medication prescribing by physicians working in nursing homes. Our objectives were to determine whether goal priority and constructs from Social Cognitive Theory (self-efficacy, outcome expectations, and descriptive norms) predicted intention to adjust prescribing of multiple high-risk medications and to investigate how physicians in nursing homes prioritise their goals related to high-risk medication prescribing. Methods Physicians in Ontario, Canada, who signed up for and accessed the audit and feedback report were invited to complete a questionnaire assessing goal priority, self-efficacy, outcome expectations, descriptive norms, and intention in relation to the three targeted behaviours (adjusting prescribing of antipsychotics, benzodiazepines, and antidepressants) and a control behaviour (adjusting statin prescribing). We conducted multiple linear regression analyses to identify predictors of intention. We also conducted semi-structured qualitative interviews to investigate how physicians in nursing homes prioritise their goals in relation to appropriately adjusting prescribing of the medications included in the report: analysis was informed by the framework analysis method. Results Thirty-three of 89 (37%) physicians completed the questionnaire. Goal priority was the only significant predictor of intention for each medication type; the greater a priority it was for physicians to appropriately adjust their prescribing, the stronger was their intention to do so. Across five interviews, physicians reported prioritising adjustment of antipsychotic prescribing specifically. This was influenced by negative media coverage of antipsychotic prescribing in nursing homes, the provincial government’s mandate to address antipsychotic prescribing, and by the deprescribing initiatives or best practice routines in place in their nursing homes. Conclusions Goal priority predicted nursing home physicians’ intention to adjust prescribing. Targeting goal priority through implementation interventions therefore has the potential to influence behaviour via increased motivation. Implementation intervention developers should consider the external factors that may drive physicians’ prioritization.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine Reis
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Family and Emergency Medicine, and Office of Education and Continuing Professional Development, Laval University, Québec City, Canada.,Laval University Research Institute for Primary Care and Health Services, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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Fonseca S, Reis C, Monteiro L, Monteiro C, Serrano M. Hearing Screening in Preschool Children of a Rural Community in Portugal - A 10-year Experience. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction Preschool hearing screening programmes would identify later onset or progressive hearing losses and conductive hearing loss, due to the high prevalence of otitis media with effusion in childhood. Hearing loss associated with otitis media with effusion can have a great impact on reading, writing, central auditory processing and balance.
Objectives The present study aims at characterising the audiological alterations found in preschool children screened in a rural community in Portugal, and the correlation between audiological findings and otoscopy.
Methodology This is an observational study using the results obtained in a ten year audiological and otological screening of preschool children. Otoscopy, Tympanometry and Audiometry (1, 2 and 4 KHz presented at 40 and 20 dB intensity) were performed at the first stage of the screening and the results were classified as “pass” or “refer”. Every non-normal result of any category would imply a second stage consisting of observation by an ENT specialist at the site and the establishing of a follow-up plan. Written Informed Consent was obtained from the parents prior to initiating the study.
Results 595 children aged 5 and 6 years were screened between 2007 and 2017, of whom 192 (32.3%) required referral to the second stage. The most frequent alteration was found in the tympanogram. The tympanograms showed a significant correlation with the otoscopy performed by the ENT doctor, mainly type B tympanograms. The pass/refer audiometry also showed a statistically significant correlation with the medical otoscopy, although weak in all frequencies studied.
Conclusion It’s extremely important to perform a hearing screening in the age range of 5-6 years (with a high predisposition to middle ear problems), with the main objective of identifying and referring for treatment children who present alterations in order to reduce the consequences of the hearing impairment.
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Affiliation(s)
- S Fonseca
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Audiologia, Portugal
| | - C Reis
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Audiologia, Portugal
| | | | | | - M Serrano
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Audiologia, Portugal
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Ivers NM, Taljaard M, Giannakeas V, Reis C, Mulhall CL, Lam JMC, Burchell AN, Lebovic G, Bronskill SE. Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes. Implement Sci Commun 2020; 1:30. [PMID: 32885189 PMCID: PMC7427908 DOI: 10.1186/s43058-020-00013-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/22/2020] [Indexed: 01/29/2023] Open
Abstract
Background Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of physicians who did and did not engage with the intervention, and assessed early changes in prescribing. Methods This population-level, retrospective cohort study used linked administrative databases to track prescribing practices in nursing homes pre-intervention (baseline), immediately post-initiative (3 months), and at follow-up (6 months). Exposure variables identified whether a physician signed up to participate (or not) or viewed the feedback following sign up (or not). Differences in the proportion of days that residents received antipsychotic medications at 6 months compared to baseline by exposure(s) were assessed using a linear mixed effects regression analysis to adjust for a range of resident, physician, and nursing home factors. Benzodiazepine and statin prescribing were assessed as a balance and tracer measures, respectively. Results Of 944 eligible physicians, 210 (22.3%) signed up to recieve the feedback report and 132 (13.9%) viewed their feedback. Physicians who signed up for feedback were more likely to have graduated from a Canadian medical school, work in urban nursing homes, and care for a larger number of residents. The clinical and functional characteristics of residents were similar across physician exposure groups. At 6 months, antipsychotic prescribing had decreased in all exposure groups. Those who viewed their feedback report had a signicantly greater reduction in antipsychotic prescribing than those who did not sign up (0.94% patient-days exposed; 95% CI 0.35 to 1.54%, p = 0.002). Trends in prescribing patterns across exposure groups for benzodiazepines and statins were not statistically significant. Interpretation Almost a quarter of eligible physicians engaged early in a voluntary audit and feedback intervention related to antipsychotic prescribing in nursing homes. Those who viewed their feedback achieved a small but statistically significant change in prescribing, equivalent to approximately 14,000 fewer days that nursing home residents received antipsychotic medications over 6 months. This study adds to the literature regarding the role of audit and feedback interventions to improve quality of care.
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Affiliation(s)
- Noah M Ivers
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave., Toronto, ON M5S 1B2 Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave., Toronto, ON M5S 1B2 Canada.,ICES, Toronto, Canada
| | - Catherine Reis
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave., Toronto, ON M5S 1B2 Canada
| | - Cara L Mulhall
- Health System Performance, Ontario Health (Quality), Toronto, Canada
| | - Jonathan M C Lam
- Health System Performance, Ontario Health (Quality), Toronto, Canada
| | - Ann N Burchell
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Susan E Bronskill
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave., Toronto, ON M5S 1B2 Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
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20
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Rebelo-Pinto T, Freitas F, Ferreira R, Almeida C, Reis C, Maruta C. AssociaçÃo nuvem vitória: the impact of bedtime stories in pediatric inpatients setting. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Reis C, Pellegrino P, Hunhoff B, Alvarenga T, Neutel D, Paiva T. Epworth sleepiness scale as a screening tool for sleep medicine patients. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Hawkins M, Williams M, Schaffer A, Reis C, Sareen J, Sockalingam S, Sinyor M. Body mass index weight categories in adults who died by suicide: An observational study. J Affect Disord 2019; 257:454-460. [PMID: 31310907 DOI: 10.1016/j.jad.2019.06.061] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/20/2019] [Accepted: 06/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is conflicting evidence about the relationship between body mass index (BMI) and suicide death. This study aimed to characterize and compare suicide deaths by weight using BMI weight categories. METHODS We examined suicide deaths in adults in the city of Toronto (2009-2015); grouped them by BMI categories (underweight, normal weight, overweight, and obese) and compared groups based on demographics, clinical variables and method of suicide death. RESULTS Suicide decedents' (n = 1429) mean age was 48.6 years (SD = 17.4) and mean BMI was 25.5 (SD = 5.4). Underweight decedents were more likely to be female and to have cancer while obese decedents were more likely to have diabetes. Underweight decedents were more likely to have an identified history of any medical condition. Obese and overweight decedents were significantly more likely to have an identified history of any psychiatric condition. Non-violent methods (e.g., self-poisoning) were used at a higher proportion by people with obesity and by people who were underweight. LIMITATIONS Psychological autopsies were not available and it was not possible to assess for change in or stability of BMI over time. CONCLUSIONS These findings add to our understanding of the relationship between suicide and weight. A higher prevalence of females as well as those with a history of cancer and any medical condition in underweight decedents was noteworthy and of potential clinical significance.
