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Hildén K, Magnuson A, Montgomery S, Schwarcz E, Hanson U, Simmons D, Backman H. Previous pre-eclampsia, gestational diabetes mellitus and the risk of cardiovascular disease: A nested case-control study in Sweden. BJOG 2023. [PMID: 36974033 DOI: 10.1111/1471-0528.17454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Pre-eclampsia and gestational diabetes mellitus (GDM) are two common pregnancy complications that affect birth outcomes and are associated with a long-term risk of cardiovascular disease (CVD). The aims of this study were to investigate if the pre-eclampsia association with CVD is independent of GDM and modified by body mass index (BMI) or GDM. DESIGN Case-control study. SETTING Sweden. POPULATION Cases were women with a first CVD event between 1991 and 2008 and a previous pregnancy who were matched with controls without CVD (1:5) by year of birth, age and region of birth. METHODS Conditional logistic regression was used to evaluate the associations of GDM, pre-eclampsia and maternal BMI with CVD adjusted for potential confounders and effect modifications with interaction tests. MAIN OUTCOME MEASURES CVD. RESULTS There were 2639 cases and 13 310 controls with complete data. Pre-eclampsia and GDM were independent risk factors for CVD (adjusted odds ratio [aOR] 2.59, 95% CI 2.12-3.17 and aOR 1.47, 95% CI 1.04-2.09, respectively). After stratifying by maternal BMI, the adjusted association of pre-eclampsia with CVD did not differ notably between BMI groups: normal weight (aOR 2.65, 95% CI 1.90-3.69), overweight (aOR 2.67, 95% CI 1.52-4.68) and obesity (aOR 3.03, 95% CI 0.74-12.4). Similar findings were seen when stratifying on GDM/non-GDM. CONCLUSIONS Pre-eclampsia and GDM are independent risk factors for later CVD and having both during pregnancy is a major risk factor for later CVD. The association between pre-eclampsia and CVD is not modified by BMI. Effective CVD preventive programs for high-risk women are urgently needed in order to improve women's long-term health.
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Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - S Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - E Schwarcz
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - U Hanson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, Health Örebro University, Örebro, Sweden
| | - D Simmons
- Faculty of Medicine, Health Örebro University, Örebro, Sweden
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - H Backman
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Witt R, Riley J, Hamparian C, Owens T, Simmons D, Byars K, Hogenesch J, Smith D, Dye T. Safe and Effective Use of Suvorexant in Children with Neurodevelopmental Disorders: A Single-Center, Retrospective Study of Clinical Practice. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Witt R, Riley J, Hamparian C, Owens T, Simmons D, Byars K, Hogenesch J, Smith D, Dye T. Suvorexant Is Safe and Effective in a Pediatric Population: A Single-Center, Retrospective Study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Riley J, Hamparian C, Sestito A, Duggins A, Owens T, Witt R, Simmons D, Byars K, Hogenesch J, Dye T, Smith D. Outcomes of Pre-treatment and Post-treatment measures after therapy for pediatric circadian disorders. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Riley J, Hamparian C, Sestito A, Duggins A, Owens T, Witt R, Simmons D, Byars K, Hogenesch J, Dye T, Smith D. Developing a Multidisciplinary Pediatric Circadian Medicine Clinic: The Circadian and Complex Sleep Disorders Clinic. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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van Poppel M, Corcoy R, Simmons D, Desoye G, Mendizabal L, Zulueta M. Interaction between MTNR1B polymorphisms and lifestyle intervention on pregnancy outcomes. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Interactions between polymorphisms of the melatonin receptor 1B gene (MTNR1B) and lifestyle intervention for gestational diabetes have been described. Whether these are specific for physical activity or healthy eating intervention is unknown.
Objectives
To assess the interaction between MTNR1B rs10830962 and rs10830963 polymorphisms and lifestyle interventions during pregnancy.
Methods
Women with a BMI of ≥ 29 kg/m2 (n = 436) received counseling on healthy eating (HE), physical activity (PA) or both. The control group received usual care. The analysis had a factorial design with comparison of HE versus no HE and PA versus no PA. Maternal outcomes at 24-28 weeks were gestational weight gain (GWG), maternal fasting glucose, insulin, insulin resistance (HOMA-IR), and development of GDM. Interaction between receiving either HE or PA intervention and genotypes of both rs10830962 and rs10830963 was assessed using multilevel regression analysis.
Results
GDM risk was increased in women homozygous for the G allele of rs10830962 or rs10830963 (OR 2.60 [95% CI 1.34, 5.06] and 2.83 [1.24, 6.47], respectively). Significant interactions between rs10830962 and interventions were found: In women homozygous for the G allele, but not in the other genotypes, the PA intervention reduced maternal fasting insulin (beta -0.16 [95%CI -0.33, 0.02], p = 0.08) and HOMA-IR (-0.17 [-0.35, 0.01], p = 0.06). In heterozygous women, HE intervention had no effect, whereas in women homozygous for the C allele, HE intervention reduced GWG (-1.6 kg [-2.4, -0.8]).
