1
|
Fisher G, Quel de Oliveira C, Stubbs PW, Power E, Checketts M, Porter-Armstrong A, Kennedy DS. Spatial Neglect: An Exploration of Clinical Assessment Behaviour in Stroke Rehabilitation. Clin Rehabil 2024; 38:688-699. [PMID: 38347746 PMCID: PMC11005297 DOI: 10.1177/02692155241230270] [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: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area. DESIGN Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment. SETTING Online stroke rehabilitation educational bootcamp. PARTICIPANTS A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp. INTERVENTION Prior to their focus group, participants watched an hour-long educational session about spatial neglect. MAIN MEASURES A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area. RESULTS Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools. CONCLUSIONS Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice.
Collapse
Affiliation(s)
- Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Emma Power
- Discipline of Speech Pathology, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Matthew Checketts
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alison Porter-Armstrong
- Healthcare Technology Innovation and Assessment in the School of Health and Social Care, Edinburgh Napier University, Scotland, UK
| | - David S Kennedy
- Motion and Mobility Rehabilitation Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| |
Collapse
|
2
|
Basnet R, Mendez DR, Lugo-González I, O'Hagan E, O'Keeffe M, Sharma S, Pate JW, Kennedy DS. Online information on chronic pain in 3 countries: an assessment of readability, credibility, and accuracy. Pain Rep 2023; 8:e1078. [PMID: 37342519 PMCID: PMC10278708 DOI: 10.1097/pr9.0000000000001078] [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: 01/12/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To assess the readability, credibility, and accuracy of online information on chronic pain in Australia, Mexico, and Nepal. Methods We assessed Google-based websites and government health websites about chronic pain for readability (using the Flesch Kincaid Readability Ease tool), credibility (using the Journal of American Medical Association [JAMA] benchmark criteria and Health on the Net Code [HONcode]), and accuracy (using 3 core concepts of pain science education: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overactive pain system). Results We assessed 71 Google-based websites and 15 government websites. There were no significant between-country differences in chronic pain information retrieved through Google for readability, credibility, or accuracy. Based on readability scores, the websites were "fairly difficult to read," suitable for ages 15 to 17 years or grades 10 to 12 years. For credibility, less than 30% of all websites met the full JAMA criteria, and more than 60% were not HONcode certified. For accuracy, all 3 core concepts were present in less than 30% of websites. Moreover, we found that the Australian government websites have low readability but are credible, and the majority provided all 3 core concepts in pain science education. A single Mexican government website had low readability without any core concepts but was credible. Conclusion The readability, credibility, and accuracy of online information on chronic pain should be improved internationally to support facilitating better management of chronic pain.
Collapse
Affiliation(s)
- Ritu Basnet
- Scheer Memorial Adventist Hospital, Benepa, Nepal
| | - David Ruiz Mendez
- Iztacala Faculty of Superior Studies, National Autonomous University of México, Tlalnepantla de Baz, Mexico
| | - Isaías Lugo-González
- Iztacala Faculty of Superior Studies, National Autonomous University of México, Tlalnepantla de Baz, Mexico
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Mary O'Keeffe
- School of Public Health, Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Joshua W. Pate
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - David S. Kennedy
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Motion and Mobility Research Laboratory, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
3
|
Rahman M, Khan SR, Alamgir ASM, Kennedy DS, Hakim F, Evers ES, Afreen N, Alam AN, Islam MS, Paul D, Bhuiyan R, Islam R, Moureen A, Salimuzzaman M, Billah MM, Sharif AR, Akter MK, Sultana S, Khan MH, von Harbou K, Zaman MM, Shirin T, Flora MS. Seroprevalence of SARS-CoV-2 antibodies among Forcibly Displaced Myanmar Nationals in Cox's Bazar, Bangladesh 2020: a population-based cross-sectional study. BMJ Open 2022; 12:e066653. [PMID: 36410810 PMCID: PMC9679871 DOI: 10.1136/bmjopen-2022-066653] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The study aimed to determine the seroprevalence, the fraction of asymptomatic infections, and risk factors of SARS-CoV-2 infections among the Forcibly Displaced Myanmar Nationals (FDMNs). DESIGN It was a population-based two-stage cross-sectional study at the level of households. SETTING The study was conducted in December 2020 among household members of the FDMN population living in the 34 camps of Ukhia and Teknaf Upazila of Cox's Bazar district in Bangladesh. PARTICIPANTS Among 860 697 FDMNs residing in 187 517 households, 3446 were recruited for the study. One individual aged 1 year or older was randomly selected from each targeted household. PRIMARY AND SECONDARY OUTCOME MEASURES Blood samples from respondents were tested for total antibodies for SARS-CoV-2 using Wantai ELISA kits, and later positive samples were validated by Kantaro kits. RESULTS More than half (55.3%) of the respondents were females, aged 23 median (IQR 14-35) years and more than half (58.4%) had no formal education. Overall, 2090 of 3446 study participants tested positive for SARS-CoV-2 antibody. The weighted and test adjusted seroprevalence (95% CI) was 48.3% (45.3% to 51.4%), which did not differ by the sexes. Children (aged 1-17 years) had a significantly lower seroprevalence 38.6% (95% CI 33.8% to 43.4%) compared with adults (58.1%, 95% CI 55.2% to 61.1%). Almost half (45.7%, 95% CI 41.9% to 49.5%) of seropositive individuals reported no relevant symptoms since March 2020. Antibody seroprevalence was higher in those with any comorbidity (57.8%, 95% CI 50.4% to 64.5%) than those without (47.2%, 95% CI 43.9% to 50.4%). Multivariate logistic regression analysis of all subjects identified increasing age and education as risk factors for seropositivity. In children (≤17 years), only age was significantly associated with the infection. CONCLUSIONS In December 2020, about half of the FDMNs had antibodies against SARS-CoV-2, including those who reported no history of symptoms. Periodic serosurveys are necessary to recommend appropriate public health measures to limit transmission.
Collapse
Affiliation(s)
- Mahbubur Rahman
- Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Samsad Rabbani Khan
- Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - A S M Alamgir
- Virology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - David S Kennedy
- WHO Emergency Sub-Office, World Health Organization, Cox's Bazar, Bangladesh
| | - Ferdous Hakim
- Research and Publication, World Health Organization Bangladesh, Dhaka, Bangladesh
| | - Egmond Samir Evers
- WHO Emergency Sub-Office, World Health Organization, Cox's Bazar, Bangladesh
| | - Nawroz Afreen
- Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Ahmed Nawsher Alam
- Virology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Md Sahidul Islam
- Research and Publication, World Health Organization Bangladesh, Dhaka, Bangladesh
| | - Debashish Paul
- WHO Emergency Sub-Office, World Health Organization, Cox's Bazar, Bangladesh
| | - Rijwan Bhuiyan
- Co-ordination Center, Ministry of Health and Family Welfare, Cox's Bazar, Bangladesh
| | - Raisul Islam
- WHO Emergency Sub-Office, World Health Organization, Cox's Bazar, Bangladesh
| | - Adneen Moureen
- IEDCR Field Laboratory, World Health Organization, Cox's Bazar, Bangladesh
| | - M Salimuzzaman
- Zoonosis, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Mallick Masum Billah
- Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Ahmed Raihan Sharif
- Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Mst Khaleda Akter
- Research and Publication, World Health Organization Bangladesh, Dhaka, Bangladesh
| | - Sharmin Sultana
- Virology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Manjur Hossain Khan
- Virology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - Kai von Harbou
- WHO Emergency Sub-Office, World Health Organization, Cox's Bazar, Bangladesh
| | | | - Tahmina Shirin
- Director, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | | |
Collapse
|
4
|
Kneebone II, Van Zanden BE, Dorstyn DS, Roberts RM, Lord SR, Querstret D, Theadom A, Kennedy DS, Raman J, Nair RD. Relaxation and related therapies for people with multiple sclerosis (MS): A systematic review. Clin Rehabil 2022; 36:883-899. [PMID: 35410503 DOI: 10.1177/02692155221091509] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish the effectiveness of relaxation and related therapies in treating Multiple Sclerosis related symptoms and sequelae. DATA SOURCES PsycINFO, PubMed, Embase, CINAHL, ProQuest Dissertations and Theses Global databases were searched. METHODS We included studies from database inception until 31 December 2021 involving adult participants diagnosed with multiple sclerosis or disseminated sclerosis, which featured quantitative data regarding the impact of relaxation interventions on multiple sclerosis-related symptoms and sequelae. Studies which examined multi-modal therapies - relaxation delivered in combination with non-relaxation interventions - were excluded. Risk of bias was assessed using the Revised Risk of Bias tool for randomised trials - ROB2, Risk of Bias in Non-Randomised Studies of Interventions ROBINS-I), and within and between-group effects were calculated (Hedges' g). RESULTS Twenty-eight studies met inclusion criteria. Twenty-three of these were randomised controlled trials, with 1246 total participants. This review reports on this data, with non-randomised study data reported in supplemental material. Post -intervention relaxation was associated with medium to large effect-size improvement for depression, anxiety, stress and fatigue. The effects of relaxation were superior to wait-list or no treatment control conditions; however, comparisons with established psychological or physical therapies were mixed. Individual studies reported sustained effects (≤ 6 months) with relaxation for stress, pain and quality of life. Most studies were rated as having a high/serious risk of bias. CONCLUSION There is emerging evidence that relaxation therapies can improve outcomes for persons with multiple sclerosis. Given the high risk of bias found for included studies, stronger conclusions cannot be drawn.
