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Talks BJ, Lynch N, Bowe I, Kelly C, Iqbal MS. A retrospective cohort study of reactive nasogastric tube feeding for head and neck cancer patients undergoing radiotherapy: Clinical and financial implications. Clin Otolaryngol 2024; 49:359-362. [PMID: 38421130 DOI: 10.1111/coa.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/13/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Benjamin James Talks
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Nola Lynch
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Isobel Bowe
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Charles Kelly
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Northern Head and Neck Cancer Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, UK
- Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
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Kovarik PDE, Fadulelmola A, Hashmi A, Kelly C, West N, Patil R, Iqbal MS. Metastatic spinal cord compression: the Spinal Instability Neoplastic Score and early surgical intervention. BMJ Support Palliat Care 2024:spcare-2023-004537. [PMID: 38458653 DOI: 10.1136/spcare-2023-004537] [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: 08/03/2023] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To evaluate the value of Spinal Instability Neoplastic Score (SINS) in patients with spine metastasis who subsequently developed or did not develop metastatic spinal cord compression (MSCC). METHODS In this single institutional retrospective descriptive observational study, of 589 patients with MSCC who were referred for radiotherapy, 34 patients (with 41 compression sites) met the inclusion criteria: availability of diagnostic MRI spine pre-development of MSCC (MRI-1) and at the time of MSCC development (MRI-2) (CordGroup).For comparison, NoCordGroup consisted of 152 patients (160 sites) treated with radiotherapy to spinal metastases. SINS was compared between the two groups. RESULTS In CordGroup, the median interval between MRI-1 and MRI-2 was 11 weeks. The median SINS was 8 (range: 4-14) and 9 (range: 7-14) on MRI-1 and MRI-2, respectively. In NoCordGroup, the median SINS was 6 (range: 4-10). CONCLUSIONS Our study showed a trend in difference in SINS value between the two groups. This difference should be a subject of future prospective research in this patient population with poor survival.
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Affiliation(s)
| | - Ahmed Fadulelmola
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ahmed Hashmi
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Charles Kelly
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Nick West
- Radiotherapy Physics, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Rahul Patil
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
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Moran K, Dyas R, Kelly C, Young D, Minnis H. Reactive attachment disorder, disinhibited social engagement disorder, adverse childhood experiences, and mental health in an imprisoned young offender population. Psychiatry Res 2024; 332:115597. [PMID: 38194802 DOI: 10.1016/j.psychres.2023.115597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/30/2022] [Revised: 03/10/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND A high proportion of young people in prison have a history of abuse and neglect, and/or of neurodevelopmental or psychiatric conditions. Despite this, the only two conditions specifically associated with abuse and neglect, Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), have never been included as part of a comprehensive prevalence study. METHODS A cross sectional study, in 110 male inmates aged 16 to 23, examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions, including RAD and DSED. OUTCOMES Virtually all of the young men (96 %) had one or more lifetime neurodevelopmental or mental health conditions, 85.5 % had a current condition, yet less than 3 % reported having received a mental health assessment in prison. High rates of RAD and/or DSED symptoms were found (53.6 %) and 74.5 % had experienced some form of abuse or neglect. INTERPRETATION There is a high prevalence of ACEs, RAD/DSED, neurodevelopmental and other mental health conditions within this population. Comprehensive clinical assessments are required to ensure appropriate support and staff training is needed to ensure that the full implications of the high prevalence of neurodevelopmental and mental health conditions are understood as part of trauma informed care.
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Affiliation(s)
- Kate Moran
- School of Psychology, Trinity College Dublin, Ireland.
| | - Rebecca Dyas
- University of Glasgow School of Health and Wellbeing, Glasgow, Scotland
| | | | - David Young
- Mathematics and Statistics, University of Strathclyde, Scotland.
| | - Helen Minnis
- University of Glasgow School of Health and Wellbeing, Glasgow, Scotland.
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Worrall AP, Connolly MJ, Kelly C, O'Connor-Byrne N, Keeling A, Glavey S, Rajab H, Naughton P. Benign gynaecological pathology causing vascular-compressed. Ir Med J 2024; 117:891. [PMID: 38259222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Kovarik PDE, Patil R, Jackson M, Kelly C, West N, Iqbal MS. In Response to the Correspondence to the Editor Regarding 'Extra-mandibular Osteoradionecrosis After the Treatment of Head and Neck Cancer'. Clin Oncol (R Coll Radiol) 2024; 36:e74-e75. [PMID: 37951767 DOI: 10.1016/j.clon.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Affiliation(s)
- P D E Kovarik
- Department of Oncology, University of Ostrava, Ostrava, Czech Republic; Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK
| | - R Patil
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Jackson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Kelly
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N West
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M S Iqbal
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University, Newcastle upon Tyne, UK.
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Lemanska A, Harkin A, Iveson T, Kelly C, Saunders M, Faithfull S. The association of clinical and patient factors with chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer: secondary analysis of the SCOT trial. ESMO Open 2023; 8:102063. [PMID: 37988949 PMCID: PMC10774973 DOI: 10.1016/j.esmoop.2023.102063] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of oxaliplatin. CIPN can impair long-term quality of life and limit the dose of chemotherapy. We investigated the association of CIPN over time with age, sex, body mass index, baseline neuropathy, and chemotherapy regimen in people treated with adjuvant oxaliplatin-containing chemotherapy for colorectal cancer. PATIENTS AND METHODS We carried out secondary analysis of data from the SCOT randomised controlled trial. SCOT compared 3 months to 6 months of oxaliplatin-containing adjuvant chemotherapy in 6088 people with colorectal cancer recruited between March 2008 and November 2013. Two different chemotherapy regimens were used: capecitabine with oxaliplatin (CAPOX) or fluorouracil with oxaliplatin (FOLFOX). CIPN was recorded with the Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-Neurotoxicity 4 tool in 2871 participants from baseline (randomisation) for up to 8 years. Longitudinal trends in CIPN [averages with 95% confidence intervals (CIs)] were plotted stratified by the investigated factors. Analysis of covariance (ANCOVA) was used to analyse the association of factors with CIPN adjusting for the SCOT randomisation arm and oxaliplatin dose. P < 0.01 was adopted as cut-off for statistical significance to account for multiple testing. RESULTS Patients receiving CAPOX had lower CIPN scores than those receiving FOLFOX. Chemotherapy regimen was associated with CIPN from 6 months (P < 0.001) to 2 years (P = 0.001). The adjusted ANCOVA coefficient for CAPOX at 6 months was -1.6 (95% CIs -2.2 to -0.9) and at 2 years it was -1.6 (95% CIs -2.5 to -0.7). People with baseline neuropathy scores ≥1 experienced higher CIPN than people with baseline neuropathy scores of 0 (P < 0.01 for all timepoints apart from 18 months). Age, sex, and body mass index did not link with CIPN. CONCLUSIONS A neuropathy assessment before treatment with oxaliplatin can help identify people with an increased risk of CIPN. More research is needed to understand the CIPN-inducing effect of different chemotherapy regimens.
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Affiliation(s)
- A Lemanska
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - A Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, UK
| | - T Iveson
- Department of Medical Oncology, University of Southampton, Southampton, UK
| | - C Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, UK
| | | | - S Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK; School of Medicine, Trinity College, Dublin, Ireland
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Quintyne K, Kelly C. Knowledge, attitudes, and perception of air pollution in Ireland. Public Health Pract (Oxf) 2023; 6:100406. [PMID: 37456905 PMCID: PMC10344793 DOI: 10.1016/j.puhip.2023.100406] [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: 01/19/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Aim Air pollution remains a major global public health challenge; and Ireland is no exception to the human health implications of exposure ambient air pollutants. Accurate and timely information can be critical to mitigate the harmful effects of air pollution. This study aimed to assess the knowledge, perceptions, and attitudes to poor air quality in Ireland to assist stakeholders in developing and implementing effective communication pieces and policies about the management of air pollution. Study design Cross-sectional population-based cohort. Method Quantitative data on knowledge, attitudes, and perceptions (KAP) were collected from respondents living across Ireland, and the results were analysed with SPSS (Version 28.0). Results Among the 1005 respondents included in this study, the mean [SD] age was 46.1 [15.3] years; 53% were female (n = 530); and 66% and 35% of respondents were aware of air pollution and its adverse effects on health at a national and local level respectively (n = 668 and n = 353 respectively). In addition, there were significant relationships between socio-demographic and air pollution awareness. There were correlation between respondent's age, gender, socio-economic group, and locality in Ireland. Conclusion This study demonstrates that environmental health literacy around air pollution in critically lacking among respondents. Given that air pollution is an increasingly important global priority, opportunities need to create to improve reach and impact of communication of air quality health risk and mitigation measures.
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Affiliation(s)
- K.I. Quintyne
- Health Service Executive (HSE) Public Health, Area A, Dr Steeven’s Hospital, Co Dublin, Ireland
- School of Public Health, University College Cork, Co Cork, Ireland
| | - C. Kelly
- Health Service Executive (HSE) Public Health, Area A, Dr Steeven’s Hospital, Co Dublin, Ireland
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Kovarik PDE, Patil R, Cvek J, Kelly C, Jackson M, Mackenzie L, West N, Willis N, Kovarik JP, Banks R, Kennedy M, Adams J, Iqbal MS. Extra-mandibular Osteoradionecrosis after the Treatment of Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e498-e505. [PMID: 37433701 DOI: 10.1016/j.clon.2023.06.013] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
AIMS Osteoradionecrosis (ORN) is a serious toxicity of head and neck radiotherapy. It predominantly affects the mandible. Extra-mandibular ORN is rare. The aim of this study was to report the incidence and outcomes of extra-mandibular ORNs from a large institutional database. MATERIALS AND METHODS In total, 2303 head and neck cancer patients were treated with radical or adjuvant radiotherapy. Of these, extra-mandibular ORN developed in 13 patients (0.5%). RESULTS Maxillary ORNs (n = 8) were a consequence of the treatment of various primaries (oropharynx = 3, sinonasal = 2, maxilla = 2, parotid = 1). The median interval from the end of radiotherapy to the development of ORN was 7.5 months (range 3-42 months). The median radiotherapy dose in the centre of the ORN was 48.5 Gy (range 22-66.5 Gy). Four patients (50%) healed in 7, 14, 20 and 41 months. All temporal bone ORNs (n = 5) developed after treatment to the parotid gland (of a total of 115 patients who received radiotherapy for parotid gland malignancy). The median interval from the end of radiotherapy to the development of ORN was 41 months (range 20-68 months). The median total dose in the centre of the ORN was 63.5 Gy (range 60.2-65.3 Gy). ORN healed in only one patient after 32 months of treatment with repeated debridement and topical betamethasone cream. CONCLUSION Extra-mandibular ORN is a rare late toxicity and this current study provides useful information on its incidence and outcome. The risk of temporal bone ORN should be considered in the treatment of parotid malignancies and patients should be counselled. More research is required to determine the optimal management of extra-mandibular ORN, particularly on the role of the PENTOCLO regimen.