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Affiliation(s)
- Michael Hawkins
- Consultation Liaison Service, Mental Health Program, Scarborough Health Network - Centenary Site, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Marissa Williams
- Department of Psychiatry, University of Toronto, Toronto, Canada; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Canada; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jitender Sareen
- Departments of Psychiatry, Psychology & Community Health Sciences, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Canada; Toronto Western Hospital Bariatric Surgery Program, University Health Network, Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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Sa Mendes G, Abecasis J, Ferreira A, Ribeiras R, Reis C, Nolasco T, Gouveia R, Abecasis M, Mendes M, Ramos S, Neves J. P4657Cardiac myxomas: are we dealing with distinct clinical entities? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac myxomas are rare, despite being the most common primary cardiac tumours. A significant number of myxomas are discovered accidentally in asymptomatic patients (pts), as there is increased use of non-invasive cardiac imaging. Our aim was to describe the experience of a cardiac surgery centre managing cardiac myxomas during the last 28 years.
Methods
Single-center retrospective study of consecutive pts admitted with the diagnosis of a cardiac myxomas between 1990 and 2018. Registry data concerning clinical presentation, non-invasive imaging assessment and definitive histopathology were collected.
Results
From 154 pts with the diagnosis of cardiac tumours, we identified 106 (68.8%) myxomas (67% females; mean age at diagnosis 61,5±13,1 years). Myxoma diagnosis increased throughout the 3 decades (27 cases until 2000; 26 cases in the second decade; 52 cases from 2010 until present). 30% of the pts were asymptomatic at diagnosis. Obstructive symptoms (heart failure and syncope) and embolic events were the most common complaints among symptomatic pts. Transthoracic echocardiography firstly identified the tumours in 88% of the cases. Cardiac magnetic resonance and computed tomography were performed for further investigation in 7% of the cases. Presumptive pre-operative diagnosis was correct in 83.8% pts.
Surgical excision was successfully achieved in all cases. 89% of the tumours were located in the left atrium with inter-atrial septum implantation (13 in right chambers; 1 valvular tumour). There were 10 multifocal tumours.
At histopathology myxomas were grossly described as mucous jelly appearance (80%), solid (15%) and mixed type lesions (5%). Rare histologic findings were described in 30% of the cases (8 tumours with bone tissue; 1 with forming bone marrow; 4 with endocrine type glandular epithelium; 16 with lympho-plasmocytic infiltrates; 3 with high mitotic grade; 5 with concomitant thrombus).
For a median follow up of 86 [31–214] months there were 15 deaths (2 of them with tumour related deaths). There were 3 recurrences (2 with high mitotic grade histology), mostly occurring 3 years after the first intervention.
Conclusion
In this case series cardiac myxomas are the most common cardiac tumours, with a significant proportion of asymptomatic lesions. Clinical heterogeneity followed polymorphic histology, with recognized differences when compared to classical descriptions of this kind of tumour.
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Affiliation(s)
| | - J Abecasis
- Hospital de Santa Cruz, Lisbon, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Lisbon, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Reis
- Hospital de Santa Cruz, Lisbon, Portugal
| | - T Nolasco
- Hospital de Santa Cruz, Lisbon, Portugal
| | - R Gouveia
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Abecasis
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| | - S Ramos
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Neves
- Hospital de Santa Cruz, Lisbon, Portugal
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Bras D, Reis C, Andrade MJ, Ribeiras R, Mendes M. P1474Simpsons Triplane versus Biplane for left ventricle ejection fraction after myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Simpson's biplane (SBP) ignores the apical long-axis plane. It is estimated that 40% of myocardial infarction (MI)-related segmental abnormalities are located in this plane. The real-time triplane (RT3P) overcomes this issue, allowing to obtain all apical views simultaneously, at the same cardiac cycle. This method could be a more precise and reliable alternative to SBP in ejection fraction (EF) quantification in this setting.
Purpose
The authors aimed to compare EF assessed by two quantification methods, SBP and RT3P, using quantitative three-dimensional echocardiography (3DE) as the reference method, in patients with MI.
Methods
We have prospectively gathered data from 52 adult patients, which had recent or past history of MI. Exclusion criteria were the presence of atrial fibrillation, unknown coronary anatomy, significant valvular disease, left branch block, ventricular pacing and poor definition of endocardial borders.
Estimation of EF by SBP, RT3P and 3DE was performed in all patients and gathered by two experienced operators. The two operators were blinded for the coronary angiography results before volume quantification. They were also blinded for their own measurements, as well as for the other operator's measurements.
Spearman's correlation and linear regression were performed for correlation analysis. Bland-Altman plot was used for agreement assessment among the different methods. Interobserver agreement was assessed by Cohen's kappa.
Results
Patient characteristics are shown in table 1. EF calculation was feasible in all patients.
There were excellent correlations between EF measured by SBP vs 3DE and RT3P vs 3DE (r=0.813 and r=0.9 respectively).
Test of equality between two correlation coefficients confirmed that EF by RT3P method is significantly more correlated with the reference method, compared with EF by SBP (p=0.004).
We have also performed a further analysis to study this results in special subsets. In anterior MI subset, EF by RT3P correlated by 0.909 with 3DE, versus 0.826 from EF by SBP (p=0.019). In inferior MI subset, EF by RT3P correlated by 0.779 with the reference method, versus 0.706 from EF by SBP (p=0.246).
Fig 1 Correlation and Bland-Altman plot
Conclusions
Estimation of EF using SBP and RT3P methods by experienced operators strongly correlate with EF determined by 3DE. The RT3P method showed the strongest correlation between the two methods, which may point to its usefulness in the evaluation of EF in patients with anterior wall motion abnormalities after myocardial infarction.