Collapse
Affiliation(s)
- Ian I Kneebone
- Graduate School of Health, 1994University of Technology Sydney, Australia
| | | | - Diana S Dorstyn
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Rachel M Roberts
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Stephen R Lord
- Neuroscience Research Australia (NeuRA), University of New South Wales, Australia
| | - Dawn Querstret
- Faculty of Health, Sport and Applied Science, St Mary's University, UK
| | - Alice Theadom
- Department of Psychology, School of Clinical Sciences, 1410Auckland University of Technology, New Zealand
| | - David S Kennedy
- Graduate School of Health, 1994University of Technology Sydney, Australia
| | - Jay Raman
- Graduate School of Health, 1994University of Technology Sydney, Australia.,School of Psychological Sciences, 5982University of Newcastle, Australia
| | - Roshan das Nair
- Faculty of Medicine & Health Sciences, 6123University of Nottingham, UK
| |
Collapse
|
5
|
Kennedy DS, Vu VK, Ritchie H, Bartlein R, Rothschild O, Bausch DG, Roser M, Seale AC. COVID-19: Identifying countries with indicators of success in responding to the outbreak. Gates Open Res 2021; 4:62. [PMID: 34703986 PMCID: PMC8515014 DOI: 10.12688/gatesopenres.13140.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
Background: In designing responses to the COVID-19 pandemic, it is critical to understand what has already worked well. We aimed to identify countries with emerging success stories from whom policymakers might draw important lessons. Methods: We developed a process to first include countries with large enough populations that results were unlikely to be due to chance, that had sufficient cases for response mechanisms to be tested, and that shared the necessary publicly available data. Within these countries, we looked at indicators suggesting success in terms of detecting disease, containing the outbreak, and treating those who were unwell. To support comparability, we measured indicators per capita (per million) and across time. We then used the indicators to identify three countries with emerging success stories to include some diversity in global region, population demographics and form of government. Results: We identified 66 countries that met our inclusion criteria on 18 th May 2020. Several of these countries had indicators of success against the set indicators at different times in the outbreak. Vietnam had high levels of testing and successful containment with no deaths reported. South Korea had high levels of testing early in the outbreak, supporting containment. Germany had high levels of sustained testing and slower increases in cases and deaths than seen in other comparable settings. Conclusions: At the time of our assessment, Vietnam and South Korea were able to contain the outbreak of COVID-19 and avoid the exponential growth in cases seen elsewhere. Germany had more cases and deaths, but was nevertheless able to contain and mitigate the outbreak. Despite the many limitations to the data currently available, looking at comparative data can help identify countries from whom we can draw lessons, so that countries can inform and adapt their strategies for success in response to COVID-19.
Collapse
Affiliation(s)
- David S. Kennedy
- UK-Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/ Public Health England, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - VK Vu
- The Bill & Melinda Gates Foundation, Seattle, USA
| | - Hannah Ritchie
- Our World in Data, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | | | | | - Daniel G. Bausch
- UK-Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/ Public Health England, London, UK
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Max Roser
- Our World in Data, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | - Anna C. Seale
- UK-Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/ Public Health England, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
6
|
Collins J, Westerveld R, Nelson KA, Rohan H, Bower H, Lazenby S, Ikilezi G, Bartlein R, Bausch DG, Kennedy DS. 'Learn from the lessons and don't forget them': identifying transferable lessons for COVID-19 from meningitis A, yellow fever and Ebola virus disease vaccination campaigns. BMJ Glob Health 2021; 6:bmjgh-2021-006951. [PMID: 34535490 PMCID: PMC8450956 DOI: 10.1136/bmjgh-2021-006951] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever) and rVSV-ZEBOV (Ebola virus disease). METHODS We conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants' experiences. Interview data were analysed thematically according to seven implementation domains. RESULTS Participants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities. CONCLUSION As supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.
Collapse
Affiliation(s)
- Julie Collins
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | - Rosie Westerveld
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate A Nelson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hana Rohan
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | - Hilary Bower
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | | | | | | | - Daniel G Bausch
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| | - David S Kennedy
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, UK
| |
Collapse
|
7
|
Avokpaho EFGA, Houngbégnon P, Accrombessi M, Atindégla E, Yard E, Rubin Means A, Kennedy DS, Littlewood DTJ, Garcia A, Massougbodji A, Galagan SR, Walson JL, Cottrell G, Ibikounlé M, Ásbjörnsdóttir KH, Luty AJF. Factors associated with soil-transmitted helminths infection in Benin: Findings from the DeWorm3 study. PLoS Negl Trop Dis 2021; 15:e0009646. [PMID: 34403424 PMCID: PMC8396766 DOI: 10.1371/journal.pntd.0009646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/27/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background Despite several years of school-based MDA implementation, STH infections remain an important public health problem in Benin, with a country-wide prevalence of 20% in 2015. The DeWorm3 study is designed to assess the feasibility of using community-based MDA with albendazole to interrupt the transmission of STH, through a series of cluster-randomized trials in Benin, India and Malawi. We used the pre-treatment baseline survey data to describe and analyze the factors associated with STH infection in Comé, the study site of the DeWorm3 project in Benin. These data will improve understanding of the challenges that need to be addressed in order to eliminate STH as a public health problem in Benin. Methods Between March and April 2018, the prevalence of STH (hookworm spp., Ascaris and Trichuris trichiura) was assessed by Kato-Katz in stool samples collected from 6,153 residents in the community of Comé, Benin using a stratified random sampling procedure. A standardized survey questionnaire was used to collect information from individual households concerning factors potentially associated with the presence and intensity of STH infections in pre-school (PSAC, aged 1–4), school-aged children (SAC, aged 5–14) and adults (aged 15 and above). Multilevel mixed-effects models were used to assess associations between these factors and STH infection. Results The overall prevalence of STH infection was 5.3%; 3.2% hookworm spp., 2.1% Ascaris lumbricoides and 0.1% Trichuris. Hookworm spp. were more prevalent in adults than in SAC (4.4% versus 2.0%, respectively; p = 0.0001) and PSAC (4.4% versus 1.0%, respectively; p<0.0001), whilst Ascaris lumbricoides was more prevalent in SAC than in adults (3.0% versus 1.7%, respectively; p = 0.004). Being PSAC (adjusted Odds Ratio (aOR) = 0.2, p< 0.001; adjusted Infection Intensity Ratio (aIIR) = 0.1, p<0.001) or SAC (aOR = 0.5, p = 0.008; aIIR = 0.3, p = 0.01), being a female (aOR = 0.6, p = 0.004; aIIR = 0.3, p = 0.001), and having received deworming treatment the previous year (aOR = 0.4, p< 0.002; aIIR = 0.2, p<0.001) were associated with a lower prevalence and intensity of hookworm infection. Lower income (lowest quintile: aOR = 5.0, p<0.001, 2nd quintile aOR = 3.6, p = 0.001 and 3rd quintile aOR = 2.5, p = 0.02), being a farmer (aOR = 1.8, p = 0.02), medium population density (aOR = 2.6, p = 0.01), and open defecation (aOR = 0.5, p = 0.04) were associated with a higher prevalence of hookworm infection. Lower education—no education, primary or secondary school- (aIIR = 40.1, p = 0.01; aIIR = 30.9, p = 0.02; aIIR = 19.3, p = 0.04, respectively), farming (aIIR = 3.9, p = 0.002), natural flooring (aIIR = 0.2, p = 0.06), peri-urban settings (aIIR = 6.2, 95%CI 1.82–20.90, p = 0.003), and unimproved water source more than 30 minutes from the household (aIIR = 13.5, p = 0.02) were associated with a higher intensity of hookworm infection. Improved and unshared toilet was associated with lower intensity of hookworm infections (aIIR = 0.2, p = 0.01). SAC had a higher odds of Ascaris lumbricoides infection than adults (aOR = 2.0, p = 0.01) and females had a lower odds of infection (aOR = 0.5, p = 0.02). Conclusion Hookworm spp. are the most prevalent STH in Comé, with a persistent reservoir in adults that is not addressed by current control measures based on school MDA. Expanding MDA to target adults and PSAC is necessary to substantially impact population prevalence, particularly for hookworm. Trial registration ClinicalTrials.gov NCT03014167. Despite several years of deworming campaigns targeting school-aged children, soil-transmitted helminths (STH) remains a public health problem in most developing countries, including Benin. The burden is mostly on children and pregnant women, but also on the whole society. Soil-transmitted helminths are responsible for malnutrition, anemia, low birth weight, cognitive impairment, decrease of school performance, and subsequently economic loss. The current strategy of the Benin National Neglected Tropical Diseases (NTD) Program is to achieve STH control through mass drug administration campaigns targeting school-aged children (SAC). The baseline data of Deworm3 study, implemented in Comé, southern Benin, as part of a multicountry (Benin, Malawi and India) STH elimination trial, shows that previous school deworming campaigns decreased STH prevalence; however there is a persistent reservoir of STH infection in adults and pre-school aged children that should be targeted for a better impact. In order to eliminate STH as a public health problem, Benin National NTD Program would need to increase its target population, from the SAC to the whole community. The future results of Deworm3 trial would demonstrate whether the STH elimination goal STH using community wide mass drug administration would be achievable.