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Affiliation(s)
- P D E Kovarik
- Department of Oncology, University of Ostrava, Ostrava, Czech Republic; Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK
| | - R Patil
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Cvek
- Department of Oncology, University of Ostrava, Ostrava, Czech Republic
| | - C Kelly
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Jackson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L Mackenzie
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N West
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N Willis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J P Kovarik
- Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Olomouc, Czech Republic
| | - R Banks
- Department of Oral and Maxillofacial Surgery, Royal Sunderland Hospital, Sunderland, UK
| | - M Kennedy
- Department of Oral and Maxillofacial Surgery, Freeman Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Adams
- Department of Oral and Maxillofacial Surgery, Freeman Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M S Iqbal
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Patil R, Uzzaman L, Kelly C, Kovarik J, Jackson M, Paterson C, Munro SP, Wilson A, Iqbal MS. Role of Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Salivary Glands: A Systematic Review. Clin Oncol (R Coll Radiol) 2023; 35:e489-e497. [PMID: 37355414 DOI: 10.1016/j.clon.2023.06.011] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
A systematic review was carried out to evaluate if adjuvant radiotherapy for acinic cell carcinomas (ACCs) of salivary glands improves survival. Twelve retrospective studies published between 2000 and 2020 that analysed the effect of radiotherapy on salivary gland neoplasms and ACCs of salivary glands and met the inclusion criteria were included in the review. The overall quality of the studies was moderate to low. There was no high-quality evidence for improved survival with radiotherapy for ACCs of the salivary gland. Some evidence suggests that there may be an advantage for patients with high-grade tumours, but these data should be interpreted with caution due to the small number of patients and low-quality evidence. Good quality of evidence is lacking. Recommendation for adjuvant radiotherapy for tumours with poor prognostic factors will require discussion and shared decision-making with the patients.
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Affiliation(s)
- R Patil
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L Uzzaman
- Department of Otolaryngology - Head and Neck Surgery, The Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Jackson
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Paterson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, Glasgow, UK
| | - S P Munro
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | - A Wilson
- Department of Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - M S Iqbal
- Newcastle University, Newcastle upon Tyne, UK.
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Saha S, Howarth R, Sharma-Saha S, Kelly C. Bioengineering of a tumour-stroma 3D-tumouroid co-culture model of hypopharyngeal cancer. Biol Open 2023; 12:310415. [PMID: 37194999 DOI: 10.1242/bio.059949] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Head and neck cancer (HNC) differs at anatomical sites and hypopharyngeal cancer (HPC) is a type of HNC. The non-surgical treatment option for advanced cases of HPC is radiotherapy (RT) with or without chemotherapy but survival is poor. Thus, new treatment approaches in combination with RT are essential. Yet, obtaining post-RT treated tumour specimens and lack of animal models with identical anatomical sites are the major translational research barriers. To overcome these barriers, for the first time, we have developed a tumour-stroma based in vitro three-dimensional (3D)-tumouroid co-culture model of HPC by growing FaDu and HS-5 cells together to mimic the complex tumour-microenvironment in a Petri dish. Before growing the cells together, imaging flow cytometry revealed distinct epithelial and non-epithelial characteristics of the cells. Growth rate of the 3D-tumouroid co-culture was significantly higher compared to the tumouroid monoculture of FaDu. Histology and morphometric analysis were done for the characterisation as well as the development of hypoxia was measured by CAIX immunostaining in this 3D-tumouroid co-culture. Taken together, this innovative in vitro 3D model of HPC resembles many features of the original tumour. The wider application of this pre-clinical research tool is in understanding newer combination (e.g. immunotherapy) treatment approaches with RT in HPC and beyond.
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Affiliation(s)
- Santu Saha
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Leukaemia Research Cytogenetics Group, Wolfson Childhood Cancer Research Centre, Level 6, Herschel Building, Brewery Lane, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Rachel Howarth
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Paul O'Gorman Building, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Sweta Sharma-Saha
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Paul O'Gorman Building, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
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Grocutt L, Rutherford A, Caldwell D, Wilkinson C, Chalmers AJ, Dempsey L, Kelly C, O'Cathail SM. The Impact of COVID-19 on Radiotherapy Services in Scotland, UK: A Population-based Study. Clin Oncol (R Coll Radiol) 2023; 35:e227-e234. [PMID: 36528474 PMCID: PMC9708615 DOI: 10.1016/j.clon.2022.11.018] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/16/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
AIMS The effect of the COVID-19 pandemic on cancer radiotherapy services is largely unknown. The aim of the present study was to investigate the impact of the resultant contingency plans on radiotherapy cancer services in Scotland. MATERIALS AND METHODS Detailed data of radiotherapy activity at our centre were collected from 1 April 2019 to 31 March 2021. Differences in mean weekly radiotherapy courses, dose and fractionation patterns and treatment intent were compared with corresponding pre-pandemic months for all treatment sites. Qualitative data were collected for a subgroup of radical radiotherapy patients. RESULTS Total radiotherapy courses decreased from 6968 to 6240 (-10%) compared with the previous year, prior to the pandemic. Average weekly radiotherapy courses delivered were 134 (standard deviation ±13), decreasing by 10% to 120 (standard deviation 15) (Welch's t-test, P < 0.001). The greatest decrease in new start treatment courses was observed from May to August 2020 (-7.7%, -24.0%, -16.7% and -18.7%) compared with the corresponding months in 2019. A significant reduction was seen for female patients <70 years (-16%) compared with females >70 years (-8%) or their male counterparts (-7% and -6%, respectively). By diagnosis, the largest reductions between pre- and post-pandemic levels were for anal (-26%), breast (-18%) and prostate (-14%) cancer. Contrarily, a significant increase was found for bladder (28%) and oesophageal (11%) cancers. CONCLUSIONS Over the first 12 months of the COVID-19 pandemic, radiotherapy activity significantly decreased compared with the 12 months prior. Due to issued guidance, the use of hypofractionated regimens increased, contributing to the reduction in treatments for some tumour sites. An increase in other tumour sites can probably be attributed to the reduction or cancellation of surgical interventions. These results will inform our understanding of the indirect consequences of the pandemic on radiotherapy services.
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Affiliation(s)
- L Grocutt
- CRUK RadNet Glasgow, University of Glasgow, Glasgow, UK; Department of Radiotherapy Physics, The Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - A Rutherford
- Department of Radiotherapy Physics, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Caldwell
- NRS CRN-W, Radiotherapy Department, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Wilkinson
- NRS CRN-W, Radiotherapy Department, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - L Dempsey
- Cancer Research UK Glasgow Clinical Trials Unit, The Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - C Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, The Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - S M O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Asherson P, Johansson L, Holland R, Bedding M, Forrester A, Giannulli L, Ginsberg Y, Howitt S, Kretzschmar I, Lawrie SM, Marsh C, Kelly C, Mansfield M, McCafferty C, Khan K, Muller-Sedgwick U, Strang J, Williamson G, Wilson L, Young S, Landau S, Thomson L. Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study. Br J Psychiatry 2023; 222:7-17. [PMID: 35657651 PMCID: PMC7613969 DOI: 10.1192/bjp.2022.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Research has shown that 20-30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders. AIMS To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. METHOD We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16-25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. RESULTS In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI -2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. CONCLUSIONS ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.
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Watson DLB, Giboreau A, Coveney J, Kelly C, Bensafi M, Braud A, Bruyas A, Carrouel F, Cartner H, Cunha L, Deary V, Dougkas A, Monteleone E, Mourier V, Singer P, Spinelli S. I-eAT, a consortium addressing gastronomic solutions for altered taste: A research and development manifesto. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Donnelly O, Kelly C, Iqbal MS. Chemoradiotherapy in Human Papillomavirus-associated Oropharyngeal Squamous Cell Carcinoma. Cetuximab is Inferior to Cisplatin - is the Case now Closed? Clin Oncol (R Coll Radiol) 2022; 34:783-785. [PMID: 35945073 DOI: 10.1016/j.clon.2022.07.004] [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] [Received: 04/10/2022] [Revised: 06/29/2022] [Accepted: 07/14/2022] [Indexed: 01/31/2023]
Affiliation(s)
- O Donnelly
- Department of Clinical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - C Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M S Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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15
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Sharrack N, Das A, Kelly C, Teh I, Stoeck CT, Kozerke S, Swoboda PP, Greenwood JP, Plein S, Schneider JE, Dall'Armellina E. The relationship between myocardial microstructure and strain in chronic infarction using cardiovascular magnetic resonance diffusion tensor imaging and feature tracking. J Cardiovasc Magn Reson 2022; 24:66. [PMID: 36419059 PMCID: PMC9685947 DOI: 10.1186/s12968-022-00892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiac diffusion tensor imaging (cDTI) using cardiovascular magnetic resonance (CMR) is a novel technique for the non-invasive assessment of myocardial microstructure. Previous studies have shown myocardial infarction to result in loss of sheetlet angularity, derived by reduced secondary eigenvector (E2A) and reduction in subendocardial cardiomyocytes, evidenced by loss of myocytes with right-handed orientation (RHM) on helix angle (HA) maps. Myocardial strain assessed using feature tracking-CMR (FT-CMR) is a sensitive marker of sub-clinical myocardial dysfunction. We sought to explore the relationship between these two techniques (strain and cDTI) in patients at 3 months following ST-elevation MI (STEMI). METHODS 32 patients (F = 28, 60 ± 10 years) underwent 3T CMR three months after STEMI (mean interval 105 ± 17 days) with second order motion compensated (M2), free-breathing spin echo cDTI, cine gradient echo and late gadolinium enhancement (LGE) imaging. HA maps divided into left-handed HA (LHM, - 90 < HA < - 30), circumferential HA (CM, - 30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) were reported as relative proportions. Global and segmental analysis was undertaken. RESULTS Mean left ventricular ejection fraction (LVEF) was 44 ± 10% with a mean infarct size of 18 ± 12 g and a mean infarct segment LGE enhancement of 66 ± 21%. Mean global radial strain was 19 ± 6, mean global circumferential strain was - 13 ± - 3 and mean global longitudinal strain was - 10 ± - 3. Global and segmental radial strain correlated significantly with E2A in infarcted segments (p = 0.002, p = 0.011). Both global and segmental longitudinal strain correlated with RHM of infarcted segments on HA maps (p < 0.001, p = 0.003). Mean Diffusivity (MD) correlated significantly with the global infarct size (p < 0.008). When patients were categorised according to LVEF (reduced, mid-range and preserved), all cDTI parameters differed significantly between the three groups. CONCLUSION Change in sheetlet orientation assessed using E2A from cDTI correlates with impaired radial strain. Segments with fewer subendocardial cardiomyocytes, evidenced by a lower proportion of myocytes with right-handed orientation on HA maps, show impaired longitudinal strain. Infarct segment enhancement correlates significantly with E2A and RHM. Our data has demonstrated a link between myocardial microstructure and contractility following myocardial infarction, suggesting a potential role for CMR cDTI to clinically relevant functional impact.