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Affiliation(s)
- D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - C Reis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M J Andrade
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
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Leal S, Oliveira S, Querido A, Sargento A, Carvalho H, Reis C, Maximiano M, Frederico M. O19 Health outcomes in long-term healthcare units: the case of the Care4Value project. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Leal
- Management and Technology Higher School of Santarém, Polytechnic Institute of Santarém, Santarém, PORTUGAL
- Quality of Life Research Centre-IPSantarém branch (CIEQV), Santarém, PORTUGAL
| | - S Oliveira
- Management and Technology Higher School of Santarém, Polytechnic Institute of Santarém, Santarém, PORTUGAL
- Centre for Health Studies and Research, University of Coimbra, Coimbra, PORTUGAL
| | - A Querido
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, PORTUGAL
- School of Health Sciences, Polytechnic Institute of Leiria, Leiria, PORTUGAL
| | - A Sargento
- Centre for Applied Research in Management and Economics, School of Technology and Management, Polytechnic of Leiria, Leiria, PORTUGAL
| | - H Carvalho
- School of Technology and Management, Polytechnic of Leiria, Leiria, PORTUGAL
| | - C Reis
- School of Technology and Management, Polytechnic of Leiria, Leiria, PORTUGAL
| | - M Maximiano
- School of Technology and Management, Polytechnic of Leiria, Leiria, PORTUGAL
- Computer Science and Communication Research Centre (CIIC), Polytechnic of Leiria, Leiria, PORTUGAL
| | - M Frederico
- Nursing School of Coimbra, Coimbra, PORTUGAL
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Linneman Z, Reis C, Balaji K, Moore J, Braude S. The vitamin D positive feedback hypothesis of inflammatory bowel diseases. Med Hypotheses 2019; 127:154-158. [PMID: 31088641 DOI: 10.1016/j.mehy.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 11/28/2022]
Abstract
While it appears that there are a variety of factors that exacerbate IBD, it is frustrating that symptoms can persist and worsen even when environmental insults are removed. We suggest that there may be a positive feedback loop which perpetuates the inflammatory response in IBD patients. The loop is triggered by vitamin D deficiency which reduces calcium uptake. Lowered vitamin D and calcium interfere with anti-inflammatory pathways. Inflammation of the mucosa inhibits absorption of calcium and thus perpetuates the reduced anti-inflammatory response. A number of predictions follow from this hypothesis and are supported by geographic and lifestyle patterns in IBD incidence and prevalence.
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Affiliation(s)
- Z Linneman
- Biology Department, Washington University, United States
| | - C Reis
- Biology Department, Washington University, United States
| | - K Balaji
- Radiation Oncology, Washington U. School of Medicine, United States
| | - J Moore
- Radiation Oncology, Washington U. School of Medicine, United States
| | - S Braude
- Biology Department, Washington University, United States.
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27
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Reis C, Faria A, Pocinho M, Loureiro H. Self-control feeding in children. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz034.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Reis
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
| | - A Faria
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
| | - M Pocinho
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
| | - H Loureiro
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
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Ivers NM, Taljaard M, Giannakeas V, Reis C, Williams E, Bronskill S. Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses. BMJ Qual Saf 2018; 28:121-131. [PMID: 30061102 PMCID: PMC6373421 DOI: 10.1136/bmjqs-2018-007840] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/26/2018] [Accepted: 07/07/2018] [Indexed: 11/18/2022]
Abstract
Background Although sometimes appropriate, antipsychotic medications are associated with increased risk of significant adverse events. In 2014, a series of newspaper articles describing high prescribing rates in nursing homes in Ontario, Canada, garnered substantial interest. Subsequently, an online public reporting initiative with home-level data was launched. We examined the impact of these public reporting interventions on antipsychotic prescribing in nursing homes. Methods Time series analysis of all nursing home residents in Ontario, Canada, between 1 October 2013 and 31 March 2016. The primary outcome was the proportion of residents prescribed antipsychotics each month. Balance measures were prescriptions for common alternative sedating agents (benzodiazepines and/or trazodone). We used segmented regression to assess the effects on prescription trends of the newspaper articles and the online home-level public reporting initiative. Results We included 120 009 nursing home resident admissions across 636 nursing homes. Following the newspaper articles, the proportion of residents prescribed an antipsychotic decreased by 1.28% (95% CI 1.08% to 1.48%) and continued to decrease at a rate of 0.2% per month (95% CI 0.16% to 0.24%). The online public reporting initiative did not alter this trend. Over 3 years, there was a net absolute reduction in antipsychotic prescribing of 6.0% (95% CI 5.1% to 6.9%). Trends for benzodiazepine prescribing did not change as substantially during the period of observation. Trazodone use has been gradually increasing, but its use did not change abruptly at the time of the mass media report or the public reporting initiative. Interpretation The rapid impact of mass media on prescribing suggests both an opportunity to use this approach to invoke change and a warning to ensure that such reporting occurs responsibly.
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Affiliation(s)
- Noah M Ivers
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Catherine Reis
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Evelyn Williams
- Division of Long Term Care, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Susan Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Reis C, Rodrigues A, Dias S, Sousa R, Branco J, Canhão H, Paiva T. Lifestyles associated to sleep duration. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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30
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Gomes J, Duarte H, Meriter S, Gomes C, Freitas D, Campos D, Balmana M, Magalhaes A, Reis C. PO-248 Novel insights on the role of glycosylation in cancer: molecular functions and clinical applications. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.764] [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: 11/03/2022] Open
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Reis C, Pilz LK, Keller L, Roenneberg T, Paiva T. PSQI largely ignores sleep on work-free days both in the general population and in clinical sleep medicine samples. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marçalo J, Garcia C, Custódio L, Nicolai M, Reis C, Rodrigues Maria J, Romagnoli A, Petruccioli E, Goletti D, Monteiro Rodrigues L, Faustino C, Fimia Gian M, Rijo P. Anti-inflammatory and anti-tubercular properties screening of natural products from Plectranthus species. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Marçalo
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
| | - C Garcia
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
| | - L Custódio
- Centre for Marine Sciences (CCMAR), University of Algarve, Campus of Gambelas, Faro, Portugal
| | - M Nicolai
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
| | - C Reis
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
- Biophysics and Biomedical Engineering Institute (IBEB), Faculty of Sciences, University of Lisbon (ULisboa), Lisbon, Portugal
| | - J Rodrigues Maria
- Centre for Marine Sciences (CCMAR), University of Algarve, Campus of Gambelas, Faro, Portugal
| | - A Romagnoli
- National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - E Petruccioli
- National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - D Goletti
- National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - L Monteiro Rodrigues
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
| | - C Faustino
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon (ULisboa), Lisbon, Portugal
| | - M Fimia Gian
- National Institute for the Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