Collapse
Affiliation(s)
- Euripide F. G. A. Avokpaho
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
- Université de Paris, ED 393 Pierre Louis de Santé Publique, Paris, France
- * E-mail:
| | | | - Manfred Accrombessi
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eloïc Atindégla
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Elodie Yard
- DeWorm3, Department of Life Sciences, Natural History Museum, London, United Kingdom
| | - Arianna Rubin Means
- DeWorm3, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - David S. Kennedy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- DeWorm3, Department of Life Sciences, Natural History Museum, London, United Kingdom
| | | | | | | | - Sean R. Galagan
- DeWorm3, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Judd L. Walson
- DeWorm3, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
- Centre de Recherche pour la lutte contre les Maladies Infectieuses Tropicales (CReMIT/TIDRC), Université d’Abomey-Calavi, Abomey-Calavi, Bénin
| | - Kristjana Hrönn Ásbjörnsdóttir
- DeWorm3, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Centre for Public Health Sciences, University of Iceland, Reykjavík, Iceland
| | | |
Collapse
|
8
|
Crothers E, Kennedy DS, Emmanuel S, Molan N, Scott S, Rogers K, Glanville AR, Ntoumenopoulos G. Incidence of early diaphragmatic dysfunction after lung transplantation: results of a prospective observational study. Clin Transplant 2021; 35:e14409. [PMID: 34192380 DOI: 10.1111/ctr.14409] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diaphragmatic dysfunction is common after cardiothoracic surgery, but few studies report its incidence and consequences after lung transplantation. We aimed to estimate the incidence of diaphragmatic dysfunction using ultrasound in lung transplant patients up to 3 months postoperatively and evaluated the impact on clinical outcomes. METHODS This was a single-center prospective observational cohort study of 27 lung transplant recipients using diaphragmatic ultrasound preoperatively, at 1 day, 1 week, 1 month, and 3 months postoperatively. Diaphragmatic dysfunction was defined as excursion < 10 mm in men and < 9 mm in women during quiet breathing. Clinical outcomes measured included duration of mechanical ventilation, length of stay (LOS) in Intensive Care (ICU), and hospital LOS. RESULTS Sixty-two percentage of recipients experienced new, postoperative diaphragmatic dysfunction, but the prevalence fell to 22% at 3 months. No differences in clinical outcomes were found between those with diaphragmatic dysfunction compared to those without. Patients who experienced diaphragmatic dysfunction at 1 day postoperatively were younger and had a lower BMI than those who did not. CONCLUSIONS Diaphragmatic dysfunction is common after lung transplant, improves significantly within 3 months, and did not impact negatively on duration of mechanical ventilation, LOS in ICU or hospital, or discharge destination.
Collapse
Affiliation(s)
- Elise Crothers
- Department of Physiotherapy, St Vincent's Hospital, Sydney, Australia.,Graduate School of Health, University of Technology, Sydney, Australia
| | - David S Kennedy
- Graduate School of Health, University of Technology, Sydney, Australia
| | - Sam Emmanuel
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Nikki Molan
- Department of Anesthetics, St Vincent's Hospital, Sydney, Australia
| | - Sean Scott
- Department of Intensive Care, St Vincent's Hospital, Sydney, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology, Sydney, Australia.,The George Institute for Global Health, Newtown, Australia
| | - Allan R Glanville
- Department of Lung Transplantation, St Vincent's Hospital, Sydney, Australia
| | | |
Collapse
|
9
|
Witek-McManus S, Simwanza J, Chisambi AB, Kepha S, Kamwendo Z, Mbwinja A, Samikwa L, Oswald WE, Kennedy DS, Timothy JWS, Legge H, Galagan SR, Emmanuel-Fabula M, Schaer F, Ásbjörnsdóttir K, Halliday KE, Walson JL, Juziwelo L, Bailey RL, Kalua K, Pullan RL. Epidemiology of soil-transmitted helminths following sustained implementation of routine preventive chemotherapy: Demographics and baseline results of a cluster randomised trial in southern Malawi. PLoS Negl Trop Dis 2021; 15:e0009292. [PMID: 33979325 PMCID: PMC8224978 DOI: 10.1371/journal.pntd.0009292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Abstract
Malawi has successfully leveraged multiple delivery platforms to scale-up and sustain the implementation of preventive chemotherapy (PCT) for the control of morbidity caused by soil-transmitted helminths (STH). Sentinel monitoring demonstrates this strategy has been successful in reducing STH infection in school-age children, although our understanding of the contemporary epidemiological profile of STH across the broader community remains limited. As part of a multi-site trial evaluating the feasibility of interrupting STH transmission across three countries, this study aimed to describe the baseline demographics and the prevalence, intensity and associated risk factors of STH infection in Mangochi district, southern Malawi. Between October-December 2017, a community census was conducted across the catchment area of seven primary healthcare facilities, enumerating 131,074 individuals across 124 villages. A cross-sectional parasitological survey was then conducted between March-May 2018 in the censused area as a baseline for a cluster randomised trial. An age-stratified random sample of 6,102 individuals were assessed for helminthiasis by Kato-Katz and completed a detailed risk-factor questionnaire. The age-cluster weighted prevalence of any STH infection was 7.8% (95% C.I. 7.0%-8.6%) comprised predominantly of hookworm species and of entirely low-intensity infections. The presence and intensity of infection was significantly higher in men and in adults. Infection was negatively associated with risk factors that included increasing levels of relative household wealth, higher education levels of any adult household member, current school attendance, or recent deworming. In this setting of relatively high coverage of sanitation facilities, there was no association between hookworm and reported access to sanitation, handwashing facilities, or water facilities. These results describe a setting that has reduced the prevalence of STH to a very low level, and confirms many previously recognised risk-factors for infection. Expanding the delivery of anthelmintics to groups where STH infection persist could enable Malawi to move past the objective of elimination of morbidity, and towards the elimination of STH. Trial registration: NCT03014167.