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Affiliation(s)
- N Sharrack
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A Das
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C Kelly
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - I Teh
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Centre for Surgical Research, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - P P Swoboda
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J P Greenwood
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S Plein
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J E Schneider
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - E Dall'Armellina
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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16
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Blackler N, Bradley KE, Kelly C, Murphy S, Cross C, Kirby M. A national survey of the radiotherapy dosimetrist workforce in the UK. Br J Radiol 2022; 95:20220459. [PMID: 36063424 PMCID: PMC9793486 DOI: 10.1259/bjr.20220459] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To undertake a national survey of the Radiotherapy Dosimetrist workforce within the UK; examining different attributes and experiences, comparing results with published evidence within the literature. METHODS A national, anonymised survey was undertaken between Dec 2020 and end of Feb 2021; employing a mixed-methods approach and blend of closed, open-ended answer choices and free-text comments. Questions included range of training routes and job titles; registration status; job tasks and engagement with Continuing Professional Development (CPD). RESULTS A total of 223 individuals responded. Nearly half were trained via therapeutic radiography; approximately, a fifth through a clinical technologist/physics routes. Most (70%) had Dosimetrist in their job title. Nearly 70% were statutorily registered, and almost a fifth were in the voluntary register of Clinical Technologists. Most job tasks were in treatment planning - with 57% spending over 70% of their time there. Most notably, 29% were not involved in any CPD scheme. No published evidence showed the same aspects identified here. CONCLUSIONS Our survey showed a unique profile of the Radiotherapy Dosimetrist workforce in the UK, with a variety of training routes and statutory registration status. Nearly, a third were not engaged in a CPD scheme - adding to the current discussion that perhaps all Dosimetrists should be statutorily registered, for ensuring safe and effective clinical practice. ADVANCES IN KNOWLEDGE A novel and unique national survey of Dosimetrists working in Radiotherapy in the UK is presented, leading to new insights into current training routes, registration status, job tasks and CPD engagement and needs.
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Affiliation(s)
| | | | | | | | | | - Mike Kirby
- The University of Liverpool, Liverpool, UK
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17
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Kovarik P, Jackson M, Patil R, Kelly C, Iqbal M. An audit of pattern of failure in patients with buccal mucosa/retromolar trigone carcinoma treated at a single UK centre. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.09.006] [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: 11/06/2022]
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18
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Kelly C, Kenny P, O'Dwyer M, Quintyne KI. The impact on ambient air pollution and asthma-related admissions of COVID-19 transport restrictions. Eur J Public Health 2022. [PMCID: PMC9593621 DOI: 10.1093/eurpub/ckac130.067] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Exposure to air pollution is a known risk factor for asthma exacerbations, emergency attendances and hospitalisations. In Europe, the main source of air pollution is the transport industry, and so the COVID-19 transport restrictions provided an opportunity to examine if reduction in traffic had a demonstrable impact on ambient air quality and asthma-related admissions. Routinely collected data was used to conduct a retrospective population cohort study. The Environmental Protection Agency provided daily nitrogen dioxide (NO2) and particulate matter (PM) concentrations for Dublin, and all asthma-related admissions were collected from the Hospital In-Patient Enquiry system. The two years prior to the pandemic were compared with the period of transport restrictions (from March 2020). During the period of restrictions, there was a significant reduction in the mean number of daily asthma admissions (2.8 v 4.5 admissions p < 0.001). There was also a significant decrease in mean daily concentrations in two pollutants: NO2 (16.7 v 24.0µg/m3 p < 0.001) and PM2.5 (7.8 v 8.9µg/m3 p = 0.002). Only NO2 had a statistically significant correlation with asthma admissions (r = 0.132 p < 0.001). Transport restrictions introduced to mitigate against COVID-19 led to improvements in air quality, as seen by the reductions in pollutant concentrations. Previously described associations between pollutants and asthma, would suggest that these improvements in air quality contributed to the reduction in asthma admissions. Whereas the primary source of NO2 is transport emissions, PM is made up of particles from multiple sources, which likely explains the lack of correlation between asthma admissions and PM. Public Health need to advocate for transport policies which can improve air quality, and as a result, public health. Key messages
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Affiliation(s)
- C Kelly
- Department of Public Health, North East, HSE , Kells, Ireland
| | - P Kenny
- National Ambient Air Quality Unit, EPA , Dublin, Ireland
| | - M O'Dwyer
- National Ambient Air Quality Unit, EPA , Dublin, Ireland
| | - KI Quintyne
- Department of Public Health, North East, HSE , Kells, Ireland
- School of Public Health, UCC , Cork, Ireland
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19
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Quintyne K, Kelly C, Brabazon E, Harrison K, White E. Public Health Response to Outbreaks of Highly Pathogenic Avian Influenza (H5N1). Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aim
Human infections from highly pathogenic avian influenza (HPAI) H5N1 are associated with significant morbidity and mortality internationally. This study aimed to use routinely available data to examine key strategies to prevent H5N1 transmission to humans during outbreaks in poultry in residents in Cavan, Louth, Meath and Monaghan.
Study design
Cross-sectional based study.
Methods
Data were obtained from Health Protection Team (HPT) in the Department of Public Health (DPH), HSE North-East and Department of Agriculture, Food, and the Marine (DAFM). Data entry and analyses were conducted using Microsoft Excel 2016.
Results
The public health response focussed on contact tracing, monitoring, and follow-up for household, farm-workers, and DAFM staff exposed on the affected farms. A total of 157 contact episodes were identified. Contacts received advice about active monitoring from their last exposure. A total of 111 (80%) were recommended chemoprophylaxis for exposure to HPAI H5N1. During the active monitoring period, two contacts developed acute respiratory symptoms, and parainfluenza 3 and rhino/enterovirus were identified in these individuals respectively.
Conclusions
The findings of this study, using routinely gathered data, highlighted that collaboration between public health and DAFM at regional and national level was key to rapid response to these outbreaks of HPAI in domesticated poultry. In addition, the public health response was successful in preventing H5N1 transmission from domesticated birds to humans.
Key messages
• HPAI H5N1 virus infections transmissions from poultry to humans is low.
• Effective public health measures are crucial to further mitigate the risks to an absolute minimum.
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Affiliation(s)
- K Quintyne
- Department of Public Health, Health Service Executive North-East , Kells, Co. Meath, Ireland
- School of Public Health, University College Cork , Cork, Ireland
| | - C Kelly
- Department of Public Health, Health Service Executive North-East , Kells, Co. Meath, Ireland
| | - E Brabazon
- Department of Public Health, Health Service Executive North-East , Kells, Co. Meath, Ireland
| | - K Harrison
- Department of Agriculture, Food and the Marine , Dublin, Ireland
| | - E White
- Department of Agriculture, Food and the Marine , Dublin, Ireland
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20
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Kelly C, McNamara Á. Adolescent Binge Drinking in the West of Ireland: Associated Risk and Protective Factors. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aimed to examine potential risk and protective factors for binge drinking among a cohort of 15-16-year-old adolescents in the West of Ireland. This study was a cross-sectional secondary analysis of 4,473 15-16-year-olds who participated in the 2020 Planet Youth survey. Binge drinking was defined as ever consumption of five or more drinks in a two-hour period or less. Data were analysed using SPSS version 27. Multivariable logistic regression was used to examine independent associations between potential risk and protective factors and binge drinking. A p-value of < 0.05 was deemed statistically significant. The prevalence of binge drinking among participants was 34.1%. Female gender (aOR 0.55, 95% CI 0.46-0.67, p < 0.001) and non-White ethnicity (aOR 0.49, 95% CI 0.31-0.77, p = 0.002) were associated with reduced odds of ever binge drinking. Self-rated ‘bad/very bad’ mental health (aOR 1.61, 95% CI 1.26-2.06, p < 0.001), current cigarette use (aOR 4.06, 95% CI 3.01-5.47, p < 0.001) and current cannabis use (aOR 2.79, 95% CI 1.80-4.31, p < 0.001) were associated with increased odds of ever binge drinking. Parental supervision (aOR 0.80, 95% CI 0.73-0.88, p < 0.001) and negative parental reaction to adolescent drunkenness (aOR 0.51, 95% CI 0.42-0.61, p < 0.001) reduced the odds of ever binge drinking among participants. Getting alcohol from parents was associated with increased odds of ever binge drinking (aOR 1.79, 95% CI 1.42-2.25, p < 0.001). Adolescents with friends who drink alcohol had almost 5 times higher odds of ever binge drinking (aOR 4.59, 95% CI 2.65-7.94, p < 0.001). Participating in team sports was also associated with increased odds of ever binge drinking (aOR 1.30, 95% CI 1.07-1.57, p = 0.008 for 1-4 times/week, aOR 1.52, 95% CI 1.07-2.16, p = 0.020 for ≥5 times/week). This study highlights key influences of adolescents’ social environment on their binge drinking, and a need for renewed public health efforts to protect adolescents from alcohol-related harm.
Key messages
• This study identified a high prevalence of ever binge drinking among adolescents in the West of Ireland - this is highly concerning as adolescents are vulnerable to alcohol-related harm.
• This study identified factors in the social environment of adolescents associated with binge drinking. This can inform public health action to protect adolescents from alcohol-related harm.
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Affiliation(s)
- C Kelly
- Health Protection Surveillance Centre , Dublin, Ireland
- Department of Public Health, HSE West , Galway, Ireland
| | - Á McNamara
- Department of Public Health, HSE West , Galway, Ireland
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21
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Kelly C, Naughton P, Kennedy E, Ward M. Establishing intersectoral ‘Schools Teams’ to mitigate SARS-CoV-2 school transmission, 2020/2021. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.283] [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
The SARS-CoV-2 pandemic disrupted the lives of up to 100,000 school-going children in Ireland. Consequently, intersectoral ‘Schools Teams’ were established for the 2020/2021 school year to reduce SARS-CoV-2 transmission in school settings. This novel public health intervention provides learning to inform future cross-sectoral collaborative work in Public Health in responding to infectious disease threats. For the 2020/2021 school year in Ireland, intersectoral Schools Teams were formed within each of eight regional Departments of Public Health to manage mitigation of SARS-CoV-2 transmission in school settings. These teams comprised of staff from Departments of Public Health and redeployed staff from the Department of Education. A nationally agreed schools process was followed by Schools Teams to manage SARS-CoV-2 cases and outbreaks in schools. Relevant cases were referred to the regional Schools Team for a public health risk assessment (PHRA). Close contacts were determined using appropriate definitions of close contact within a school setting through the PHRA. This model with centralised procedures and linked health/education teams was novel and adaptable to additional settings. Results from the East region of Ireland showed testing of close contacts of COVID-19 was conducted in 71.8% (676/942) of schools, with 43881 tests completed. Most Schools Team members reported efficient communication within the team (88.7%), a positive team culture (96.3%) and feeling comfortable in their roles following training (82.7%). The majority of members felt the team was able to effectively support schools to reduce COVID-19 transmission (92.5%). Lessons learnt include the synergistic working of educational and health professionals towards a common goal, maximising the skills of all, ensuring a better outcome for school children. Involving educational teams in active contact tracing of COVID-19 cases in schools maximised engagement of the educational sector in the COVID-19 response.