- Department of Biological and Environmental Sciences and Technologies (Di.S.Te.B.A.), University of Salento, Lecce, Italy
| | - P Rijo
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon (ULisboa), Lisbon, Portugal
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Marçalo J, Garcia C, Nicolai M, Reis C, Faustino C, Rodrigues Luís M, Rijo P. Screening the dermatological potential of Plectranthus species components – antioxidant and inhibitory capacities over elastase, collagenase and tyrosinase. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Marçalo
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisbon, Portugal
| | - C Garcia
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisbon, Portugal
| | - M Nicolai
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisbon, Portugal
| | - C Reis
- Biophysics and Biomedical Engineering Institute (IBEB), Faculty of Sciences, University of Lisbon (ULisboa), Lisbon, Portugal
| | - C Faustino
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - M Rodrigues Luís
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisbon, Portugal
| | - P Rijo
- Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisbon, Portugal
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Ivers NM, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard MK, McCleary N, Thavorn K, Grimshaw JM. Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial. Implement Sci 2017; 12:86. [PMID: 28705208 PMCID: PMC5512954 DOI: 10.1186/s13012-017-0615-7] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Audit and feedback (AF) interventions that leverage routine administrative data offer a scalable and relatively low-cost method to improve processes of care. AF interventions are usually designed to highlight discrepancies between desired and actual performance and to encourage recipients to act to address such discrepancies. Comparing to a regional average is a common approach, but more recipients would have a discrepancy if compared to a higher-than-average level of performance. In addition, how recipients perceive and respond to discrepancies may depend on how the feedback itself is framed. We aim to evaluate the effectiveness of different comparators and framing in feedback on high-risk prescribing in nursing homes. Methods This is a pragmatic, 2 × 2 factorial, cluster-randomized controlled trial testing variations in the comparator and framing on the effectiveness of quarterly AF in changing high-risk prescribing in nursing homes in Ontario, Canada. We grouped homes that share physicians into clusters and randomized these clusters into the four experimental conditions. Outcomes will be assessed after 6 months; all primary analyses will be by intention-to-treat. The primary outcome (monthly number of high-risk medications received by each patient) will be analysed using a general linear mixed effects regression model. We will present both four-arm and factorial analyses. With 160 clusters and an average of 350 beds per cluster, assuming no interaction and similar effects for each intervention, we anticipate 90% power to detect an absolute mean difference of 0.3 high-risk medications prescribed. A mixed-methods process evaluation will explore potential mechanisms underlying the observed effects, exploring targeted constructs including intention, self-efficacy, outcome expectations, descriptive norms, and goal prioritization. An economic analysis will examine cost-effectiveness analysis from the perspective of the publicly funded health care system. Discussion This protocol describes the rationale and methodology of a trial testing manipulations of theory-informed components of an audit and feedback intervention to determine how to improve an existing intervention and provide generalizable insights for implementation science. Trial registration NCT02979964 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0615-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noah M Ivers
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada. .,Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada. .,Institute for Clinical Evaluative Studies, Toronto, Canada. .,Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Laura Desveaux
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.,Institut de recherche de l'hôpital Montfort, Ottawa, Canada
| | - Catherine Reis
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - Holly O Witteman
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Family and Emergency Medicine, Laval University, Québec, Canada.,Office of Education and Continuing Professional Development, Laval University, Québec, Canada.,Laval University Research Institute for Primary Care and Health Services, Québec, Canada.,Population Health and Optimal Health Practices, CHU de Québec, Québec, Canada
| | - Monica K Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kednapa Thavorn
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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Sinyor M, Kozloff N, Reis C, Schaffer A. An Observational Study of Suicide Death in Homeless and Precariously Housed People in Toronto. Can J Psychiatry 2017; 62:501-505. [PMID: 28525964 PMCID: PMC5528989 DOI: 10.1177/0706743717705354] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Homelessness has been identified as an important risk factor for suicide death, but there is limited research characterising homeless people who die by suicide. The goal of this study is to identify personal, clinical, and suicide method-related factors that distinguish homeless and precariously housed people who die from suicide from those who are not homeless at the time of suicide. METHODS Coroner records were reviewed for all suicide deaths in Toronto from 1998 to 2012. Data abstracted included housing status as well as other demographics, clinical variables such as the presence of mental illness, and suicide method. RESULTS Of 3319 suicide deaths, 60 (1.8%) were homeless and 230 (6.9%) were precariously housed. Homeless and precariously housed people were each younger than nonhomeless people ( P < 0.0001). Compared with nonhomeless, homeless people were more likely to be male and less likely to be married, to have interpersonal conflict, or to leave a suicide note. Homeless people and precariously housed were more likely to have died by fall/jump than nonhomeless people (62%, 57%, and 29%, respectively). CONCLUSIONS Homeless and precariously housed people are overrepresented among suicide deaths in a large urban center and differ demographically, clinically, and in their suicide method from nonhomeless people who die by suicide. Targeted suicide prevention strategies should aim to address factors specific to homeless people.
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Affiliation(s)
- Mark Sinyor
- 1 Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Nicole Kozloff
- 2 Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
| | - Catherine Reis
- 1 Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Ayal Schaffer
- 1 Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
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Schaffer A, Weinstock LM, Sinyor M, Reis C, Goldstein BI, Yatham LN, Levitt AJ. Self-poisoning suicide deaths in people with bipolar disorder: characterizing a subgroup and identifying treatment patterns. Int J Bipolar Disord 2017; 5:16. [PMID: 28332123 PMCID: PMC5406320 DOI: 10.1186/s40345-017-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/21/2017] [Indexed: 02/05/2023] Open
Abstract
Objective To characterize self-poisoning suicide deaths in BD compared to other suicide decedents. Methods Extracted coroner data from all suicide deaths (n = 3319) in Toronto, Canada from 1998 to 2012. Analyses of demographics, clinical history, recent stressors, and suicide details were conducted in 5 subgroups of suicide decedents: BD self-poisoning, BD other methods, non-BD self-poisoning, non-BD other methods, and unipolar depression self-poisoning. Toxicology results for lethal and present substances were also compared between BD and non-BD self-poisoning subgroups as well as between BD and unipolar depression self-poisoning subgroups. Results Among BD suicide decedents, self-poisoning was significantly associated with female sex, past suicide attempts, and comorbid substance abuse. In both the BD and non-BD self-poisoning groups, opioids were the most common class of lethal medication. For both groups, benzodiazepines and antidepressants were the most common medications present at time of death, and in 23% of the BD group, an antidepressant was present without a mood stabilizer or antipsychotic. Only 31% of the BD group had any mood stabilizer present, with carbamazepine being most common. No antidepressant, mood stabilizer, or antipsychotic was present in 15.5% of the BD group. Relative to unipolar depression self-poisoning group, the BD self-poisoning group evidenced higher proportion of previous suicide attempt(s) and psychiatry/ER visits in the previous week. Conclusion People with BD who die by suicide via self-poisoning comprise a distinct but understudied group. The predominant absence of guideline-concordant pharmacologic care comprises a crucial target for future policy and knowledge translation efforts.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