Collapse
Affiliation(s)
- Stefan Witek-McManus
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - James Simwanza
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alvin B. Chisambi
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Stella Kepha
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
- Pwani University Bioscience Research Centre, Pwani University, Kilifi, Kenya
| | - Zachariah Kamwendo
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alfred Mbwinja
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lyson Samikwa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - William E. Oswald
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David S. Kennedy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph W. S. Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hugo Legge
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sean R. Galagan
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Fabian Schaer
- DeWorm3, Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Kristjana Ásbjörnsdóttir
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Katherine E. Halliday
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine and Department of Paediatrics, University of Washington, Seattle, Washington, United States of America
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health & Population, Lilongwe, Malawi
| | - Robin L. Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rachel L. Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
10
|
Ajjampur SSR, Kaliappan SP, Halliday KE, Palanisamy G, Farzana J, Manuel M, Abraham D, Laxmanan S, Aruldas K, Rose A, Kennedy DS, Oswald WE, Pullan RL, Galagan SR, Ásbjörnsdóttir K, Anderson RM, Muliyil J, Sarkar R, Kang G, Walson JL. Epidemiology of soil transmitted helminths and risk analysis of hookworm infections in the community: Results from the DeWorm3 Trial in southern India. PLoS Negl Trop Dis 2021; 15:e0009338. [PMID: 33930024 PMCID: PMC8184002 DOI: 10.1371/journal.pntd.0009338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/07/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022] Open
Abstract
Since 2015, India has coordinated the largest school-based deworming program globally, targeting soil-transmitted helminths (STH) in ~250 million children aged 1 to 19 years twice yearly. Despite substantial progress in reduction of morbidity associated with STH, reinfection rates in endemic communities remain high. We conducted a community based parasitological survey in Tamil Nadu as part of the DeWorm3 Project—a cluster-randomised trial evaluating the feasibility of interrupting STH transmission at three geographically distinct sites in Africa and Asia—allowing the estimation of STH prevalence and analysis of associated factors. In India, following a comprehensive census, enumerating 140,932 individuals in 36,536 households along with geospatial mapping of households, an age-stratified sample of individuals was recruited into a longitudinal monitoring cohort (December 2017-February 2018) to be followed for five years. At enrolment, a total of 6089 consenting individuals across 40 study clusters provided a single adequate stool sample for analysis using the Kato-Katz method, as well as answering a questionnaire covering individual and household level factors. The unweighted STH prevalence was 17.0% (95% confidence interval [95%CI]: 16.0–17.9%), increasing to 21.4% when weighted by age and cluster size. Hookworm was the predominant species, with a weighted infection prevalence of 21.0%, the majority of which (92.9%) were light intensity infections. Factors associated with hookworm infection were modelled using mixed-effects multilevel logistic regression for presence of infection and mixed-effects negative binomial regression for intensity. The prevalence of both Ascaris lumbricoides and Trichuris trichiura infections were rare (<1%) and risk factors were therefore not assessed. Increasing age (multivariable odds ratio [mOR] 21.4, 95%CI: 12.3–37.2, p<0.001 for adult age-groups versus pre-school children) and higher vegetation were associated with an increased odds of hookworm infection, whereas recent deworming (mOR 0.3, 95%CI: 0.2–0.5, p<0.001) and belonging to households with higher socioeconomic status (mOR 0.3, 95%CI: 0.2–0.5, p<0.001) and higher education level of the household head (mOR 0.4, 95%CI: 0.3–0.6, p<0.001) were associated with lower odds of hookworm infection in the multilevel model. The same factors were associated with intensity of infection, with the use of improved sanitation facilities also correlated to lower infection intensities (multivariable infection intensity ratio [mIIR] 0.6, 95%CI: 0.4–0.9, p<0.016). Our findings suggest that a community-based approach is required to address the high hookworm burden in adults in this setting. Socioeconomic, education and sanitation improvements alongside mass drug administration would likely accelerate the drive to elimination in these communities. Trial Registration:NCT03014167. Approximately 1 in 5 people in India are infected with soil transmitted helminths (STH), leading to anaemia and malnutrition. To tackle this large burden of infection, the government of India launched one of the world’s largest school-based deworming programs in 2015 aiming to deworm all pre-school and school-aged children between 1 to 19 years of age twice yearly on the National Deworming Days. Deworming programs, including those in India, are focused on pre-school aged children, school aged children and women of reproductive age group. However, prevailing environmental and socioeconomic conditions, including poor sanitation, can contribute to high rates of reinfection from untreated adults and children. The DeWorm3 Project is a cluster-randomised trial evaluating the feasibility of interrupting STH transmission with community wide deworming of all individuals aged one to 99 years of age or older. As part of the study, we conducted a parasitological survey in the Deworm3 trial site in rural Tamil Nadu. Here we present the factors associated with STH infection and burden in these communities.
Collapse
Affiliation(s)
- Sitara S. R. Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
- * E-mail:
| | | | - Katherine E. Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
| | - Gokila Palanisamy
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jasmine Farzana
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Malathi Manuel
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Dilip Abraham
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Selvi Laxmanan
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Anuradha Rose
- Department of Community Medicine, Christian Medical College, Vellore, India
| | - David S. Kennedy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - William E. Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sean R. Galagan
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Kristjana Ásbjörnsdóttir
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Roy M. Anderson
- School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Jayaprakash Muliyil
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Rajiv Sarkar
- Indian Institute of Public Health, Shillong, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Judd L. Walson
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine (Infectious Diseases) and Pediatrics, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
11
|
Oswald WE, Kennedy DS, Farzana J, Kaliappan SP, Atindegla E, Houngbégnon P, Chisambi A, Witek-McManus S, Galagan SR, Emmanuel-Fabula M, Gwayi-Chore MC, Legge H, Yard E, Kalua K, Ibikounlé M, Ajjampur SSR, Means AR, Ásbjörnsdóttir KH, Halliday KE, Walson JL. Development and application of an electronic treatment register: a system for enumerating populations and monitoring treatment during mass drug administration. Glob Health Action 2021; 13:1785146. [PMID: 32666905 PMCID: PMC7480461 DOI: 10.1080/16549716.2020.1785146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We developed an electronic treatment register for the DeWorm3 Project, a cluster-randomised, controlled trial in Benin, India, and Malawi testing the feasibility of interrupting transmission of soil-transmitted helminths through community-wide mass drug administration. The electronic treatment register was designed in xlsform, deployed via the SurveyCTO mobile data collection platform, and implemented on smartphones running the Android operating system. The versatile system enables collection of census and treatment status information, facilitates data aggregation and visualisation, and permits real-time feedback loops during implementation of mass drug administration. Here we describe the system’s design and use within the DeWorm3 Project and key features, and by sharing the register here, we hope our readers will further explore its use within their research and disease-control activities.
Collapse
Affiliation(s)
- William E Oswald
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London, UK
| | - David S Kennedy
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London, UK
| | - Jasmine Farzana
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College , Vellore, India
| | | | - Eloic Atindegla
- Institut de Recherche Clinique du Bénin (IRCB) , Calavi, Benin
| | | | - Alvin Chisambi
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital , Blantyre, Malawi
| | - Stefan Witek-McManus
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London, UK
| | - Sean R Galagan
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Department of Global Health, University of Washington , Seattle, WA, USA
| | - Mira Emmanuel-Fabula
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Department of Global Health, University of Washington , Seattle, WA, USA
| | - Marie-Claire Gwayi-Chore
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Department of Global Health, University of Washington , Seattle, WA, USA
| | - Hugo Legge
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London, UK
| | - Elodie Yard
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital , Blantyre, Malawi
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Bénin (IRCB) , Calavi, Benin.,Département de Zoologie, Faculté des Sciences et Techniques, Université d'Abomey-Calavi , Cotonou, Benin
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College , Vellore, India
| | - Arianna Rubin Means
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Department of Global Health, University of Washington , Seattle, WA, USA
| | - Kristjana H Ásbjörnsdóttir
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Department of Epidemiology, University of Washington , Seattle, WA, USA
| | - Katherine E Halliday
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London, UK
| | - Judd L Walson
- DeWorm3, Division of Life Sciences, Natural History Museum , London, UK.,Department of Global Health, University of Washington , Seattle, WA, USA
| |
Collapse
|
12
|
Abstract
INTRODUCTION Fatigue-related group III/IV muscle afferent firing from agonist, antagonist or distal muscles impairs the ability to drive the elbow flexors maximally, that is, reduces voluntary activation. In the lower limb, the effect of feedback from distal muscles on the proximal knee extensors is unknown. Here, we test whether maintained group III/IV afferent feedback from the plantarflexor muscles reduces voluntary activation of the knee extensors. METHODS On 2 d, voluntary activation of the knee extensors during maximal voluntary contractions (MVCs) was assessed in 12 participants before and after a 3-min fatiguing task of the plantarflexors. On 1 d, an inflatable cuff around the calf occluded blood flow for 2 min immediately postexercise (cuff day). The other day had no occlusion (no-cuff day). Supramaximal stimulation of the femoral nerve elicited superimposed twitches during MVC of the knee extensors and resting twitches 2 to 3 s after relaxation. Pain (0-10 point scale) was reported throughout. RESULTS In the 2 min after the 3-min fatiguing plantarflexor task, voluntary activation was 5.3% (SD, 7%) lower on the cuff day than on the no-cuff day (P = 0.045), and MVC force was reduced by 13% (SD, 16%) (P = 0.021). The resting twitch was similar on both days (P = 0.98). Pain rated 4.9 points higher with the cuff inflated (P = 0.001). CONCLUSIONS Maintained group III/IV afferent feedback from the fatigued plantarflexor muscles reduced maximal force and voluntary activation of the unfatigued knee extensors, suggesting that afferents from the calf act centrally to inhibit the ability to drive the motoneurones of the knee extensors.