Key messages
• Establishing intersectoral ‘Schools Teams’ pooled skills, resources and expertise, enabling development of synergistic solutions to a complex problem.
• This exemplifies a large national cross-sectoral collaborative working process involving education and public health sectors, providing a model for future responses to infectious disease threats.
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Affiliation(s)
- C Kelly
- Health Protection Surveillance Centre , Dublin, Ireland
| | - P Naughton
- Department of Public Health HSE East, CHO Area 6 , Dublin, Ireland
| | - E Kennedy
- Department of Public Health HSE East, CHO Area 6 , Dublin, Ireland
| | - M Ward
- Department of Public Health HSE East, CHO Area 6 , Dublin, Ireland
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22
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Kelly C, Chu M, Untaru R, Assadi-Khansari B, Chen D, Croft A, Horowitz J, Sverdlov AL, Ngo DTM. Heart failure is associated with low circulating levels of secreted frizzled receptor protein 5 (Sfrp5). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.918] [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/Introduction
Obesity and metabolic dysregulation are closely associated with the pathophysiology of multiple cardiovascular diseases (CVD). To date, the pathophysiological mechanism(s) of obesity and its link with cardiovascular systems remain largely unknown. Adipose tissue inflammation as a result of excessive fat expansion in obesity, leading to increased systemic production of growth factors and recruitment of inflammatory cells have been postulated to be a major factor. Secreted frizzled-related protein 5 (SFRP5) is an anti-inflammatory adipokine that is linked with obesity and metabolic regulation and has been indicated to affect cardiovascular functions. Currently, the role of circulating SFRP5 levels as a biomarker for cardiovascular diseases are poorly understood, with studies yielding discordant results.
Purpose
This study aims to evaluate the relationship between circulating SFRP5 and cardiovascular functions in a cohort of patients with established CVD.
Methods
Patients (n=262, 148 male (56.5%), age (68±11 yrs)) presenting to the cardiology unit for cardiovascular investigations were recruited into the study. Plasma SFRP5 levels were measured via enzyme-linked immunosorbent assay (ELISA). Associations between plasma SFRP5 levels, cardiovascular functions, and patients' co-morbidities were analysed using univariate and multivariate analyses.
Results
Plasma SFRP5 levels were significantly lower in patients presenting with: heart failure (HF) vs non-HF (median; (10.7 vs 31.0; p<0.001); coronary artery disease (CAD) vs non-CAD; (11.0 vs 33.8; p<0.001); and atrial fibrillation (AF) vs non-AF; (11.2 vs 23.2; p=0.001). On univariate analyses, SFRP5 levels also significantly positively correlated with left ventricular ejection fraction (LVEF) (r=0.52, p<0.001), estimated glomerular filtration rate (eGFR) (r=0.16, p=0.02), total cholesterol levels and triglycerides (r=0.29, p<0.001; r=0.17, p<0.01 respectively). Low SFRP5 levels were correlated with high C-reactive protein (CRP) and E/E' (r=−0.29, p<0.001, r=−0.30, p<0.001, respectively). Patients with HF, CAD, statin use, low LVEF, low triglycerides, high CRP and high eGFR were associated with lower SFRP5 levels independent of age, BMI or diabetes on multivariate analysis (overall model r=0.729, SE=0.638).
Conclusion
Our results show that low plasma SFRP5 levels are independently associated with HF, CAD, and impaired systolic and diastolic functions. These results suggest that SFRP5 may regulate cardiovascular functions independent of obesity and metabolic regulations.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Heart Foundation of Australia Future Leader FellowshipsNSW Ministry of Health EMC FellowshipHeart Foundation of Australia Future Leader Fellowship
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Affiliation(s)
- C Kelly
- University of Newcastle , Newcastle , Australia
| | - M Chu
- University of Adelaide , Adelaide , Australia
| | - R Untaru
- University of Newcastle , Newcastle , Australia
| | | | - D Chen
- University of Newcastle , Newcastle , Australia
| | - A Croft
- University of Newcastle , Newcastle , Australia
| | - J Horowitz
- University of Adelaide , Adelaide , Australia
| | | | - D T M Ngo
- University of Newcastle , Newcastle , Australia
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23
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Croft A, Kelly C, Chen D, Murtha L, Sugito S, Boyle A, Sverdlov AL, Ngo DTM. Mechanism(s) for age-related sex differences in diet-induced cardiomyopathy: role of RNA methylation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2869] [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/Introduction
Age and sexual dimorphism contribute to the differential cardiometabolic dysfunctions associated with diet-induced obesity. However, the underlying mechanisms remain elusive. RNA modifications via RNA m6A methylation, is an emerging mediator of RNA stability, translation and localization responsible for regulation of multiple biological functions. RNA m6A modifications are regulated by “writers”, “erasers” and “readers”. The role of RNA methylation machinery genes in the heart is largely unexplored, and may provide insight into the influence of age and sex on cardiometabolic dysfunction.
Purpose
We aim to determine differential RNA methylation changes within the heart in a diet-induced cardiomyopathy mouse model, stratified according to age and sex.
Methods
Male and female C57BL/6 mice (6–8wk-old) were fed normal chow (NC) or high-fat/high-sucrose (HFHS) diet for 1 or 4 months. Echocardiographic measurements were performed at 1 and 4 months according to the American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. At study endpoint, glucose and insulin tolerance testing was conducted by injecting mice intraperitoneally with 2g/kg glucose or 0.6U/kg insulin, and monitoring blood glucose levels over a 2 hour period. RNA from heart tissue was subjected to quantitative PCR for RNA methylation machinery genes (FTO, ALKBH5, METTL3, METTL4, METTL14, YTHDF1 and YTHDF2). PPIA was used to normalise qPCR data.
Results
Both male and female mice showed evidence of age- and diet-induced metabolic dysfunction, however, males and females showed markedly different metabolic impairments. For example, glucose tolerance was exacerbated by 4 months of HFHS diet in males but not females; and only females showed impaired insulin tolerance. Echocardiography showed that males had systolic (stoke volume, cardiac output) and diastolic (E/A ratio) dysfunction after 4 months of HFHS diet, while females were unperturbed. We identified that METTL3 and METTL14, the “writers” of m6A methylation, were consistently increased in male mouse hearts at 1 vs 4 months of age but were unchanged or decreased in females, irrespective of diet. Conversely, YTHDF1, a “reader”, was unchanged in male mouse hearts at 1 vs. 4 months of age but was significantly increased in female hearts.
Conclusion
Our study confirms that markedly different cardiometabolic impairments occur in male versus female mice in response to long-term HFHS diet. Despite significant metabolic impairment in both sexes, cardiac dysfunction was only evident in males. RNA methylation machinery genes were differentially expressed in mouse hearts according to age and sex, suggesting that RNA methylation may be involved in age-related sexual dimorphism in cardiometabolic impairments.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Heart Foundation
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Affiliation(s)
- A Croft
- University of Newcastle , Newcastle , Australia
| | - C Kelly
- University of Newcastle , Newcastle , Australia
| | - D Chen
- University of Newcastle , Newcastle , Australia
| | - L Murtha
- University of Newcastle , Newcastle , Australia
| | - S Sugito
- John Hunter Hospital , Newcastle , Australia
| | - A Boyle
- University of Newcastle , Newcastle , Australia
| | | | - D T M Ngo
- University of Newcastle , Newcastle , Australia
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24
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Chen D, Croft A, Kelly C, Haw TJ, Leong A, Sverdlov A, Ngo D. Doxorubicin-induced upregulation of follistatin-like 3 (FSTL3): a new therapeutic target. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2928] [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
Introduction
Doxorubicin (DOX) is among the most used anticancer drugs with associated cardiotoxicity. Follistatin-like 3 (FSTL3), a secreted member of the follistatins family that can selectively bind to members of the TGF-β superfamily, is involved in regulation of cardiac hypertrophy and heart failure. FSTL3 is also upregulated in breast and colorectal cancer tumours, is also an unfavourable prognostic indicator for various cancers.
Purpose
We aim to determine the dual role of FSTL3 in prevention of DOX-induced cardiotoxicity and synergistic anti-cancer effects.
Methods
Human cardiomyocytes (HCMs) were treated with DOX at 1uM (EC50) for 72 hours. Cell viability was assessed via CellTiter-Glo®. Secreted FSTL3 levels, as measured by ELISA (R&D systems). FSTL3 and TGF-β mRNA levels were measured by qPCR. Co-treatment of DOX with human anti-FSTL3 antibodies (Aviva Systems Biology) at 10ug/mL were introduced for 72hrs treatment.
Results
Secreted FSTL3 levels were significantly increased in DOX-treated HCMs at 72hrs compared to control (n=5, p<0.001). Consistently, FSTL3 and TGF-β mRNA levels, in collected HCMs were significantly increased in DOX-treated cells. Co-treatment of DOX with human anti-FSTL3 antibodies at 10ug/mL significantly improved HCM viability compared to IgG control group. Conversely, anti-FSTL3 antibodies provided synergistic anti-cancer effects with DOX: MCF-7 breast cancer cells were significantly reduced when co-treated with DOX and anti-FSTL3 antibody vs. IgG controls.