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Cueva Recalde JF, Velcea A, Aguiar Rosa S, Surkova E, Bucciarelli V, Kupczynska K, Miskowiec D, Reskovic Luksic V, Verseckaite R, Jillott N, Muraru D, Muraru D, Borizanova A, Caroli S, Guerreiro S, Miskowiec D, Miskowiec D, Mahmoud HM, Peovska Mitevska I, Babukov R, Brecht A, Garcia-Sanchez MJ, Gayan Ordas J, Lacambra Blasco I, Mihaila S, Andronic AA, Marcu S, Vinereanu D, Galrinho A, Branco L, Timoteo A, Cunha P, Lousinha A, Valente B, Pereira Silva T, Oliveira M, Cruz Ferreira R, Aalen J, Samset E, Bidviene J, Aruta P, Romeo G, Sambugaro F, Badano LP, Muraru D, Bianco F, Di Blasio A, Izzicupo P, Ghinassi B, Napolitano G, Di Baldassarre A, Gallina S, Michalski B, Miskowiec D, Kasprzak JD, Lipiec P, Kupczynska K, Michalski B, Simiera M, Lipiec P, Wejner-Mik P, Wierzbowska-Drabik K, Ojrzanowski M, Kasprzak JD, Pasalic M, Separovic Hanzevacki J, Mizariene V, Montvilaite A, Unikaite R, Bieseviciene M, Jurkevicius R, Wilson S, Marotta C, Mihaila S, Calore C, Bidviene J, Surkova E, Romeo G, Aruta P, Palermo C, Badano LP, Marotta C, Mihaila S, Calore C, Aruta P, Romeo G, Surkova E, Bidviene J, Iliceto S, Badano LP, Kinova E, Kundurzhiev T, Goudev A, Bellsham-Revell HR, Bell AJ, Miller OI, Simpson JM, Raposo L, Andrade MJ, Horta E, Reis C, Almeida M, Mendes M, Wejner-Mik P, Kasprzak JD, Qawoq HD, Zycinski P, Wcislo T, Kupczynska K, Lipiec P, Wejner-Mik P, Kasprzak JD, Qawoq HD, Zycinski P, Wcislo T, Kupczynska K, Lipiec P, Abdel Raouf O, Kheir A, Halawa S, Al-Ghamdi M, Ghabashi A, Srbinovska E, Antova E, Bosevski M, Bazilev VV, Bartosh FL, Bathe M, Oertelt-Prigione S, Seeland U, Regitz-Zagrosek V, Baumann G, Stangl K, Stangl V, Knebel F, Dreger H, Barreiro-Perez M, Arribas-Jimenez A, Martin-Garcia A, Diaz-Pelaez E, Rama-Merchan JC, Cruz-Gonzalez I, Sanchez PL. HIT Poster session 2P479Strain concordance in a real-world setting: experience in our laboratory after equipment upgradeP4803D echocardiography is a fast-learning and reliable method for the measurements of left atrial volumesP481Echocardiographic parameters associated with long-term appropriate antiarrhythmic therapies in cardiac resynchronization therapy defibrillator patientsP482Noninvasively measured global wasted myocardial work allows for quantitative assessment of typical left ventricular mechanical dyssynchrony pattern in patients with left bundle branch blockP483The impact of adherence to physical exercise on the improvement of cardiovascular remodeling and metabolic status in healthy untrained postmenopausal womenP484The impact of the latest chamber quantification recommendations on the prediction of left atrial appendage thrombus presenceP485The cardiac-enriched miRNAs plasma levels (miR-1, miR-133a, miR-499) reflect the impaired left ventricular systolic function and correlate with cardiac necrosis markers in early phase of NSTE-ACSP486Acute regional myocardial deformation changes in patients with severe aortic stenosis and preserved ejection fraction after isolated aortic valve replacementP487Left ventricular rotational deformation in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction P488The appropriate use of transthoracic echocardiography for the exclusion of infective endocarditisP489In patients with hypertrophic cardiomyopathy, left ventricular mass and shape by three-dimensional echocardiography are related with dynamic obstruction and functional capacityP490Mitral leaflet sizing in hypertrophic cardiomyopathy: impact of method and timingP491Echocardiographic predictors of atrial fibrillation in obese womenP492Echocardiographic risk factors for 30 day mortality after the hybrid procedure for hypoplastic left heart syndromeP493Left ventricular mass is an independent predictor of coronary flow reserve: insights from a single centre stress echo cohortP494Transesophageal echocardigoraphy uner conscious sedation for guiding cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation - the safety and feasibility studyP495Transesophageal echocardigoraphy under conscious sedation for guiding cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation - the safety and feasibility studyP496Three-dimensional trans-esophageal echocardiography assessment of the immediate morphological changes of the mitral annulus after percutaneous mitral edge-to-edge repairP497Clinical value of global and regional longitudinal strain in prediction of myocardial ischemia in asymptomatic diabetes type 2 patientsP499Comparison of prognostic operative risk impact on the global longitudinal strain right ventricle (GLS RV) and tricuspid annular plane systolic excursion (TAPSE) values in patients with ischemic cardioP498Right heart function in early diastolic dysfunction: 2D speckle-tracking echocardiography-based assessment of right atrial and right ventricular functionP500 Comparison of 2D, 3D transesophageal echocardiography and computed tomography during the assessment of left atrial appendage closure. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fartaria MJ, Reis C, Pereira J, Pereira MF, Cardoso JV, Santos LM, Oliveira C, Holovey V, Pascoal A, Alves JG. Assessment of the mean glandular dose using LiF:Mg,Ti, LiF:Mg,Cu,P, Li2B4O7:Mn and Li2B4O7:Cu TL detectors in mammography radiation fields. Phys Med Biol 2016; 61:6384-99. [DOI: 10.1088/0031-9155/61/17/6384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schaffer A, Sinyor M, Kurdyak P, Vigod S, Sareen J, Reis C, Green D, Bolton J, Rhodes A, Grigoriadis S, Cairney J, Cheung A. Population-based analysis of health care contacts among suicide decedents: identifying opportunities for more targeted suicide prevention strategies. World Psychiatry 2016; 15:135-45. [PMID: 27265704 PMCID: PMC4911782 DOI: 10.1002/wps.20321] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 01/17/2023] Open
Abstract
The objective of this study was to detail the nature and correlates of mental health and non-mental health care contacts prior to suicide death. We conducted a systematic extraction of data from records at the Office of the Chief Coroner of Ontario of each person who died by suicide in the city of Toronto from 1998 to 2011. Data on 2,835 suicide deaths were linked with provincial health administrative data to identify health care contacts during the 12 months prior to suicide. Sub-populations of suicide decedents based on the presence and type of mental health care contact were described and compared across socio-demographic, clinical and suicide-specific variables. Time periods from last mental health contact to date of death were calculated and a Cox proportional hazards model examined covariates. Among suicide decedents, 91.7% had some type of past-year health care contact prior to death, 66.4% had a mental health care contact, and 25.3% had only non-mental health contacts. The most common type of mental health contact was an outpatient primary care visit (54.0%), followed by an outpatient psychiatric visit (39.8%), an emergency department visit (31.1%), and a psychiatric hospitalization (21.0%). The median time from last mental health contact to death was 18 days (interquartile range 5-63). Mental health contact was significantly associated with female gender, age 25-64, absence of a psychosocial stressor, diagnosis of schizophrenia or bipolar disorder, past suicide attempt, self-poisoning method and absence of a suicide note. Significant differences between sub-populations of suicide decedents based on the presence and nature of their health care contacts suggest the need for targeting of community and clinical-based suicide prevention strategies. The predominance of ambulatory mental health care contacts, often close to the time of death, reinforce the importance of concentrating efforts on embedding risk assessment and care pathways into all routine primary and specialty clinical care, and not only acute care settings.