Collapse
Affiliation(s)
| | - David S Kennedy
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, NSW, AUSTRALIA
| | - Simon Green
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, AUSTRALIA
| | | |
Collapse
|
13
|
Abstract
We examined if transcranial magnetic stimulation (TMS) is a valid tool for assessment of voluntary activation of the knee extensors in healthy individuals. Maximal M-waves (Mmax) of vastus lateralis (VL) were evoked with electrical stimulation of femoral nerve (FNS); Mmax of medial hamstrings (HS) was evoked with electrical stimulation of sciatic nerve branches; motor evoked potentials (MEPs) of VL and HS were evoked with TMS; superimposed twitches (SIT) of knee extensors were evoked with FNS and TMS. In study 1, TMS intensity [69% output (SD: 5)] was optimized for MEP sizes, but guidelines for test validity could not be met. Agonist VL MEPs were too small [51.4% Mmax (SD: 11.9); guideline ≥70% Mmax] and antagonist HS MEPs were too big [16.5% Mmax (SD: 10.3); guideline <10% Mmax]. Consequently, the TMS estimated resting twitch [99.1 N (SD: 37.2)] and FNS resting twitch [142.4 N (SD: 41.8)] were different. In study 2, SITs at 90% maximal voluntary contraction (MVC) were similar between TMS [16.1 N (SD: 10.3)] and FNS [20.9 N (SD: 16.7)], when TMS intensity was optimized for this purpose, suggesting a procedure that combines TMS SITs with FNS resting twitches could be valid. In study 3, which tested the TMS intensity [56% output (SD: 18)] that evoked the largest SIT at 90% MVC, voluntary activation from TMS [87.3% (SD: 7.1)] and FNS [84.5% (SD: 7.6)] was different. In sum, the contemporary procedure for TMS-based voluntary activation of the knee extensors is invalid. A modified procedure improves validity but only in individuals who meet rigorous inclusion criteria for SITs and MEPs.NEW & NOTEWORTHY We discovered that the contemporary procedure for assessing voluntary activation of the knee extensor muscles with transcranial magnetic stimulation (TMS) is invalid. TMS activates too few agonist quadriceps motoneurons and too many antagonist hamstrings motoneurons to estimate the resting twitch accurately. A modified procedure, in which TMS-evoked superimposed twitches are considered together with the resting twitch from femoral nerve stimulation, is valid but only in select individuals who meet rigorous eligibility criteria.
Collapse
Affiliation(s)
- James L Nuzzo
- Neuroscience Research Australia, Randwick, Australia
| | - David S Kennedy
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | | - Janet L Taylor
- Neuroscience Research Australia, Randwick, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| |
Collapse
|
14
|
Djajadikarta ZJ, Dongés SC, Brooks J, Kennedy DS, Gandevia SC, Taylor JL. Impaired central drive to plantarflexors and minimal ankle proprioceptive deficit in people with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102584. [PMID: 33296980 DOI: 10.1016/j.msard.2020.102584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND A common and disruptive symptom of multiple sclerosis is difficulty in walking. Deficits in ankle proprioception and in plantarflexor muscle function may contribute to these mobility issues. In this study, ankle proprioceptive ability and plantarflexor performance of people with multiple sclerosis (PwMS) were compared to healthy controls to determine whether multiple sclerosis causes impairments in these systems. METHODS PwMS (n = 30, median EDSS 4.0, IQR 2) were compared to age- and sex-matched healthy controls (n = 30) across tests of ankle proprioception and plantarflexor muscle performance. Proprioceptive tests: detection of passive movement, reaction time and ankle joint position sense. Plantarflexor performance: strength, fatigue, recovery and voluntary activation (level of neural drive) of the plantarflexor muscles, assessed through brief and sustained fatiguing (2 min) isometric maximal voluntary contractions with nerve stimulation to evoke superimposed and resting muscle twitches. RESULTS PwMS had unimpaired movement detection and joint position sense but had a slower reaction time to respond with plantarflexion to an imposed ankle movement (between group difference = 0.11 [95% CI; 0.05 to 0.17] s). During brief, maximal contractions PwMS produced lower torque (difference = -25.1 [-42.0 to -8.2] Nm) with reduced voluntary activation (difference = -14.6 [-25.1 to -4.1]%) but no impairment of the muscle itself (resting twitch torque difference = 0.3 [-2.8 to 2.2] Nm). At the end of the fatiguing contraction, neural drive decreased for PwMS (-19.5 [-27.1 to -11.9]%, p <0.0001) but not for controls (-2.5 [-6.9 to 1.8]%, p = 0.242). Fatigue did not affect the resting twitch size for controls (-1.3 [-2.7 to -0.03] Nm, p = 0.134) or PwMS (-0.1 [-1.1 to 1.0] Nm, p = 0.90). CONCLUSIONS PwMS showed no deficit in their ability to sense ankle position or imposed movements but were slow when a motor response was required. Their plantarflexor muscles produced similar torque with electrical stimulation but voluntary strength was impaired. Both groups experienced overall fatigue following the 2-minute maximal voluntary contraction but PwMS also had significantly reduced neural drive indicating central fatigue. PwMS showed mainly central deficits in motor output at the ankle with little impairment of proprioceptive acuity.
Collapse
Affiliation(s)
| | | | - Jack Brooks
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - David S Kennedy
- Neuroscience Research Australia, Sydney, NSW, Australia; Graduate School of Health, Physiotherapy, University of Technology Sydney, Australia.
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia; University of New South Wales, Sydney, Australia.
| | - Janet L Taylor
- Neuroscience Research Australia, Sydney, NSW, Australia; Edith Cowan University, Joondalup, Perth, WA, Australia.
| |
Collapse
|
15
|
Kennedy DS, Vu VK, Ritchie H, Bartlein R, Rothschild O, Bausch DG, Roser M, Seale AC. COVID-19: Identifying countries with indicators of success in responding to the outbreak. Gates Open Res 2020; 4:62. [PMID: 34703986 PMCID: PMC8515014 DOI: 10.12688/gatesopenres.13140.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 07/29/2023] Open
Abstract
Background: In designing responses to the COVID-19 pandemic, it is critical to understand what has already worked well. We aimed to identify countries with emerging success stories from whom policymakers might draw important lessons. Methods: We developed a process to first include countries with large enough populations that results were unlikely to be due to chance, that had sufficient cases for response mechanisms to be tested, and that shared the necessary publicly available data. Within these countries, we looked at indicators suggesting success in terms of detecting disease, containing the outbreak, and treating those who were unwell. To support comparability, we measured indicators per capita (per million) and across time. We then used the indicators to identify three countries with emerging success stories to include some diversity in global region, population demographics and form of government. Results: We identified 66 countries that met our inclusion criteria on 18 th May 2020. Several of these countries had indicators of success against the set indicators at different times in the outbreak. Vietnam had high levels of testing and successful containment with no deaths reported. South Korea had high levels of testing early in the outbreak, supporting containment. Germany had high levels of sustained testing and slower increases in cases and deaths than seen in other comparable settings. Conclusions: At the time of our assessment, Vietnam and South Korea were able to contain the outbreak of COVID-19 and avoid the exponential growth in cases seen elsewhere. Germany had more cases and deaths, but was nevertheless able to contain and mitigate the outbreak. Despite the many limitations to the data currently available, looking at comparative data can help identify countries from whom we can draw lessons, so that countries can inform and adapt their strategies for success in response to COVID-19.
Collapse
Affiliation(s)
- David S. Kennedy
- UK-Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/ Public Health England, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - VK Vu
- The Bill & Melinda Gates Foundation, Seattle, USA
| | - Hannah Ritchie
- Our World in Data, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | | | | | - Daniel G. Bausch
- UK-Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/ Public Health England, London, UK
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Max Roser
- Our World in Data, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | - Anna C. Seale
- UK-Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/ Public Health England, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
16
|
Boyce MJ, Kennedy DS, McCambridge AB. Letter to the Editor, "A randomized study of botulinum toxin versus botulinum toxin plus physical therapy for treatment of cervical dystonia". Parkinsonism Relat Disord 2020; 74:83-84. [PMID: 32035806 DOI: 10.1016/j.parkreldis.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Melani J Boyce
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia; Physiotherapy Department, Westmead Hospital, Sydney, Australia.