Conclusion
We show, for the first time, that: 1) FSTL3 is secreted directly from HCMs; 2) FSTL3 levels (both circulating and mRNA) is markedly elevated with DOX treatment; 3) neutralisation of FSTL3 in DOX-treated HCMs, restored HCM viability; and 4) exhibit synergistic anti-cancer effects with DOX. Taken together, FSTL3 is a potential target for dual anti-cancer and cardioprotective effects.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Heart Foundation of Australia Future Leader FellowshipsNSW Ministry of Health EMC FellowshipNSW Ministry of Health Translational Research Grant
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Affiliation(s)
- D Chen
- University of Newcastle , Newcastle , Australia
| | - A Croft
- University of Newcastle , Newcastle , Australia
| | - C Kelly
- University of Newcastle , Newcastle , Australia
| | - T J Haw
- University of Newcastle , Newcastle , Australia
| | - A Leong
- University of Newcastle , Newcastle , Australia
| | - A Sverdlov
- University of Newcastle , Newcastle , Australia
| | - D Ngo
- University of Newcastle , Newcastle , Australia
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Quintyne KI, Kelly C, Brabazon E, Harrison K, White E. Public health response to outbreaks of highly pathogenic avian influenza (H5N1) among poultry in Northeast of Ireland, November 2021 to January 2022. Public Health 2022; 212:28-32. [PMID: 36182748 DOI: 10.1016/j.puhe.2022.08.014] [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: 02/18/2022] [Revised: 06/21/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Human infections from highly pathogenic avian influenza (HPAI) H5N1 are associated with significant morbidity and mortality internationally. This study aimed to use routinely available data to examine key strategies to prevent H5N1 transmission to humans during outbreaks in poultry in residents in Cavan, Louth, Meath and Monaghan. STUDY DESIGN This was a cross-sectional based study. METHODS Data were obtained from Health Protection Team in the Department of Public Health, HSE North East and Department of Agriculture, Food, and the Marine (DAFM). Data entry and analyses were conducted using Microsoft Excel 2016. RESULTS The public health response focussed on contact tracing, monitoring and follow-up for household, farm workers and DAFM staff exposed on the affected farms. A total of 157 contact episodes were identified. Contacts received advice about active monitoring from their last exposure. A total of 111 (80%) were recommended chemoprophylaxis for exposure to HPAI H5N1. During the active monitoring period, two contacts developed acute respiratory symptoms, and parainfluenza 3 and rhino/enterovirus were identified in these individuals, respectively. CONCLUSIONS The findings of this study, using routinely gathered data, highlighted that collaboration between public health and DAFM at regional and national levels was key to rapid response to these outbreaks of HPAI in domesticated poultry. In addition, the public health response appears to have been successful in preventing H5N1 transmission from domesticated birds to humans.
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Affiliation(s)
- K I Quintyne
- Department of Public Health, Health Service Executive (HSE) North-East, Navan, Co Meath, Ireland; School of Public Health, University College Cork, College Road, Co Cork, Ireland.
| | - C Kelly
- Department of Public Health, Health Service Executive (HSE) North-East, Navan, Co Meath, Ireland
| | - E Brabazon
- Department of Public Health, Health Service Executive (HSE) North-East, Navan, Co Meath, Ireland
| | - K Harrison
- Department of Agriculture, Food, and the Marine (DAFM), Agriculture House, Kildare Street, Co Dublin, Ireland
| | - E White
- Department of Agriculture, Food, and the Marine (DAFM), Agriculture House, Kildare Street, Co Dublin, Ireland
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Carserides C, Smith K, Zinicola M, Kumar A, Swedrowska M, Scala C, Cameron G, Riches Z, Iannelli F, Pozzi G, Hold GL, Forbes B, Kelly C, Hijazi K. Comprehensive Study of Antiretroviral Drug Permeability at the Cervicovaginal Mucosa via an In Vitro Model. Pharmaceutics 2022; 14:pharmaceutics14091938. [PMID: 36145684 PMCID: PMC9504208 DOI: 10.3390/pharmaceutics14091938] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Modulation of drug transporter activity at mucosal sites of HIV-1 transmission may be exploited to optimize retention of therapeutic antiretroviral drug concentrations at target submucosal CD4+ T cells. Previously, we showed that darunavir was a substrate for the P-glycoprotein efflux drug transporter in colorectal mucosa. Equivalent studies in the cervicovaginal epithelium have not been reported. Here, we describe the development of a physiologically relevant model to investigate the permeability of antiretroviral drugs across the vaginal epithelium. Barrier properties of the HEC-1A human endometrial epithelial cell line were determined, in a dual chamber model, by measurement of transepithelial electrical resistance, immunofluorescent staining of tight junctions and bi-directional paracellular permeability of mannitol. We then applied this model to investigate the permeability of tenofovir, darunavir and dapivirine. Efflux ratios indicated that the permeability of each drug was transporter-independent in this model. Reduction of pH to physiological levels in the apical compartment increased absorptive transfer of darunavir, an effect that was reversed by inhibition of MRP efflux transport via MK571. Thus, low pH may increase the transfer of darunavir across the epithelial barrier via increased MRP transporter activity. In a previous in vivo study in the macaque model, we demonstrated increased MRP2 expression following intravaginal stimulation with darunavir which may further increase drug uptake. Stimulation with inflammatory modulators had no effect on drug permeability across HEC-1A barrier epithelium but, in the VK2/E6E7 vaginal cell line, increased expression of both efflux and uptake drug transporters which may influence darunavir disposition.
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Affiliation(s)
- Constandinos Carserides
- Centre for Host Microbiome Interactions, King’s College London, London SE1 9NH, UK
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK
| | - Kieron Smith
- School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZR, UK
| | - Marta Zinicola
- Centre for Host Microbiome Interactions, King’s College London, London SE1 9NH, UK
| | - Abhinav Kumar
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK
| | - Magda Swedrowska
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK
| | - Carlo Scala
- Centre for Host Microbiome Interactions, King’s College London, London SE1 9NH, UK
| | - Gary Cameron
- School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZR, UK
| | - Zoe Riches
- School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZR, UK
| | - Francesco Iannelli
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Gianni Pozzi
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Georgina L. Hold
- School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZR, UK
| | - Ben Forbes
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK
| | - Charles Kelly
- Centre for Host Microbiome Interactions, King’s College London, London SE1 9NH, UK
| | - Karolin Hijazi
- School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZR, UK
- Correspondence: ; Tel.: +44-(0)-1224-555153
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Croghan S, Compton N, Kelly C, Daniels A, Fitzgibbon L, Daly P, Cullen I. Oncoplastic Penile Surgery: Patients’ Perceptions of Form and Function. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Church D, Hay J, Sansom O, N. Maka, Oien K, Iveson T, Saunders M, Edwards J, Harkin A, Boukovinas I, Moustou E, Messaritakis I, Chondrozoumaki M, Georgoulias V, Boquet I, Pages F, Catteau A, Galon J, Kelly C, Souglakos I. 336P Prognostic and predictive value of Immunoscore in stage III colorectal cancer in the combined SCOT and IDEA-HORG studies. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kovarik J, Kelly C, Cunnell M, Jamil F, Iqbal MS. Hypofractionated (2.75 Gy per fraction) versus Conventionally Fractionated Primary Radiotherapy for T2N0M0 Carcinoma of the Glottis. Int Arch Otorhinolaryngol 2022; 27:e16-e23. [PMID: 36714891 PMCID: PMC9879650 DOI: 10.1055/s-0042-1745855] [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: 06/26/2020] [Accepted: 05/17/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Radiotherapy provides excellent outcome in early stage glottic cancer; however, the optimal radiotherapy dose fractionation remains unknown. Objective To investigate the outcome of patients with T2N0M0 treated with either hypofractionated (HypoFxn) or conventionally fractionated radical (ConFxn) radiotherapy. Methods According to our institutional protocol, patients with T2N0M0 glottic cancer can be treated either with ConfFxn or HypoFxn radiotherapy, as per clinician's and patient's choice, following shared decision making discussing the advantages and disadvantages of both modalities. A total of 77 patients with T2N0M0 squamous cell carcinoma of glottis treated with either HypoFxn 55Gy in 20 fractions ( n = 19) or ConFxn 63 to 65Gy in 30 fractions ( n = 58) were included. Results With median follow-up of 3.4 years, there was no significant difference in disease-free survival (median: HypoFxn = 65.2 months, and ConFxn = 75.3 months; p = 0.874), local recurrence free survival rates (median: HypoFxn = 78.8 months vs. ConFxn = 81.2 months; p = 0.274), and overall survival (median: HypoFxn = 65.9 months vs. ConFxn = 67.7 months; p = 0.532). Elective neck irradiation was given to 43 patients, all in the ConFxn group, and this was associated with poorer local control ( p = 0.027). The use of radiotherapy modality, three-dimensional conformal radiotherapy (3DRT) versus intensity modulated radiotherapy (IMRT), was not a prognostic factor ( p = 0.36). In the HypoFxn group, grade III acute dysphagia requiring nasogastric tube was 16%, compared with 25% in the ConFxn group ( p = 0.446). Conclusion HypoFxn radiotherapy provides a comparable treatment outcome with acceptable toxicity. The addition of prophylactic irradiation of the neck lymph nodes has no impact on regional control.
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Affiliation(s)
- Josef Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom,Address for correspondence Josef Kovarik, PhD Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon Tyne, NE7 7DNUnited Kingdom
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michelle Cunnell
- Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Fatima Jamil
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Papanikolaou N, Coulden A, Parker N, Lee S, Kelly C, Anderson R, Rees A, Cox J, Dhillo W, Meeran K, Al-Memar M, Karavitaki N, Jayasena C. P-698 Pituitary functioning gonadotroph adenomas (FGA)-induced ovarian hyperstimulation syndrome (OHSS): results from tertiary neuroendocrine centres in the UK. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.647] [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
Study question
There are no published series of OHSS due to FGA. What FGA features should clinicians look for during OHSS, and what treatments are effective?
Summary answer
FGA tumour size is always >10mm. Other pituitary hormones may be deficient. Surgical resection of FGA is an effective treatment for OHSS.
What is known already
Pituitary adenomas affect 1:1000 adults and are classified as functioning or non-functioning. Non-functioning pituitary adenomas do not secrete hormones, but most commonly stain histologically gonadotroph cells. Functional pituitary adenomas secrete hormones such as prolactin causing prolactinoma. However, it is rare for a pituitary tumour to cause clinical features of excessive gonadotrophins (functioning gonadotroph adenoma; FGA).
Single case reports, but no case series, have been published on the presentation of FGA-induced OHSS in women.
Surgical excision of adenomas has been reported to cause remission of symptoms, though systematic data are lacking owing to rarity of these tumours.
Study design, size, duration
National case series from tertiary neuroendocrine units in England, Wales and Scotland.
Participants/materials, setting, methods
Eight high-volume pituitary endocrine tertiary units within England, Wales and Scotland audited their records for any cases of FGA-induced OHSS; only seven patients have been identified to date. In all cases, there had been no recent exposure to assisted reproductive technologies (ART) or drugs known to induce OHSS including gonadotrophins or selective oestrogen receptor modulators (SERMS).
Main results and the role of chance
Seven cases of FGA were identified with mean age 31.6 years (range 16-48) at diagnosis. Two-of-seven women presented acutely unwell with abdominal pain, distention and palpable mass requiring oophorectomy for ovarian torsion/ruptured ovarian cyst. The remaining five women presented with abdominal pain (n = 2), thyrotoxicosis (n = 1), menstrual irregularities/galactorrhoea (n = 1) and visual disturbances (n = 1). All women experienced intermittent pelvic pain during medical attendance. Pelvic ultrasound demonstrated enlarged multiseptated ovaries (volume ranging 27-442cm3). Ascites was noted in one woman. Six women had visual field defects due to optic chiasm compression on formal assessment. Median FSH was 26.10 u/L (8.3-33), but LH was <2.5 u/L in all cases. Estradiol (E2) far exceeded the reference range in 5/7 women (2990 to > 18000pmol/L);E2 was at the upper limit of normal in the remaining 2/7 women (960-1450pmol/L). Hyperprolactinaemia, hyperthyroidism and other pituitary hormones deficiency were noted in 6/7, 1/7 and 4/7 women respectively. All FGAs were macroadenomas with diameters ranging 16-48mm. Two patients were administered a somatostatin analogue prior to surgery, but FSH, E2 and tumour size did not change. Transsphenoidal surgery was performed in 6/7 women, and always improved symptomatic and biochemical features of OHSS; however, residual FGA tumour was present post-operatively in all cases studied.