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Affiliation(s)
- Ayal Schaffer
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Mark Sinyor
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada,Health Systems Research, Centre for Addiction and Mental HealthTorontoCanada
| | - Simone Vigod
- Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada,Department of PsychiatryWomen's College HospitalTorontoCanada
| | - Jitender Sareen
- University of ManitobaWinnipegCanada,Winnipeg Regional Health Authority Adult Mental Health ProgramWinnipegCanada
| | - Catherine Reis
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoCanada
| | - Diane Green
- Institute for Clinical Evaluative SciencesTorontoCanada
| | - James Bolton
- Department of PsychiatryUniversity of ManitobaWinnipegCanada,Mood and Anxiety Disorders Program, Health Sciences CentreWinnipegCanada
| | - Anne Rhodes
- Department of Psychiatry and Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada,Offord Centre for Child StudiesHamiltonCanada,McMaster UniversityHamiltonCanada,Institute for Clinical Evaluative SciencesTorontoCanada
| | - Sophie Grigoriadis
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - John Cairney
- Department of Family MedicineMcMaster UniversityHamiltonCanada
| | - Amy Cheung
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
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Hawkins M, Schaffer A, Reis C, Sinyor M, Herrmann N, Lanctôt KL. Suicide in males and females with cardiovascular disease and comorbid depression. J Affect Disord 2016; 197:88-93. [PMID: 26971126 DOI: 10.1016/j.jad.2016.02.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 11/04/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myocardial infarction (MI) has been associated with an increased risk of suicide, further increased among individuals with a comorbid psychiatric illness. A paucity of studies have examined details of suicide among individuals with cardiovascular disease (CVD) and comorbid depression. We aimed to compare demographic, clinical and suicide-specific characteristics between suicide victims with CVD with depression (CVD+D) and without comorbid depression (CVD-D). METHODS Coroner data on suicide decedents with CVD (n=413) occurring in Toronto, Canada from 1998 to 2012 were collected. Characteristics were compared between the CVD+D and CVD-D groups. Regression analysis examined for gender differences in these groups. RESULTS CVD+D subjects compared to CVD-D were more likely to have had a past suicide attempt (p=0.008), and to have experienced a bereavement (p=0.008) or financial stressor (p=0.005) in the past year. Each of these variables remained significantly associated with the presence of depression after the regression analysis. Within the CVD+D group, females were more likely to die from suicide by self-poisoning (p<0.0001) and males by shooting (p=0.001). LIMITATIONS Psychological autopsies were not available. The definition of CVD was broad and the accuracy of its diagnosis could not be confirmed. CONCLUSION Individuals with CVD+D who died from suicide had significant differences in clinical characteristics and specific stressors compared to those without depression. These data may help to better characterize suicide risk and prevention in this vulnerable population.
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Affiliation(s)
- Michael Hawkins
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Canada; Mood & Anxiety Disorders Program, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.
| | - Catherine Reis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Mood & Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada; Departments of Psychiatry, and Pharmacology and Toxicology, University of Toronto, Toronto, Canada
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Reis C, Domingues A, Mestre C, Ribeiro J, Sanches J, Paiva T. Individual variability to biological, hormonal and psychological responses to sleep deprivation. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schaffer A, Isometsä ET, Azorin JM, Cassidy F, Goldstein T, Rihmer Z, Sinyor M, Tondo L, Moreno DH, Turecki G, Reis C, Kessing LV, Ha K, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:1006-20. [PMID: 26175498 PMCID: PMC5858693 DOI: 10.1177/0004867415594428] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. METHODS A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. RESULTS We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. CONCLUSION There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology, and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Abstract
BACKGROUND Little has been published on the sources of medications used in suicide by self-poisoning. AIMS To examine data on self-poisoning occurring through the use of medications returned to the next of kin after the death of a family member or friend ("returned medication") and to examine public policies relevant to this issue. METHOD A review of charts at the Office of the Chief Coroner of Ontario for deaths by self-poisoning suicide in the City of Toronto occurring between 1998 and 2010 was conducted. Information regarding the source of medication used in self-poisoning was extracted. Federal, provincial, and local policies were also examined to determine whether there are guidelines governing returning medication to next of kin. RESULTS Of 567 suicide deaths by self-poisoning in Toronto over 13 years, there were eight cases in which returned medication was used in suicide by self-poisoning. No policies prohibiting this type of medication return were identified. CONCLUSION Suicide by self-poisoning using returned medications is an important consideration that may not yet be fully appreciated, and has relevance for suicide prevention policies.
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Affiliation(s)
- Catherine Reis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada Department of Psychiatry, University of Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada Department of Psychiatry, University of Toronto, Canada
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Machado A, Reis C, Seabra V, das Neves J, Sarmento B. Antiretroviral-loaded nanoparticle-in-vaginal film systems for preventing HIV transmission: Safety and toxicity. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.610] [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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Schaffer A, Isometsä ET, Tondo L, Moreno DH, Sinyor M, Kessing LV, Turecki G, Weizman A, Azorin JM, Ha K, Reis C, Cassidy F, Goldstein T, Rihmer Z, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:785-802. [PMID: 26185269 PMCID: PMC5116383 DOI: 10.1177/0004867415594427] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. METHODS Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. RESULTS The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4-14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23-26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. CONCLUSION This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Schaffer A, Isometsä ET, Tondo L, Moreno D, Turecki G, Reis C, Cassidy F, Sinyor M, Azorin JM, Kessing LV, Ha K, Goldstein T, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Rihmer Z, Yatham LN. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord 2015; 17:1-16. [PMID: 25329791 PMCID: PMC6296224 DOI: 10.1111/bdi.12271] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [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: 05/01/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta-analyzed using fixed or random-effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies. RESULTS Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first-degree family history of suicide. Suicide deaths were significantly associated with male gender and first-degree family history of suicide. CONCLUSIONS This paper reports on the presence and magnitude of the correlates of suicide attempts and suicide deaths in bipolar disorder. These findings do not address causation, and the heterogeneity of data sources should limit the direct clinical ranking of correlates. Our results nonetheless support the notion of incorporating diagnosis-specific data in the development of models of understanding suicide in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Erkki T Isometsä
- Institute of Clinical Medicine University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy and Harvard Medical School, McLean Hospital, Boston, MA, USA
| | - Doris Moreno
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Departments of Psychiatry, Human Genetics, and Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine Reis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Frederick Cassidy
- Department of Psychiatry and Behavioural Sciences, Duke University, Durham, USA
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Michel Azorin
- Department of Psychiatry, University of Aix-Marseille II, Marseille, France
| | - Lars Vedel Kessing
- Faculty of Health Sciences, University of Copenhagen, Psychiatric Center Copenhagen Department, Copenhagen, Denmark
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University, Bundang Hospital, Seoul, Republic of Korea
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abraham Weizman
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | | | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Orii M, Tanimoto T, Yokoyama M, Ota S, Kubo T, Hirata K, Tanaka A, Imanishi T, Akasaka T, Michelsen M, Pena A, Mygind N, Hoest N, Prescott E, Abd El Dayem S, Battah A, Abd El Azzez F, Ahmed A, Fattoh A, Ismail R, Andjelkovic K, Kalimanovska Ostric D, Nedeljkovic I, Andjelkovic I, Rashid H, Abuel Enien H, Ibraheem M, Vago H, Toth A, Csecs I, Czimbalmos C, Suhai FI, Kecskes K, Becker D, Simor T, Merkely B, D'ascenzi F, Pelliccia A, Natali B, Cameli M, Lisi M, Focardi M, Corrado D, Bonifazi M, Mondillo S, Zaha V, Kim G, Su K, Zhang J, Mikush N, Ross J, Palmeri M, Young L, Tadic M, Ilic S, Celic V, Jaimes C, Gonzalez Mirelis J, Gallego M, Goirigolzarri J, Pellegrinet M, Poli S, Prati G, Vriz O, Di Bello V, Carerj S, Zito C, Mateescu A, Popescu B, Antonini-Canterin F, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hewing B, Theres L, Dreger H, Spethmann S, Stangl K, Baumann G, Knebel F, Uejima T, Itatani K, Nakatani S, Lancellotti P, Seo Y, Zamorano J, Ohte N, Takenaka K, Naar J, Mortensen L, Johnson J, Winter R, Shahgaldi K, Manouras A, Braunschweig F, Stahlberg M, Coisne D, Al Arnaout AM, Tchepkou C, Raud Raynier P, Diakov C, Degand B, Christiaens L, Barbier P, Mirea O, Cefalu C, Savioli G, Guglielmo M, Maltagliati A, O'neill L, Walsh K, Hogan J, Manzoor T, Ahern B, Owens P, Savioli G, Guglielmo M, Mirea O, Cefalu C, Barbier P, Marta L, Abecasis J, Reis C, Ribeiras R, Andrade M, Mendes M, D'andrea A, Stanziola A, Di Palma E, Martino M, Lanza M, Betancourt V, Maglione M, Calabro' R, Russo M, Bossone E, Vogt MO, Meierhofer C, Rutz T, Fratz S, Ewert P, Roehlig C, Kuehn A, Storsten P, Eriksen M, Remme E, Boe E, Smiseth O, Skulstad H, Ereminiene E, Ordiene R, Ivanauskas V, Vaskelyte J, Stoskute N, Kazakauskaite E, Benetis R, Marketou M, Parthenakis F, Kontaraki J, Zacharis E, Maragkoudakis S, Logakis J, Roufas K, Vougia D, Vardas P, Dado E, Dado E, Knuti G, Djamandi J, Shota E, Sharka I, Saka J, Halmai L, Nemes A, Kardos A, Neubauer S, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Chung H, Kim J, Yoon Y, Min P, Lee B, Hong B, Rim S, Kwon H, Choi E, Soya O, Kuryata O, Kakihara R, Naruse C, Inayoshi A, El Sebaie M, Frer A, Abdelsamie M, Eldamanhory A, Ciampi Q, Cortigiani L, Simioniuc A, Manicardi C, Villari B, Picano E, Sicari R, Ferferieva V, Deluyker D, Lambrichts I, Rigo J, Bito V, Kuznetsov V, Yaroslavskaya E, Krinochkin D, Pushkarev G, Gorbatenko E, Trzcinski P, Michalski B, Lipiec P, Szymczyk E, Peczek L, Nawrot B, Chrzanowski L, Kasprzak J, Todaro M, Zito C, Khandheria B, Cusma-Piccione M, La Carrubba S, Antonini-Canterin F, Di Bello V, Oreto G, Di Bella G, Carerj S, Gunyeli E, Oliveira Da Silva C, Sahlen A, Manouras A, Winter R, Shahgaldi K, Spampinato R, Tasca M, Roche E Silva J, Strotdrees E, Schloma V, Dmitrieva Y, Dobrovie M, Borger M, Mohr F, Calin A, Rosca M, Beladan C, Mirescu Craciun A, Gurzun M, Mateescu A, Enache R, Ginghina C, Popescu B, Antova E, Georgievska Ismail L, Srbinovska E, Andova V, Peovska I, Davceva J, Otljanska M, Vavulkis M, Tsuruta H, Kohsaka S, Murata M, Yasuda R, Dan M, Yashima F, Inohara T, Maekawa Y, Hayashida K, Fukuda K, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Amano M, Izumi C, Miyake M, Tamura T, Kondo H, Kaitani K, Nakagawa Y, Ghulam Ali S, Fusini L, Tamborini G, Muratori M, Gripari P, Bottari V, Celeste F, Cefalu' C, Alamanni F, Pepi M, Teixeira R, Monteiro R, Garcia J, Ribeiro M, Cardim N, Goncalves L, Miglioranza M, Muraru D, Cavalli G, Addetia K, Cucchini U, Mihaila S, Tadic M, Veronesi F, Lang R, Badano L, Galian Gay L, Gonzalez Alujas M, Teixido Tura G, Gutierrez Garcia L, Rodriguez-Palomares J, Evangelista Masip A, Conte L, Fabiani I, Giannini C, La Carruba S, De Carlo M, Barletta V, Petronio A, Di Bello V, Mahmoud H, Al-Ghamdi M, Ghabashi A, Salaun E, Zenses A, Evin M, Collart F, Pibarot P, Habib G, Rieu R, Fabregat Andres O, Estornell Erill J, Cubillos-Arango A, Bochard-Villanueva B, Chacon-Hernandez N, Higueras-Ortega L, Perez-Bosca L, Paya-Serrano R, Ridocci-Soriano F, Cortijo-Gimeno J, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Mrabet K, Kamoun S, Fennira S, Ben Chaabene A, Kraiem S, Schnell F, Betancur J, Daudin M, Simon A, Lentz P, Tavard F, Hernandes A, Carre F, Garreau M, Donal E, Abduch M, Vieira M, Antunes M, Mathias W, Mady C, Arteaga E, Alencar A, Tesic M, Djordjevic-Dikic A, Beleslin B, Giga V, Trifunovic D, Petrovic O, Jovanovic I, Petrovic M, Stepanovic J, Vujisic-Tesic B, Choi E, Cha J, Chung H, Kim K, Yoon Y, Kim J, Lee B, Hong B, Rim S, Kwon H, Bergler-Klein J, Geier C, Maurer G, Gyongyosi M, Cortes Garcia M, Oliva M, Navas M, Orejas M, Rabago R, Martinez M, Briongos S, Romero A, Rey M, Farre J, Ruisanchez Villar C, Ruiz Guerrero L, Rubio Ruiz S, Lerena Saenz P, Gonzalez Vilchez F, Hernandez Hernandez J, Armesto Alonso S, Blanco Alonso R, Martin Duran R, Gonzalez-Gay M, Novo G, Marturana I, Bonomo V, Arvigo L, Evola V, Karfakis G, Lo Presti M, Verga S, Novo S, Petroni R, Acitelli A, Bencivenga S, Cicconetti M, Di Mauro M, Petroni A, Romano S, Penco M, Park S, Kim S, Kim