| | - David S Kennedy
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia
| | - Alana B McCambridge
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
17
|
|
18
|
Norton J, Whittaker G, Kennedy DS, Jenkins JM, Bew D. Shooting up? Analysis of 182 gunshot injuries presenting to a London major trauma centre over a seven-year period. Ann R Coll Surg Engl 2018; 100:464-474. [PMID: 29962301 DOI: 10.1308/rcsann.2018.0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Metropolitan Police data, and those from the emergency department at a London major trauma centre show a resurgence in gun crime. The aim of this study was to collect data on all gunshot injuries over a seven-year period at South-East London's trauma hub. Materials and methods This was a retrospective observational study of all gunshot injuries between 1 January 2010 and 31 December 2016 at a London major trauma centre. Information regarding patient demographics, morbidity and mortality was collected. Data from the English indices of multiple deprivation were reviewed in relation to shooting locations and socioeconomic status in South-East London. Results A total of 182 patients from 939,331 emergency admissions presented with firearm injuries. Males comprised 178 (97.8%) victims and 124 (68.1%) were documented as being Black or Afro-Caribbean. The median age was 22 years. Some 124 (71.7%) victims were shot within a 4 km radius of the hospital. The mean indices of multiple deprivation decile ranking in shooting locations compared with non-shooting locations was 2.6 (± 0.1384) and 3.8 (± 0.1149), respectively. A total of 122 (67.0%) patients underwent specialist operative intervention and 111 (61.0%) suffered only superficial or musculoskeletal injuries. Six patients required emergency thoracotomies; three (50.0%) survived to discharge. The median length of stay was 4 days (interquartile range 2-9 days) and 35 (24.0%) were admitted to intensive care. Ten (5.5%) patients died. Discussion and conclusion Firearms injuries are increasing and place a significant burden on hospital resources. Care provided to gunshot victims has improved as a result of recent trauma management initiatives at South-East London's major trauma centre.
Collapse
Affiliation(s)
- J Norton
- Department of Trauma and Acute Surgery, King's College Hospital , London , UK
| | - G Whittaker
- Department of Trauma and Acute Surgery, King's College Hospital , London , UK
| | - D S Kennedy
- Department of Trauma and Acute Surgery, King's College Hospital , London , UK
| | - J M Jenkins
- Department of Trauma and Acute Surgery, King's College Hospital , London , UK
| | - D Bew
- Department of Trauma and Acute Surgery, King's College Hospital , London , UK
| |
Collapse
|
19
|
Harrington KA, Kennedy DS, Tang B, Hickie C, Phelan E, Torreggiani W, Halpenny D. Computed tomographic evaluation of the thymus-does obesity affect thymic fatty involution in a healthy young adult population? Br J Radiol 2018; 91:20170609. [PMID: 29356558 DOI: 10.1259/bjr.20170609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine a relationship between increased body mass index (BMI) and fatty involution of the thymus in subjects aged between 20 and 30 years. METHODS CT images of 94 patients aged between 20 and 30 years were reviewed. Quantitative thymic mean attenuation was recorded and qualitative thymic attenuation was assigned to 1 of 4 possible grades. BMI and subcutaneous fat thickness were documented. Correlations between thymic attenuation, and BMI and subcutaneous fat thickness were assessed using linear regression models. Differences in thymic attenuation in overweight vs normal weight patients were assessed using t-test and Pearson Χ2 analysis. RESULTS Low mean thymic attenuation values were associated with higher patient BMI (p = 0.024). Normal weight patients had a mean quantitative thymic attenuation of 15.5 Hounsfield unit and overweight patients had a mean quantitative thymic attenuation of -16.4 Hounsfield unit (p = 0.0218). There was a significant association between increasing subcutaneous fat thickness and reduced mean quantitative thymic attenuation (p < 0.0001). There was also a significant difference in subcutaneous fat thickness when comparing qualitatively assessed thymic Grade 0 with grades 2 and 3 (p = 0.027 and 0.001 respectively); and Grade 1 with Grade 3 (p = 0.001). CONCLUSION In patients between 20 and 30 years old, the degree of thymic fatty infiltration is related to BMI. Advances in knowledge: Multidetector CT can assess fatty involution of the thymus gland. This retrospective study demonstrates a relationship between BMI and thymus gland fatty involution. Subjects with increased subcutaneous fat have decreased mean thymus gland attenuation.
Collapse
Affiliation(s)
- Kate A Harrington
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - David S Kennedy
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Bobby Tang
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Conor Hickie
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Emma Phelan
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - William Torreggiani
- 1 Radiology Department, Adelaide and Meath Hospital , Tallaght, Dublin , Ireland
| | - Darragh Halpenny
- 2 Radiology Department, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| |
Collapse
|
20
|
Finn HT, Rouffet DM, Kennedy DS, Green S, Taylor JL. Motoneuron excitability of the quadriceps decreases during a fatiguing submaximal isometric contraction. J Appl Physiol (1985) 2018; 124:970-979. [PMID: 29357479 DOI: 10.1152/japplphysiol.00739.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
During fatiguing voluntary contractions, the excitability of motoneurons innervating arm muscles decreases. However, the behavior of motoneurons innervating quadriceps muscles is unclear. Findings may be inconsistent because descending cortical input influences motoneuron excitability and confounds measures during exercise. To overcome this limitation, we examined effects of fatigue on quadriceps motoneuron excitability tested during brief pauses in descending cortical drive after transcranial magnetic stimulation (TMS). Participants ( n = 14) performed brief (~5-s) isometric knee extension contractions before and after a 10-min sustained contraction at ~25% maximal electromyogram (EMG) of vastus medialis (VM) on one ( n = 5) or two ( n = 9) days. Electrical stimulation over thoracic spine elicited thoracic motor evoked potentials (TMEP) in quadriceps muscles during ongoing voluntary drive and 100 ms into the silent period following TMS (TMS-TMEP). Femoral nerve stimulation elicited maximal M-waves (Mmax). On the 2 days, either large (~50% Mmax) or small (~15% Mmax) TMS-TMEPs were elicited. During the 10-min contraction, VM EMG was maintained ( P = 0.39), whereas force decreased by 52% (SD 13%) ( P < 0.001). TMEP area remained unchanged ( P = 0.9), whereas large TMS-TMEPs decreased by 49% (SD 28%) ( P = 0.001) and small TMS-TMEPs by 71% (SD 22%) ( P < 0.001). This decline was greater for small TMS-TMEPs ( P = 0.019; n = 9). Therefore, without the influence of descending drive, quadriceps TMS-TMEPs decreased during fatigue. The greater reduction for smaller responses, which tested motoneurons that were most active during the contraction, suggests a mechanism related to repetitive activity contributes to reduced quadriceps motoneuron excitability during fatigue. By contrast, the unchanged TMEP suggests that ongoing drive compensates for altered motoneuron excitability. NEW & NOTEWORTHY We provide evidence that the excitability of quadriceps motoneurons decreases with fatigue. Our results suggest that altered intrinsic properties brought about by repetitive activation of the motoneurons underlie their decreased excitability. Furthermore, we note that testing during voluntary contraction may not reflect the underlying depression of motoneuron excitability because of compensatory changes in ongoing voluntary drive. Thus, this study provides evidence that processes intrinsic to the motoneuron contribute to muscle fatigue of the knee extensors.
Collapse
Affiliation(s)
- Harrison T Finn
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,University of New South Wales , Kensington, New South Wales , Australia
| | - David M Rouffet
- Victoria University , Melbourne, Victoria , Australia.,Australian Institute for Musculoskeletal Science, Victoria University , Melbourne , Australia.,Institute of Sport, Exercise, and Active Living, Victoria University , Melbourne , Australia
| | - David S Kennedy
- University of Sydney, Cumberland, New South Wales , Australia.,University of Technology , Ultimo, New South Wales , Australia
| | - Simon Green
- Western Sydney University, Campbelltown, New South Wales , Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,University of New South Wales , Kensington, New South Wales , Australia.,Edith Cowan University , Perth, Western Australia , Australia
| |
Collapse
|
21
|
Kennedy DS, McNeil CJ, Gandevia SC, Taylor JL. Effects of fatigue on corticospinal excitability of the human knee extensors. Exp Physiol 2016; 101:1552-1564. [PMID: 27652591 DOI: 10.1113/ep085753] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 02/15/2016] [Accepted: 09/19/2016] [Indexed: 01/05/2023]
Abstract
NEW FINDINGS What is the central question of this study? Do group III and IV muscle afferents act at the spinal or cortical level to affect the ability of the central nervous system to drive quadriceps muscles during fatiguing exercise? What is the main finding and its importance? The excitability of the motoneurone pool of vastus lateralis was unchanged by feedback from group III and IV muscle afferents. In contrast, feedback from these afferents may contribute to inhibition at the cortex. However, the excitability of the corticospinal pathway was not directly affected by feedback from these afferents. These findings are important for understanding neural processes during fatiguing exercise. In upper limb muscles, changes in afferent feedback, motoneurone excitability, and motor cortical output can contribute to failure of the central nervous system to recruit muscles fully during fatigue. It is not known whether similar changes occur with fatigue of muscles in the lower limb. We assessed the corticospinal pathway to vastus lateralis during fatiguing sustained maximal voluntary contractions (MVCs) of the knee extensors and during firing of fatigue-sensitive group III/IV muscle afferents maintained by postexercise ischaemia after fatiguing MVCs of the knee extensors and, separately, the flexors. In two experiments, subjects (n = 9) performed brief knee extensor MVCs before and after 2-min sustained MVCs of the knee extensors (experiment 1) or knee flexors (experiment 2). During MVCs, motor evoked potentials (MEPs) were elicited by transcranial magnetic stimulation over the motor cortex and thoracic motor evoked potentials (TMEPs) by electrical stimulation over the thoracic spine. During the 2-min extensor contraction, the size of vastus lateralis MEPs normalized to the maximal M-wave increased (P < 0.05), but normalized TMEPs were unchanged (P = 0.16). After the 2-min MVC, maintained firing of group III/IV muscle afferents had no effect on vastus lateralis MEPs or TMEPs (P = 0.18 and P = 0.50, respectively). Likewise, after the 2-min knee flexor MVC, maintained firing of these afferents showed no effect on vastus lateralis MEPs or TMEPs (P = 0.69 and P = 0.34, respectively). Motoneurones of vastus lateralis do not become less excitable during fatiguing isometric MVCs. Moreover, fatigue-sensitive group III/IV muscle afferents fail to affect the overall excitability of vastus lateralis motoneurones during MVCs.