Limitations, reasons for caution
It is possible that some ‘non-functioning’ gonadotroph adenomas cause subclinical problems including menstrual irregularity and mild OHSS which were never diagnosed.
We have insufficient data to determine the prognosis for future pregnancy after FGA-induced OHSS.
This study utilised historical case-notes, so some data is missing.
Wider implications of the findings
The ‘spontaneous’ presentation of OHSS may be confusing for clinicians. We report that FGA is an important cause of spontaneous OHSS which has well-defined biochemical and radiological characteristics, which may be treated effectively in the short-to-medium with pituitary surgery. Results of this study may provide greater awareness of FGA-induced OHSS.
Trial registration number
N/A
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Affiliation(s)
- N Papanikolaou
- Imperial College London, Metabolism-Digestion and Reproduction , London, United Kingdom
| | - A Coulden
- University hospitals Birmingham NHS Foundation Trust , Endocrinology, Birmingham, United Kingdom
| | - N Parker
- Imperial College Healthcare NHS Trust, Obstetrics and Gynaecology , London, United Kingdom
| | - S Lee
- Royal Infirmary of Edinburgh , Endocrinology, Edinburgh, United Kingdom
| | - C Kelly
- NHS Forth Valley , Endocrinology, Larbert, United Kingdom
| | - R Anderson
- University of Edinburgh, Obstetrics and Gynaecology- Center for Reproductive health , Edinburgh, United Kingdom
| | - A Rees
- Cardiff University- School of Medicine , Endocrinology, Cardiff, United Kingdom
| | - J Cox
- Imperial College Healthcare NHS Trust , Endocrinology, London, United Kingdom
| | - W Dhillo
- Imperial College London, Metabolism- Digestion and Reproduction , London, United Kingdom
| | - K Meeran
- Imperial College Healthcare NHS Trust , Endocrinology, London, United Kingdom
| | - M Al-Memar
- Imperial College Healthcare NHS Trust, Obstetrics and Gynaecology , London, United Kingdom
| | - N Karavitaki
- University hospitals Birmingham NHS Foundation Trust , Endocrinology, Birmingham, United Kingdom
| | - C Jayasena
- Imperial College London, Metabolism-Digestion and Reproduction , London, United Kingdom
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Kovarik J, Patil R, Kelly C, Iqbal MS. In Regard to Brennan et al. Int J Radiat Oncol Biol Phys 2022; 113:470-471. [PMID: 35569479 DOI: 10.1016/j.ijrobp.2022.02.022] [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] [Received: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Josef Kovarik
- Department of Clinical Oncology, Northern Center for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Rahul Patil
- Department of Clinical Oncology, Northern Center for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Charles Kelly
- Department of Clinical Oncology, Northern Center for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Center for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Iqbal MS, Tin A, Mian A, Ali A, O'Hara J, Kovarik J, Patil R, Aynsley E, Kelly C. Survival outcomes for patients with nasopharyngeal carcinoma in non–endemic region in the UK treated with intensity modulated based radiotherapy 65 Gy in 30 fractions ± weekly cisplatin chemotherapy. Rep Pract Oncol Radiother 2022; 27:401-409. [PMID: 36186694 PMCID: PMC9518771 DOI: 10.5603/rpor.a2022.0062] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Materials and methods Results Conclusion
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Kovarik J, Kelly C, West N, Drinnan M, Dobrowsky W, Iqbal MS. Shrinkage of the non-malignant prostate gland volume after receiving incidental radiotherapy for rectal cancer. Rep Pract Oncol Radiother 2022; 27:577-582. [PMID: 36186705 PMCID: PMC9518781 DOI: 10.5603/rpor.a2022.0026] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to assess the impact of coincidental radiotherapy on the volume of the non-malignant prostate gland in rectal cancer patients treated with neo-adjuvant radiotherapy. Materials and methods In this retrospective analysis, thirty male patients with rectal cancer who had neoadjuvant radiotherapy met the inclusion criteria. These patients had pre-treatment magnetic resonance imaging (MRI) and at least one post-treatment MRI of the pelvis and the whole of their prostate volume received the full prescribed radiotherapy dose; 45 Gy in 25 fractions (n = 22), 45 Gy in 20 fractions (n = 4) and 25 Gy in 5 fractions (n = 4). Results The median age of this patient cohort was 66 years (range: 30–87). With a median interval between pre-treatment MRI and first MRI post-treatment of 2 months (range: 1–11), the mean prostate volume reduced from 36.1 cm3 [standard deviation (SD) 14.2] pre-radiotherapy to 31.3 cm3 (SD 13.0) post radiotherapy and this difference was significant (p = 0.0004). Conclusion Radiotherapy may cause shrinkage in volume of normal (non-malignant) prostate. Further research is required in this field, since these results may be of some comfort to men contemplating the consequences of radiotherapy on their quality of life. The authors suggest recording flow-rate and international prostate symptom score (IPSS) during rectal radiotherapy as a next step.
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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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Lee CW, Dupré S, Marlborough F, Iqbal MS, Kelly C, Bashir MA, Ahmed OA, Ragbir M, Saleh DB. Postoperative radiotherapy delay in head and neck cancer patients undergoing major resection and free flap reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2084-2089. [PMID: 35351393 DOI: 10.1016/j.bjps.2022.02.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/15/2021] [Revised: 01/16/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delays to postoperative radiotherapy (PORT) are frequent and associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. Free flap patients have been suggested as the most at-risk group. Thus, PORT delivery experienced by HNC patients who required a free flap reconstruction was analysed, identifying reasons for the delays if any. METHODS A retrospective analysis of a single tertiary unit's PORT delivery to HNC patients undergoing major resection followed by free flap reconstruction between 2017 and 2020. RESULTS Eighty-seven patients were identified. Thirty-two patients received PORT within 6 weeks of their surgery date. Reasons for the delays could be categorised into surgery-derived, system-derived and patient-derived reasons. Five patients (5.74%) received PORT >6 weeks after their surgery due to surgical complications. No patients experienced surgical complications during their PORT. CONCLUSION In our experience, surgical aspects of free flap reconstructions do not appear to overtly delay or interrupt PORT.
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Affiliation(s)
- Chang Woo Lee
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | - Sophie Dupré
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Fergal Marlborough
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Muhammad Asim Bashir
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Omar A Ahmed
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Maniram Ragbir
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Daniel B Saleh
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
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Gianni L, Huang CS, Egle D, Bermejo B, Zamagni C, Thill M, Anton A, Zambelli S, Bianchini G, Russo S, Ciruelos EM, Greil R, Semiglazov V, Colleoni M, Kelly C, Mariani G, Del Mastro L, Maffeis I, Valagussa P, Viale G. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple negative, early high-risk and locally advanced breast cancer. NeoTRIP Michelangelo randomized study. Ann Oncol 2022; 33:534-543. [PMID: 35182721 DOI: 10.1016/j.annonc.2022.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [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: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High-risk triple negative breast cancers (TNBC) are characterized by poor prognosis, rapid progression to metastatic stage and onset of resistance to chemotherapy, thus representing an area in need of new therapeutic approaches. PD-L1 expression is an adaptive mechanism of tumour resistance to tumour infiltrating lymphocytes, which in turn are needed for response to chemotherapy. Overall, available data support the concept that blockade of PD-L1/PD-1 check-point may improve efficacy of classical chemotherapy. PATIENTS AND METHODS Two-hundred-eighty patients with TNBC were enrolled in this multicentre study (NCT002620280) and randomized to neoadjuvant carboplatin AUC 2 and nab-paclitaxel 125 mg/m2 iv on days 1 and 8, without (N = 142) or with (N = 138) atezolizumab 1200 mg iv on day 1. Both regimens were given q3 weeks for 8 cycles before surgery and 4 cycles of an adjuvant anthracycline regimen. The primary aim of the study is to compare event-free survival, an important secondary aim was the rate of pathological complete remission (pCR defined as absence of invasive cells in breast and lymph nodes). The primary population for all efficacy endpoints is the intention-to-treat population. RESULTS The intention-to-treat analysis revealed that pCR rate after treatment with atezolizumab (48.6%) did not reach statistical significance compared to no atezolizumab [44.4%: odds ratio (OR) 1.18; 95% CI 0.74-1.89; P = 0.48]. Treatment-related adverse events were similar with either regimen except for a significantly higher overall incidence of serious adverse events and liver transaminases abnormalities with atezolizumab. CONCLUSIONS The addition of atezolizumab to nab-paclitaxel and carboplatin did not significantly increase the rate of pCR in women with TNBC. In multivariate analysis the presence of PD-L1 expression was the most significant factor influencing rate of pCR (OR 2.08). Continuing follow up for the event-free survival is ongoing, and molecular studies are under way.
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Affiliation(s)
- L Gianni
- Fondazione Michelangelo, Milano, Italy.
| | - C S Huang
- National Taiwan University Hospital and Taiwan Breast Cancer Consortium, Taipei, Taiwan
| | - D Egle
- Department of Gynecology, Brust Gesundheit Zentrum Tirol, Medical University Innsbruck, Austria
| | - B Bermejo
- Hospital Clinico Universitario, Valencia, Spain
| | - C Zamagni
- Addarii Medical Oncology IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - M Thill
- Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - A Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - E M Ciruelos
- Hospital Universitario 12 de octubre, Madrid, Spain
| | - R Greil
- 3rd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; and Cancer cluster Salzburg, Austria
| | - V Semiglazov
- NN Petrov Research Inst of Oncology, St. Petersburg, Russia
| | - M Colleoni
- IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - C Kelly
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - G Mariani
- Istituto Nazionale Tumori, Milano, Italy
| | - L Del Mastro
- IRCCS Ospedale Policlinico San Martino, UO Breast Unit, Genova, Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Genova - Italy
| | - I Maffeis
- Fondazione Michelangelo, Milano, Italy
| | | | - G Viale
- IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy; University of Milan, Milano, Italy
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Ahmed A, Vandrevala T, Hendy J, Kelly C, Ala A. An examination of how to engage migrants in the research process: building trust through an 'insider' perspective. Ethn Health 2022; 27:463-482. [PMID: 31722534 DOI: 10.1080/13557858.2019.1685651] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Introduction: Ensuring all members of society can equally participate in research and the provision of services is a challenging goal. Increased migration has been mirrored by media narratives of social threat, leaving many migrants feeling differentiated and distrustful of mainstream society.Objectives: We explore how migrant and ethnic minority populations can be given the opportunity to participate in the research process. In this work, we iteratively and jointly developed a range of engagement strategies that adopt an 'insider' approach; seeking to eliminate feelings of differentiation and 'otherness' by establishing mutual trust.Design: Recruitment activities were carried out with 8 focus groups of first-generation South Asian migrants (the largest ethnic minority group in England). Our analysis was grounded in the broad principles of action research with reflective evaluation of our recruitment process using field observations and relevant focus group data; asking whether we tackled barriers to engagement.Results: Our findings show that 'otherness' can be reduced by establishing a trustworthy researcher-community relationship, but also that this relationship is complex, and needs to acknowledge residual mistrust. Alongside, researchers need to enable opportunities for empowered interaction, with flexible strategies to negotiate potential power divides.Conclusions: We can successfully create opportunities for engagement but there is no 'one size fits all'. Engagement requires tailored approaches that embrace flexibility, and position both engagement and non-engagement as positive and empowered choices.