M, Shim W, Tadic M, Majstorovic A, Ivanovic B, Celic V, Driessen MMP, Meijboom F, Mertens L, Dragulescu A, Friedberg M, De Stefano F, Santoro C, Buonauro A, Muscariello R, Lo Iudice F, Ierano P, Esposito R, Galderisi M, Sunbul M, Kivrak T, Durmus E, Yildizeli B, Mutlu B, Rodrigues A, Daminello E, Echenique L, Cordovil A, Oliveira W, Monaco C, Lira E, Fischer C, Vieira M, Morhy S, Mignot A, Jaussaud J, Chevalier L, Lafitte S, D'ascenzi F, Cameli M, Curci V, Alvino F, Lisi M, Focardi M, Corrado D, Bonifazi M, Mondillo S, Ikonomidis I, Pavlidis G, Lambadiari V, Kousathana F, Triantafyllidi H, Varoudi M, Dimitriadis G, Lekakis J, Cho JS, Cho E, Yoon H, Ihm S, Lee J, Molnar AA, Kovacs A, Apor A, Tarnoki A, Tarnoki D, Horvath T, Maurovich-Horvat P, Jermendy G, Kiss R, Merkely B, Petrovic-Nagorni S, Ciric-Zdravkovic S, Stanojevic D, Jankovic-Tomasevic R, Atanaskovic V, Mitic V, Todorovic L, Dakic S, Coppola C, Piscopo G, Galletta F, Maurea C, Esposito E, Barbieri A, Maurea N, Kaldararova M, Tittel P, Kantorova A, Vrsanska V, Kollarova E, Hraska V, Nosal M, Ondriska M, Masura J, Simkova I, Tadeu I, Azevedo O, Lourenco M, Luis F, Lourenco A, Planinc I, Bagadur G, Bijnens B, Ljubas J, Baricevic Z, Skoric B, Velagic V, Milicic D, Cikes M, Campanale CM, Di Maria S, Mega S, Nusca A, Marullo F, Di Sciascio G, El Tahlawi M, Abdallah M, Gouda M, Gad M, Elawady M, Igual Munoz B, Maceira Gonzalez Alicia A, Estornell Erill J, Donate Betolin L, Vazquez Sanchez Alejandro A, Valera Martinez F, Sepulveda- Sanchez P, Cervera Zamora A, Piquer Gil Marina M, Montero- Argudo A, Naka K, Evangelou D, Lakkas L, Kalaitzidis R, Bechlioulis A, Gkirdis I, Tzeltzes G, Nakas G, Pappas K, Michalis L, Mansencal N, Bagate F, Arslan M, Siam-Tsieu V, Deblaise J, El Mahmoud R, Dubourg O, Wierzbowska-Drabik K, Plewka M, Kasprzak J, Bandera F, Generati G, Pellegrino M, Alfonzetti E, Labate V, Villani S, Gaeta M, Guazzi M, Bandera F, Generati G, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Grycewicz T, Szymanska K, Grabowicz W, Lubinski A, Sotaquira M, Pepi M, Tamborini G, Caiani E, Bochard Villanueva B, Chacon-Hernandez N, Fabregat-Andres O, Garcia-Gonzalez P, Cubillos-Arango A, De La Espriella-Juan R, Albiach-Montanana C, Berenguer-Jofresa A, Perez-Bosca J, Paya-Serrano R, Cheng HL, Huang CH, Wang YC, Chou WH, Kuznetsov V, Melnikov N, Krinochkin D, Kolunin G, Enina T, Sierraalta W, Le Bihan D, Barretto R, Assef J, Gospos M, Buffon M, Ramos A, Garcia A, Pinto I, Souza A, Mueller H, Reverdin S, Ehret G, Conti L, Dos Santos S, Abdel Moneim SS, Nhola LF, Huang R, Kohli M, Longenbach S, Green M, Villarraga HR, Bordun KA, Jassal DS, Mulvagh SL, Evangelista A, Madeo A, Piras P, Giordano F, Giura G, Teresi L, Gabriele S, Re F, Puddu P, Torromeo C, Suwannaphong S, Vathesatogkit P, See O, Yamwong S, Katekao W, Sritara P, Iliuta L, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Weng KP, Lin CC, Hein S, Lehmann L, Kossack M, Juergensen L, Katus H, Hassel D, Turrini F, Scarlini S, Giovanardi P, Messora R, Mannucci C, Bondi M, Olander R, Sundholm J, Ojala T, Andersson S, Sarkola T, Karolyi M, Kocsmar I, Raaijmakers R, Kitslaar P, Horvath T, Szilveszter B, Merkely B, Maurovich-Horvat P. Poster session 4: Friday 5 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cambronero Cortinas E, Garcia Guereta Silva L, Rivero Jimenez N, Deiros Bronte L, Bret Zurita M, Sanz Pascual E, Labrandero C, Corbi Pascual M, Arreo Del Val V, Gutierrez Laraya Aguado F, Shimada E, West C, Babu-Narayan S, Li W, Castro M, Abecasis J, Santos M, Reis C, Ribeiras R, Marques M, Andrade M, Abecasis M, Mendes M, Karvounaris S, Karampetsos V, Michas G, Argirou A, Mavrommatis P, Pereira VH, Portugues J, Calvo L, Ferreira F, Machado I, Lourenco M, Lourenco A, Bercu G, Tamisier D. Case-based session: new ways to look at old problems in cardiac heart disease: Saturday 6 December 2014, 11:00-12:30 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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A, Stoebe S, Pfeiffer D, Hagendorff A, Haykal M, Ryu S, Park J, Kim S, Choi J, Goh C, Byun Y, Choi J, Sonoko M, Onishi T, Fujimoto W, Yamada S, Taniguchi Y, Yasaka Y, Kawai H, Okura H, Sakamoto Y, Murata E, Kanai M, Kataoka T, Kimura T, Watanabe N, Kuriyama N, Nakama T, Furugen M, Sagara S, Koiwaya H, Ashikaga K, Matsuyama A, Shibata Y, Meimoun P, Abouth S, Martis S, Boulanger J, Elmkies F, Zemir H, Tzvetkov B, Luycx-Bore A, Clerc J, Galli E, Oger E, Guirette Y, Daudin M, Fournet M, Donal E, Galli E, Guirette Y, Mabo P, Donal E, Keramida K, Kouris N, Kostopoulos V, Psarrou G, Petrogiannos C, Hatzigiannis P, Olympios C, Igual Munoz B, Erdociain Perales M, Maceira Gonzalez Alicia A, Vazquez Sanchez A, Miro Palau V, Alonso Fernandez P, Donate Bertolin L, Estornell Erill J, Cervera A, Montero Argudo Anastasio A, Okura H, Koyama T, Maehama T, Imai K, Yamada R, Kume T, Neishi Y, Caballero Jimenez L, Garcia-Navarro M, Saura D, Oliva M, Gonzalez-Carrillo J, Espinosa M, Valdes M, De La Morena 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Ferreira R, Al-Mallah M, Alsaileek A. Poster session 5: Friday 5 December 2014, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schaffer A, Sinyor M, Reis C, Goldstein BI, Levitt AJ. Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disord 2014; 16:732-40. [PMID: 24890795 DOI: 10.1111/bdi.12219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The development of more sophisticated models for understanding suicide among people with bipolar disorder (BD) requires diagnosis-specific data. The present study aimed to elucidate differences between people who die by suicide with and without BD, and to identify subgroups within those with BD. METHODS Data on all suicide deaths in the city of Toronto from 1998 to 2010 were extracted from the Office of the Chief Coroner of Ontario, including demographics, clinical variables, recent stressors, and details of the suicide. Comparisons of person- and suicide-specific variables between suicide deaths among those with BD (n = 170) and those without (n = 2,716) were conducted, and a cluster analysis was performed among the BD suicide group only. RESULTS Those in the BD suicide group were more likely than those in the non-BD suicide group to be female [odds ratio (OR) = 1.75, 95% confidence interval (CI): 1.27-2.42; p = 0.001], to have made a past suicide attempt (OR = 2.01, 95% CI: 1.45-2.80; p < 0.0001), and to have had recent contact with psychiatric or emergency services (OR = 1.59, 95% CI: 1.00-2.52; p = 0.049). Five clusters were identified within the BD group, with differences between clusters in age; sex; marital status; living circumstances; past suicide attempts; substance abuse; interpersonal, employment/financial, and legal/police stressors; and rates of death by fall/jump or self-poisoning. CONCLUSIONS The present findings identified differences between BD and non-BD suicide groups, providing support to the utilization of an illness-specific approach to better understanding suicide in BD. Subgroups of BD suicide deaths, if replicated, should also be incorporated into the design and analysis of future studies of suicide in BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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