Collapse
Affiliation(s)
- David S Kennedy
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Kensington, NSW, Australia
| | - Chris J McNeil
- Neuroscience Research Australia, Randwick, NSW, Australia.,Centre for Heart, Lung and Vascular Health, School of Health & Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Kensington, NSW, Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Kensington, NSW, Australia
| |
Collapse
|
22
|
Kennedy DS, Fitzpatrick SC, Gandevia SC, Taylor JL. Fatigue-related firing of muscle nociceptors reduces voluntary activation of ipsilateral but not contralateral lower limb muscles. J Appl Physiol (1985) 2014; 118:408-18. [PMID: 25525208 DOI: 10.1152/japplphysiol.00375.2014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During fatiguing upper limb exercise, maintained firing of group III/IV muscle afferents can limit voluntary drive to muscles within the same limb. It is not known if this effect occurs in the lower limb. We investigated the effects of group III/IV muscle afferent firing from fatigued ipsilateral and contralateral extensor muscles and ipsilateral flexor muscles of the knee on voluntary activation of the knee extensors. In three experiments, we examined voluntary activation of the knee extensors by measuring changes in superimposed twitches evoked by femoral nerve stimulation. Subjects attended on 2 days for each experiment. On one day a sphygmomanometer cuff occluded blood flow of the fatigued muscles to maintain firing of group III/IV muscle afferents. After a 2-min extensor contraction (experiment 1; n = 9), mean voluntary activation was lower with than without maintained ischemia (47 ± 19% vs. 87 ± 8%, respectively; P < 0.001). After a 2-min knee flexor maximal voluntary contraction (MVC) (experiment 2; n = 8), mean voluntary activation was also lower with than without ischemia (59 ± 21% vs. 79 ± 9%; P < 0.01). After the contralateral (left) MVC (experiment 3; n = 8), mean voluntary activation of the right leg was similar with or without ischemia (92 ± 6% vs. 93 ± 4%; P = 0.65). After fatiguing exercise, activity in group III/IV muscle afferents reduces voluntary activation of the fatigued muscle and nonfatigued antagonist muscles in the same leg. However, group III/IV muscle afferents from the fatigued left leg had no effect on the unfatigued right leg. This suggests that any "crossover" of central fatigue in the lower limbs is not mediated by group III/IV muscle afferents.
Collapse
Affiliation(s)
- David S Kennedy
- Neuroscience Research Australia, Randwick, NSW, Australia; and University of New South Wales, Kensington, NSW, Australia
| | - Siobhan C Fitzpatrick
- Neuroscience Research Australia, Randwick, NSW, Australia; and University of New South Wales, Kensington, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia; and University of New South Wales, Kensington, NSW, Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Randwick, NSW, Australia; and University of New South Wales, Kensington, NSW, Australia
| |
Collapse
|
23
|
Kennedy DS, McNeil CJ, Gandevia SC, Taylor JL. Fatigue-related firing of distal muscle nociceptors reduces voluntary activation of proximal muscles of the same limb. J Appl Physiol (1985) 2013; 116:385-94. [PMID: 24356522 DOI: 10.1152/japplphysiol.01166.2013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
With fatiguing exercise, firing of group III/IV muscle afferents reduces voluntary activation and force of the exercised muscles. These afferents can also act across agonist/antagonist pairs, reducing voluntary activation and force in nonfatigued muscles. We hypothesized that maintained firing of group III/IV muscle afferents after a fatiguing adductor pollicis (AP) contraction would decrease voluntary activation and force of AP and ipsilateral elbow flexors. In two experiments (n = 10) we examined voluntary activation of AP and elbow flexors by measuring changes in superimposed twitches evoked by ulnar nerve stimulation and transcranial magnetic stimulation of the motor cortex, respectively. Inflation of a sphygmomanometer cuff after a 2-min AP maximal voluntary contraction (MVC) blocked circulation of the hand for 2 min and maintained firing of group III/IV muscle afferents. After a 2-min AP MVC, maximal AP voluntary activation was lower with than without ischemia (56.2 ± 17.7% vs. 76.3 ± 14.6%; mean ± SD; P < 0.05) as was force (40.3 ± 12.8% vs. 57.1 ± 13.8% peak MVC; P < 0.05). Likewise, after a 2-min AP MVC, elbow flexion voluntary activation was lower with than without ischemia (88.3 ± 7.5% vs. 93.6 ± 3.9%; P < 0.05) as was torque (80.2 ± 4.6% vs. 86.6 ± 1.0% peak MVC; P < 0.05). Pain during ischemia was reported as Moderate to Very Strong. Postfatigue firing of group III/IV muscle afferents from the hand decreased voluntary drive and force of AP. Moreover, this effect decreased voluntary drive and torque of proximal unfatigued muscles, the elbow flexors. Fatigue-sensitive group III/IV muscle nociceptors act to limit voluntary drive not only to fatigued muscles but also to unfatigued muscles within the same limb.
Collapse
Affiliation(s)
- David S Kennedy
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | | | | |
Collapse
|
24
|
Kennedy DS, McNeil CJ, Gandevia SC, Taylor JL. Firing of antagonist small-diameter muscle afferents reduces voluntary activation and torque of elbow flexors. J Physiol 2013; 591:3591-604. [PMID: 23652589 DOI: 10.1113/jphysiol.2012.248559] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During muscle fatigue, firing of small-diameter muscle afferents can decrease voluntary activation of the fatigued muscle. However, these afferents may have a more widespread effect on other muscles in the exercising limb. We examined if the firing of fatigue-sensitive afferents from elbow extensor muscles in the same arm reduces torque production and voluntary activation of elbow flexors. In nine subjects we examined voluntary activation of elbow flexors by measuring changes in superimposed twitches evoked by transcranial magnetic stimulation of the motor cortex during brief (2-3 s) maximal voluntary contractions (MVC). Inflation of a blood pressure cuff following a 2-min sustained MVC blocked blood flow to the fatigued muscle and maintained firing of small-diameter afferents. After a fatiguing elbow flexion contraction, maximal flexion torque was lower (26.0 ± 4.4% versus 67.9 ± 5.2% of initial maximal torque; means ± s.d.; P < 0.001) and superimposed twitches were larger (4.1 ± 1.1% versus 1.8 ± 0.2% ongoing MVC, P = 0.01) with than without ischaemia. After a fatiguing elbow extensor contraction, maximal flexion torque was also reduced (82.2 ± 4.9% versus 91.4 ± 2.3% of initial maximal torque; P = 0.007), superimposed twitches were larger (2.7 ± 0.7% versus 1.3 ± 0.2% ongoing MVC; P = 0.02) and voluntary activation lower (81.6 ± 8.2% versus 95.5 ± 6.9%; P = 0.04) with than without ischaemia. After a fatiguing contraction, voluntary drive to the fatigued muscles is reduced with continued input from small-diameter muscle afferents. Furthermore, fatigue of the elbow extensor muscles decreases voluntary drive to unfatigued elbow flexors of the same arm. Therefore, firing of small-diameter muscle afferents from one muscle can affect voluntary activation and hence torque generation of another muscle in the same limb.