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Affiliation(s)
- Ayesha Ahmed
- Brunel Business School, Brunel University London, London, UK
| | - T Vandrevala
- Department of Psychology, School of Social and Behavioural Sciences, Kingston University, Kingston-Upon-Thames, UK
| | - J Hendy
- Brunel Business School, Brunel University London, London, UK
| | - C Kelly
- Department of Gastroenterology and Hepatology, The Royal Surrey County Hospital NHS Foundation Trust Guildford, Guildford, UK
| | - A Ala
- Department of Gastroenterology and Hepatology, The Royal Surrey County Hospital NHS Foundation Trust Guildford, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Institute of Liver Studies, King's College Hospital London, London, UK
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Kelly C, Lan N, Phan J, Hng C, Matthews A, Rankin J, Dwivedi G, Hillis G, Ihdayhid A. An Evaluation of Standard Modifiable Risk Factor (SMuRF) Prevalence and Preventive Treatment Among Patients ≤45 Years of Age Presenting With ST-Elevation Myocardial Infarction. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.484] [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: 10/16/2022]
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Croft A, Kelly C, Chen D, Murtha L, Sugito S, Boyle A, Sverdlov A, Ngo D. Mechanism(s) for Age-Related Sex Differences in Diet-Induced Cardiomyopathy: Role of RNA Methylation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.043] [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: 10/16/2022]
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Iqbal MS, Uzzaman L, Fox H, Munro S, Kelly C. The impact of COVID-19 on the presentation, stage and management of head and neck cancer patients: A real-time assessment. Clin Otolaryngol 2022; 47:251-253. [PMID: 34651421 PMCID: PMC8652780 DOI: 10.1111/coa.13874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical OncologyNorthern Centre for Cancer CareThe Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Lubna Uzzaman
- Department of Head and Neck SurgeryFreeman HospitalThe Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Hannah Fox
- Department of Head and Neck SurgeryFreeman HospitalThe Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Sam Munro
- Newcastle UniversityNewcastle upon TyneUK
| | - Charles Kelly
- Department of Clinical OncologyNorthern Centre for Cancer CareThe Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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Edmondson RJ, O'Connell RL, Banerjee S, Mileshkin L, Sykes P, Beale P, Fisher A, Bonaventura A, Millan D, Nottley S, Benson C, Hamilton A, Sjoquist K, Alexander L, Kelly C, Carty K, Divers L, Bradshaw N, Friedlander M. Phase 2 study of anastrozole in rare cohorts of patients with estrogen receptor/progesterone receptor positive leiomyosarcomas and carcinosarcomas of the uterine corpus: The PARAGON trial (ANZGOG 0903). Gynecol Oncol 2021; 163:524-530. [PMID: 34625284 DOI: 10.1016/j.ygyno.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aromatase inhibitors have been used empirically to treat a subset of patients with hormone receptor positive uterine leiomyosarcomas(LMS) and carcinosarcomas (UCS) mainly supported by retrospective data. We evaluated the activity of anastrozole in two rare cohorts; patients with recurrent/metastatic LMS and UCS enrolled in PARAGON, a basket trial of anastrozole in estrogen receptor (ER+)/progesterone receptor positive (PR+) gynecological cancers. METHOD An investigator-initiated, single-arm, prospective open-label trial of anastrozole 1 mg/day in patients with ER &/or PR + ve LMS or UCS with measurable disease, treated until progression or unacceptable toxicity. Primary endpoint was clinical benefit (complete/partial response + stable disease) rate (CBR) at 3 months. Secondary endpoints include progression-free survival (PFS), quality of life and toxicity. RESULTS 39 eligible patients were enrolled, 32 with LMS and 7 with UCS. For the LMS cohort CBR at 3 months was 35% (95% CI: 21-53%) with a median duration of clinical benefit of 5.8 months. Best response was a partial response in one patient. Two patients remained on treatment for more than one year. The median progression-free survival was 2.8 months (95% CI: 2.6-4.9). For the UCS cohort CBR at 3 months was 43% (95% CI: 16-75%) with a median duration of clinical benefit of 5.6 months. Stable disease was seen in 3 patients but no objective responses were seen. The median progression-free survival was 2.7 months (95% CI, 1.1-8.2). Safety was acceptable with 5/39 evaluable patients showing grade 3 toxicities. CONCLUSION Whilst objective response rates with anastrozole are low, the clinical benefit rate and good tolerance suggests that aromatase inhibitor therapy may have a role in a subset of patients with metastatic LMS and UCS.
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Affiliation(s)
- R J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK.
| | - R L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L Mileshkin
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - P Sykes
- Dept of Obstetrics and Gynaecology, University of Otago, New Zealand
| | - P Beale
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - A Fisher
- Queen Elizabeth Hospital, Gateshead, UK
| | - A Bonaventura
- School of Medicine & Public Health, University of Newcastle, Australia
| | - D Millan
- Queen Elizabeth University Hospital, Glasgow, UK
| | - S Nottley
- Royal Hospital for Women/Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - C Benson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A Hamilton
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - K Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - L Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - C Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - K Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Divers
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - N Bradshaw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Abstract
AbstractObjectiveTo examine the patterns of care for octogenarian head and neck cancer patients.MethodsAll newly diagnosed patients aged 80 years or older, who presented at our centre between June 2018 and October 2020, were included.ResultsThe total number of patients was 42. The median Charlson Comorbidity Index was 5 (range, 4–9). The larynx was the most common subsite (n = 12). Twenty-nine patients (66 per cent) were diagnosed at disease stage IV. Squamous cell carcinoma was the most common histology (86 per cent). Twenty-six patients (62 per cent) had radical treatment and 16 (38 per cent) had palliative treatment. The estimated six-month and one-year overall survival rates for the radical and palliative treatment cohorts were 92.3 per cent and 42.9 per cent (p = 0.001) and 65.4 per cent and 15.4 per cent (p = 0.003), respectively.ConclusionThis study provides useful information on octogenarian patients with head and neck cancer. This information may help in conducting prospective studies, especially those focusing on older patients with head and neck cancer, in order to define the ideal care of this patient population.
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Affiliation(s)
- Muhammad Shahid Iqbal
- Department of clinical oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United
| | - Carolina Navarro-Rodriguez
- Department of clinical oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United
| | - Sam Munro
- Newcastle University, Newcastle upon Tyne, United
| | - Belgin Ozalp
- Department of geriatric medicine, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United
| | - Charles Kelly
- Department of clinical oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United
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West N, Kelly C, Kovarik J, Iqbal MS. Stereotactic radiotherapy for reirradiation of head and neck cancer: Dosimetric details matter. Head Neck 2021; 44:287-288. [PMID: 34766399 DOI: 10.1002/hed.26925] [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] [Received: 08/24/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nick West
- Department of Radiotherapy Physics, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charles Kelly
- Department of Clinical Oncology, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Josef Kovarik
- Department of Clinical Oncology, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, The Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Honorary Clinical Senior Lecturer, Newcastle University, Newcastle upon Tyne, UK
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Vaughan E, Költő A, Ravikumar D, Kelly C, Nic Gabhainn S. Gender minority youth: Shifting the paradigm from risk to resilience. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Discourse on the lives, health, and well-being of transgender and other gender minority (TGM) youth frequently revolves around narratives of risk and victimisation. While TGM youth undeniably face many challenges, such singular discourses belie a more complex picture of TGM youth lives and problematically position them as passive victims rather than as social subjects with agency.
Methods
The “LGBTI+ Landscape and Knowledge Gap Analysis” aimed to systematically map research evidence on sexual and gender minority (SGM) youth in Ireland and other European countries. A scoping review methodology was employed in which the systematic concept searches were linked to the five outcomes of Ireland's Better Outcomes, Better Futures national youth policy framework, which in turn are aligned with the fifteen objectives of the Irish LGBTI+ National Youth Strategy.
Results
One hundred and twenty-six pieces of evidence were included in the final sample for analysis, which were mapped to the fifteen objectives of the National Youth Strategy. Particular attention was given to the positive aspects and protective factors identified throughout the literature. The evidence showed that while TGM youth disproportionately experience stigma, discrimination and unequal health outcomes, there were sources of resilience at the micro-, meso-, and macro- levels that serve as protective factors against health inequalities.
Conclusions
Discourse that focuses exclusively on the ‘at-riskness' of trans and gender minority young people presents a one-dimensional perspective that fails to capture the reality and richness of their lives. Over-emphasising individual risk factors may obscure the structural and social factors that underpin the health inequalities experienced by TGM youth.
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Affiliation(s)
- E Vaughan
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - A Költő
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - D Ravikumar
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - C Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - S Nic Gabhainn
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
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Ravikumar D, Nic Gabhann S, Kelly C. A systematic review of the determinants of the nutritional quality of food for homeless populations. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Studies assessing the nutritional quality of food provided to homeless population show deficiencies in micronutrients and excess fat, sugar and salt. The availability of cheap, energy-dense and nutrient poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homelessness population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise qualitative literature with the aim of understanding of the determinants of the nutritional quality of food provided to the homeless population.
Methods
This qualitative evidence synthesis will include English language primary research empirical studies from Europe, North America and Oceania. Searches will be conducted on Web of Science, CINAHL, Embase, Scopus, PsycINFO, Google Scholar, OpenGrey and ProQuest. Quality appraisal will be conducted using the Standards for Reporting Qualitative Research tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts.
Results
Demographic data on study participants and findings and quotations will be extracted. Thematic synthesis will be employed. Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this presentation.
Conclusions
Findings from this review will be used to develop best-practice guidelines for policy makers and service providers to improve the nutritional quality of food provided in the homeless sector.
Key messages
The determinants of the nutritional quality of food provided to the homeless population are influenced by multiple factors. This review will provide a comprehensive assessment of these determinants. This presentation will detail the iterative steps undertaken to conduct this systematic review.
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Affiliation(s)
- D Ravikumar
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - S Nic Gabhann
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - C Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
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Kelly C, O'Connell E. SARS-CoV-2 in a long-term care facility: lessons learnt and importance of repeated mass testing. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The COVID-19 pandemic has had a devastating impact on long-term care facilities worldwide. Reflecting on public health management of COVID-19 outbreaks in these settings is crucial to identify lessons learnt and improve outbreak control strategies for the future. A confirmed case of COVID-19 in a private nursing home facility was notified to the Department of Public Health West on December 30th 2020. Immediate actions included case investigation, contact tracing, implementation of infection prevention and control (IPC) measures and mass testing of all residents and staff. On December 31st 2 more confirmed cases were notified. A multidisciplinary outbreak control team was convened. Testing of SARS-CoV-2 samples was via reverse transcription polymerase chain reaction. IPC site visits were made. Seven further mass testing rounds were completed at 5-7-day intervals. Data collation and descriptive analyses were performed using Microsoft Excel. There were 56 laboratory-confirmed COVID-19 cases associated with the outbreak (28 residents, 28 staff). Overall attack rate was 52.8% (66.7% for residents, 44.0% for staff). Over half of all cases (51.7%) were detected from the first and second mass testing rounds (positivity rates 34.2% and 27.8% respectively) in the first week of the outbreak. Mean age of resident cases was 81.5 years. The majority (96.4%) were symptomatic (diarrhoea 64.3%, fever 57.1% and anorexia 25%). Hospitalisation and case fatality rates for residents were 21.4% and 41.4% respectively. Mean age of staff cases was 35.5 years. One-quarter were asymptomatic, with no hospitalisations or deaths. The outbreak was declared over on February 16th 2021. Residents of long-term care facilities are extremely vulnerable to COVID-19. Mass testing is a critically important outbreak control strategy which can facilitate rapid case finding and contact tracing in these settings, minimising the potential for further spread of infection and harm to residents and staff.
Key messages
Residents of long-term care facilities are extremely vulnerable to COVID-19, and may present with atypical clinical symptoms and signs of this disease. A low threshold for testing is required. Mass testing is a crucial COVID-19 outbreak control strategy in long-term care facilities to enable rapid case finding and contact tracing, minimising the potential for further spread of infection.
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Affiliation(s)
- C Kelly
- Department of Public Health, Health Service Executive West, Galway, Ireland
| | - E O'Connell
- Department of Public Health, Health Service Executive West, Galway, Ireland
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Ravikumar D, Spyreli E, Woodside J, McKinley M, Kelly C. A rapid review of factors influencing food decisions among economically disadvantaged families. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The importance of external and household family food environments in establishing healthy eating habits during childhood is well reported. Deprived areas are at a nutritional disadvantage due to the high prevalence of fast food outlets and convenience stores. Little is known about the impact of food environments on food-related behaviours of low-income families. This rapid review aimed to synthesise available qualitative evidence on parental perspectives of environmental factors that influence food planning, purchasing and processing among economically disadvantaged families with children.
Methods
This review included qualitative and mixed-methods studies published after 2000 from Europe, North America and Oceania. Search strategies included seven concepts: family, food, perceptions, influences, environment, socio-economic status and study type. Thematic synthesis was employed.
Results
Fourteen articles from the USA, Australia and the UK remained following screening by two reviewers. All parents had a desire to provide healthy food for their children, but they were impeded by child food preferences and beliefs about food behaviours and nutrition. In the external environment, food outlets/availability, cost and marketing influenced food choices amongst parents. Social determinants had a dominant negative influence on food decisions, including hectic daily schedules and time constraints and most importantly limited finances. Social support and support from nutrition programmes and cooking interventions had a positive influence on family food decisions.
Conclusions
This synthesis of qualitative evidence highlights the challenges and opportunities that low-income parents face to feed their families. Improvements in parental food choices and feeding behaviours can only be improved if inequities in health, such as access to affordable healthy food, are addressed.
Key messages
This review concluded that income, time constraints, food cost and limited food availability/outlets can have a negative effect on family food decisions. Social supports such as cooking programmes play a positive role in ensuring healthy food options for families.
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Affiliation(s)
- D Ravikumar
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - E Spyreli
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - J Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - M McKinley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - C Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
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Kelly C, Fitzpatrick P, Quinn C, Flanagan F, Connors A, Larke A, Mooney T, O'Doherty A. Ductal Carcinoma in Situ in Ireland, 2008-2020: Screening Data related to Low-Risk Management Trials. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Four clinical trials are on-going to determine if active surveillance is a feasible management option for patients with low-risk ductal carcinoma in situ (DCIS), in response to concerns that breast cancer screening programmes have increased the incidence of DCIS, some of which may never progress to invasive cancer. This study aimed to describe the epidemiology of screen-detected DCIS in Ireland through the BreastCheck, the national breast screening programme in Ireland (commenced 2000 but fully national since 2008).
Methods
This was a cross-sectional analysis of anonymised BreastCheck data provided by the National Screening Service, including all cases of screen-detected DCIS between 2008 and 2020. Statistical tests included Mann-Whitney U, Chi square, and multivariable logistic regression.
Results
2,240 women were diagnosed with DCIS through BreastCheck between 2008 and 2020 (1353 (60.4%) high-grade and 876 (39.1%) low/intermediate grade). The overall rate of screen-detected DCIS incidence has remained relatively stable during this time. Women with high- grade DCIS were older than women with low/intermediate DCIS (57 (IQR 53-61) years v 56 (IQR 56-61) years; p < 0.001). They were also more likely to have been diagnosed at a subsequent screening episode than at an initial episode (71.0% v 57.5%; p < 0.001). After adjustment (deprivation score, screening unit and year) the odds ratio for high-grade was 1.62 (95% CI 1.30-2.03; p < 0.001) for subsequent compared with initial screening episode.
Conclusions
When trial results are available, these data will assist with service planning should active surveillance be approved as a management option. Based on trial inclusion criteria, up to 40% of women diagnosed with DCIS through BreastCheck may be eligible for consideration for active surveillance. These women are younger and often diagnosed on initial screening episode, so may require longer active follow-up.
Key messages
Majority of DCIS in national screening programme is high grade. Randomised controlled trial evidence will provide guidance on management of low-risk DCIS.
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Affiliation(s)
- C Kelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Department of Public Health North East, Health Service Executive, Navan, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- National Screening Service, Dublin, Ireland
| | - C Quinn
- BreastCheck, National Screening Service, Dublin, Ireland
| | - F Flanagan
- BreastCheck, National Screening Service, Dublin, Ireland
| | - A Connors
- BreastCheck, National Screening Service, Dublin, Ireland
| | - A Larke
- BreastCheck, National Screening Service, Dublin, Ireland
| | - T Mooney
- National Screening Service, Dublin, Ireland
| | - A O'Doherty
- BreastCheck, National Screening Service, Dublin, Ireland
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Abstract
Introduction The COVID-19 pandemic has had an inordinate influence on people's lives, including impacts on food behaviours. This study explored the impacts of the COVID-19 crisis and ensuing public health restrictions on food-related practices of families living on a tight budget on the Island of Ireland. Methods Photovoice and creative mapping methods were used whereby parents were requested to take photos of factors influencing food-related decisions and draw maps of their food environments. These items were then used during qualitative interviews with 28 parents from across the Island of Ireland as a reference for discussions around the food environment and food decision-making processes of economically disadvantaged parents. Data were analysed using deductive thematic analysis. Results The findings were situated in Bronfenbrenner's Social Ecological Theoretical framework, conceptualising the COVID-19 crisis as an exogenous socio-historical factor that exerted significant influence on the food-related practices of families in Ireland. The pandemic and responses to it altered patterns of food purchasing, preparation, decision-making and consumption. Changes to practices included increased unhealthy snacking and grazing and consuming fewer meals outside the home. Participants on particularly low incomes relied more on benefits and subsidised food sources and consumed more cheap, processed and frozen foods. Conclusions This study provides insight into the impacts of the COVID-19 crisis on dietary habits. The observed changes to food practices may compound food insecurity and already high levels of obesity, particularly among children and young people, and have future implications on prevalence of nutrition-related conditions. This highlights the need for healthcare professionals and policy-makers to be cognisant of the mounting health issues that will need to be addressed in the wake of COVID-19. Key messages The COVID-19 crisis significantly impacted on family food related behaviours in Ireland. Post-COVID health promoters should re-focus efforts on healthy eating initiatives.
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Affiliation(s)
- E Vaughan
- Health Promotion Research Centre, NUI Galway, Galway, Ireland
| | - E Spyreli
- Centre for Public Health, Queen's University, Belfast, UK
| | - J Woodside
- Centre for Public Health, Queen's University, Belfast, UK
| | - M McKinley
- Centre for Public Health, Queen's University, Belfast, UK
| | - C Kelly
- Health Promotion Research Centre, NUI Galway, Galway, Ireland
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50
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Nic Gabhainn S, Gavin A, Kelly C, Hanafin S. Long-term research impact: the case of adolescents having ‘good places to spend free time’ in Ireland. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Demonstrating long-term impacts of research can be fraught with methodological challenges, especially when approached retrospectively. Potential accusations of bias or over-interpretation, and a lack of clear and specific causal data, can be real obstacles. This paper presents a case study of research impact, including enablers and context to aid interpretation. To develop a national set of child wellbeing indicators in line with UNCRC commitments, a participative study of children's understandings of wellbeing was undertaken to accompany a Delphi study with experts. The children contributed a number of unique indicators, including having ‘good places to spend free time'.
Methods
Public actions which aimed to meet Irish commitments to child wellbeing were documented. Collected evidence comprised the development of, and reporting on, a national set of wellbeing indictors for children, the development and implementation of two national policies and cyclical monitoring data, collected through the nationally representative data sets of the Health Behaviour in School-aged Children (HBSC) study in Ireland, 2002-2018.
Results
Measurement of stakeholder-informed indicators helped stimulate national policies on play (2004) and recreation (2007). Partnership-based policy implementation led to increases in spaces for play and recreation. Trends data from the HBSC study revealed significant and meaningful increases in ‘good places to go spend free time' for children aged 10-17 from 45.1% in 2002 to 63.5% in 2018, and for all socio-demographic sub-groups. Temporal analyses showed that increases followed policy implementation.
Conclusions
This impact case study links an original participative study, though policy development and implementation, to long-term improvements in Irish children reporting having ‘good places to spend free time'. An understanding of the decision-making context at key points is important to aid interpretation of the evidence under investigation.
Key messages
Commitment to child participation influenced national indicator adoption, policy development and implementation, with subsequent improvements to children’s health-related environments. The quality and specificity of data needed to demonstrate long-term research impact is challenging and interpretation requires contextualisation to avoid leaps of faith.
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Affiliation(s)
- S Nic Gabhainn
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - A Gavin
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - C Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - S Hanafin
- Research Matters, Research Matters, Tipperary, Ireland
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