Collapse
|
25
|
Wang H, Kennedy DS, Nugent KD, Taylor GK, Goodlett DR. A Qit-q-Tof mass spectrometer for two-dimensional tandem mass spectrometry. Rapid Commun Mass Spectrom 2007; 21:3223-6. [PMID: 17764102 DOI: 10.1002/rcm.3204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
26
|
Kennedy DS, Heywood SM. The role of muscle and reticulocyte initiation factor 3 on the translation of myosin and globin messenger RNA in a wheat germ cell-free system. FEBS Lett 2001; 72:314-8. [PMID: 16386048 DOI: 10.1016/0014-5793(76)80994-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D S Kennedy
- Genetics and Cell Biology, University of Connecticut Storrs, Connecticut 06268, USA
| | | |
Collapse
|
27
|
Kennedy DS, Linden GJ. Resolution of gingival overgrowth following change from cyclosporin to tacrolimus therapy in a renal transplant patient. J Ir Dent Assoc 2001; 46:3-4. [PMID: 11323935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Gingival overgrowth is a well documented and common side-effect of cyclosporin therapy. Gingival swelling in this condition hinders efficient oral hygiene and is of aesthetic concern to patients. This case report outlines rapid and dramatic reduction in overgrowth when tacrolimus replaced cyclosporin as the immunosuppressive agent in a renal transplant patient with established overgrowth.
Collapse
Affiliation(s)
- D S Kennedy
- Division of Restorative Dentistry, School of Dentistry, Queen's University, Belfast
| | | |
Collapse
|
28
|
|
29
|
Challis D, Trudinger BJ, Moore L, Kennedy DS, Ryan G, Toi A, Seaward G, Chitayat D. Intra-abdominal varix of the umbilical vein—Is it an indication for fetal karyotyping? Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80376-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
|
31
|
|
32
|
Bester AJ, Durrheim G, Kennedy DS, Heywood SM. Isolation of myosin messenger ribonucleoprotein particles which contain a protein fraction affecting myosin synthesis. Biochem Biophys Res Commun 1980; 92:524-31. [PMID: 7356480 DOI: 10.1016/0006-291x(80)90365-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
33
|
Abstract
In the light of earlier work [1] which demonstrated the presence of a large number of myosin heavy chain (MHC) transcripts in chick myoblasts prior to cell fusion and the burst of MHC synthesis it was of great interest to determine the subcellular localization of the still inactive transcripts. It has been determined in differentiating muscle cells in culture. Two populations of cells were examined -- monucleated myoblasts just prior to cell fusion and myotubes where at least 80% of the cells were fused. Utilizing a myosin complementary DNA (cDNA) probe [2] it is observed that just prior to cell fusion, when the "burst" of myosin synthesis has not yet occurred, the vast majority of cytoplasmic myosin mRNA transcripts are found in a stored messenger RNA protein complex with a minimal amount found in the heavy polysome fraction. In differentiated myotube cultures, when myosin synthesis is progressing at a high rate, the reverse is found, i.e, the amount of stored myosin messenger RNA (mRNA) is minimal while the largest amount of myosin mRNA transcripts are localized in the polysome fraction. The number of total cytoplasmic myosin transcripts is found to decrease after cell fusion at a time when myosin synthesis is maximal suggesting that the efficiency of translation of myosin mRNA increases during terminal differentiation.
Collapse
|
34
|
Heywood SM, Kennedy DS. Messenger RNA affinity column fractionation of eukaryotic initiation factor and the translation of myosin messenger RNA. Arch Biochem Biophys 1979; 192:270-81. [PMID: 434822 DOI: 10.1016/0003-9861(79)90092-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
35
|
|
36
|
Myers MG, Kearns PM, Kennedy DS, Fisher RH. Postural hypotension and diuretic therapy in the elderly. Can Med Assoc J 1978; 119:581-5. [PMID: 709449 PMCID: PMC1818427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Blood pressures were recorded in 319 ambulatory subjects, largely men, age 50 to 99 years. The mean systolic pressures were maximal in the seventh and eighth decades (136.0 and 132.1 mm Hg with the subjects supine and erect, respectively), whereas the mean diastolic pressures fell progressively after age 69. The distribution of postural changes in mean blood pressure was similar in each decade; a decrease of 20 mm Hg on more was noted in 3.4% of the subjects aged 80 to 99 years and in 4.1% of those aged 50 to 79 years. The frequency of postural hypotension was 4.6% in subjects treated with diuretics and 3.4% in those not so treated. Blood pressures and the frequency of postural hypotension did not progressively increase in age in this elderly population.
Collapse
|
37
|
Kennedy DS, Siegel E, Heywood SM. Purification of myosin mRNP translational control RNA and its inhibition of myosin and globin messenger translation. FEBS Lett 1978; 90:209-14. [PMID: 566677 DOI: 10.1016/0014-5793(78)80370-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
38
|
|
39
|
Abstract
Myosin messenger ribonucleoprotein-translational control ribonucleic acid (mRNP-tcNA) from myosin mRNPs found in embryonic chick muscle has been further purified by Dowex chromatography and, from a number of controls, it is suggested that this small RNA is not an artifact produced through the degradation of RNA during its isolation. This highly purified myosin mRNP-tcRNA is shown to have a molecular weight of 10 000 on formamide-acrylamide gels, and reacts stoichometrically (on a 1:1 mole ratio) with myosin mRNA. The stoichiometric interaction between myosin mRNA and myosin mRNP-tcRNP is demonstrated by ists ability to increase the nuclease resistance of the messenger, as well as inhibit its translation in a cell-free amino acid incorporating system.
Collapse
|
40
|
Heywood SM, Kennedy DS, Bester AJ. Studies concerning the mechanism by which translational-control RNA regulates protein synthesis in embryonic muscle. Eur J Biochem 1975; 58:587-93. [PMID: 1237405 DOI: 10.1111/j.1432-1033.1975.tb02409.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Muscle translational-control RNA (tcRNA) has been separated into two classes, polysomal and messenger ribonuclear protein (mRNA - protein), which have different sizes as determined by acrylamide gel electrophoresis. While normally translation of mRNA - protein mRNA is inhibited by tcRNA derived from the same mRNA - proteins, this inhibition does not occur if the messenger is previously de-adenylated. This suggests that the poly(A) segment of mRNA is required for the tcRNA activity. Utilizing different mRNA - protein fractions from muscle, myosin mRNA - protein and small mRNA - proteins ( less than 30 S), we have been able to demonstrate that a degree of specificity exists in the interaction of tcRNA and mRNA derived from the same mRNA - proteins. This is illustrated by the facts that (a) each tcRNA only inhibits the translation of its respective mRNA and (b) the highest percentage of structural change occurs when each tcRNA is hybridized to its respective mRNA as measured by its resistance to T1 and T2 RNase.
Collapse
|
41
|
|
42
|
Bester AJ, Kennedy DS, Heywood SM. Two classes of translational control RNA: their role in the regulation of protein synthesis. Proc Natl Acad Sci U S A 1975; 72:1523-7. [PMID: 1055423 PMCID: PMC432569 DOI: 10.1073/pnas.72.4.1523] [Citation(s) in RCA: 93] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Two classes of translation control RNA (tcRNA) have been isolated from embryonic chick muscle. One of these classes, the tcRNA isolated from messenger ribonucleoprotein particles (mRNP-tcRNA), is effective in inhibiting the translation of mRNP-mRNA while having little if any effect on polysomal mRNA. The other class, polysome-tcRNA, has no effect on mRNP-mRNA while it stimulates the translation of polysomal mRNA. The mRNP tcRNA contains approximately 50 percent uridylate residues and forms small but stable hybrids with poly (A), while polysome-tcRNA contains fewer uridylate residues and is much less effective in forming a hybrid with poly (A). A proposed model concerning the role of these two classes of tcRNA in the regulation of protein synthesis is presented.
Collapse
|
43
|
|
44
|
|
45
|
Heywood SM, Kennedy DS, Bester AJ. Separation of specific initiation factors involved in the translation of myosin and myoglobin messenger RNAs and the isolation of a new RNA involved in translation. Proc Natl Acad Sci U S A 1974; 71:2428-31. [PMID: 4526305 PMCID: PMC388470 DOI: 10.1073/pnas.71.6.2428] [Citation(s) in RCA: 82] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Two messenger specific factors, phosphocellulose fractions 3 and 4, have been isolated from the initiation factor 3 fraction of red muscle initiation factors by chromatography on phosphocellulose. When added to a reticulocyte cell-free system containing both myoglobin and myosin mRNAs, phosphocellulose fraction 3 is found to specifically stimulate the synthesis of myoglobin while phosphocellulose fraction 4 is found to specifically stimulate the synthesis of myosin. In addition, a new RNA, isolated from the initiation factor 3 fraction, is shown to specifically inhibit the translation of heterologous mRNAs.
Collapse
|