Discussion
In women homozygous for the risk allele of MTNR1B rs10830962, GDM risk was increased and PA intervention might be more beneficial than HE intervention for reducing maternal insulin resistance.
Key messages
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Affiliation(s)
- M van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz , Graz, Austria
| | - R Corcoy
- Institut de Recerca de ĺHospital de la Santa Creu , Barcelona, Spain
| | - D Simmons
- Western Sydney University , Campbelltown, Australia
| | - G Desoye
- Department of Obstetrics and Gynecology, Medical Universit , Graz, Austria
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Simmons D. S-16-03 Endogenous retroviral envelope genes in placentation. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Jo J, Tran TT, Beyda ND, Simmons D, Hendrickson JA, Almutairi MS, Alnezary FS, Gonzales-Luna AJ, Septimus EJ, Garey KW. Development of the invasive candidiasis discharge [I Can discharge] model: a mixed methods analysis. Eur J Clin Microbiol Infect Dis 2022; 41:1207-1213. [PMID: 36002777 PMCID: PMC9489576 DOI: 10.1007/s10096-022-04473-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
Patients with invasive candidiasis (IC) have complex medical and infectious disease problems that often require continued care after discharge. This study aimed to assess echinocandin use at hospital discharge and develop a transition of care (TOC) model to facilitate discharge for patients with IC. This was a mixed method study design that used epidemiologic assessment to better understand echinocandin use at hospital discharge TOC. Using grounded theory methodology focused on patients given echinocandins during their last day of hospitalization, a TOC model for patients with IC, the invasive candidiasis [I Can] discharge model was developed to better understand discharge barriers. A total of 33% (1405/4211) echinocandin courses were continued until the last day of hospitalization. Of 536 patients chosen for in-depth review, 220 (41%) were discharged home, 109 (20%) were transferred, and 207 (39%) died prior to discharge. Almost half (46%, 151/329) of patients discharged alive received outpatient echinocandin therapy. Independent predictors for outpatient echinocandin use were osteomyelitis (OR, 4.1; 95% CI, 1.1-15.7; p = 0.04), other deep-seated infection (OR, 4.4; 95% CI, 1.7-12.0; p = 0.003), and non-home discharge location (OR, 3.9, 95% CI, 2.0-7.7; p < 0.001). The I Can discharge model was developed encompassing four distinct themes which was used to identify potential barriers to discharge. Significant echinocadin use occurs at hospital discharge TOC. The I Can discharge model may help clinical, policy, and research decision-making processes to facilitate smoother and earlier hospital discharges.
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Affiliation(s)
- Jinhee Jo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA
| | - Truc T Tran
- University of Texas Health Science Center, Houston, TX, USA
| | - Nicholas D Beyda
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA
| | - Debora Simmons
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, USA
| | | | - Masaad Saeed Almutairi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA.,Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Faris S Alnezary
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA.,Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Medinah, Saudi Arabia
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA
| | - Edward J Septimus
- Department of Population Medicine Harvard Medical School, Boston, MA, USA.,Texas A&M College of Medicine, Houston, TX, USA
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA.
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Acosta-Manzano P, Leopold-Posch B, Simmons D, Devlieger R, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Tanvig M, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill DJ, Snoek FJ, Jelsma J, Desoye G, van Poppel M. The unexplored role of sedentary time and physical activity in glucose and lipid metabolism-related placental mRNAs in pregnant women who are obese: the DALI lifestyle randomised controlled trial. BJOG 2022; 129:708-721. [PMID: 34559946 DOI: 10.1111/1471-0528.16945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We aimed to explore: (i) the association of sedentary time (ST) and physical activity (PA) during pregnancy with the placental expression of genes related to glucose and lipid metabolism in pregnant women who are obese; (ii) maternal metabolic factors mediating changes in these placental transcripts; and (iii) cord blood markers related to the mRNAs mediating neonatal adiposity. DESIGN Multicentre randomised controlled trial. SETTING Hospitals in nine European countries. POPULATION A cohort of 112 pregnant women with placental tissue. METHODS Both ST and moderate-to-vigorous PA (MVPA) levels were measured objectively using accelerometry at three time periods during pregnancy. MAIN OUTCOME MEASURES Placental mRNAs (FATP2, FATP3, FABP4, GLUT1 and PPAR-γ) were measured with NanoString technology. Maternal and fetal metabolic markers and neonatal adiposity were assessed. RESULTS Longer periods of ST, especially in early to middle pregnancy, was associated with lower placental FATP2 and FATP3 expression (P < 0.05), whereas MVPA at baseline was inversely associated with GLUT1 mRNA (P = 0.02). Although placental FATP2 and FATP3 expression were regulated by the insulin-glucose axis (P < 0.05), no maternal metabolic marker mediated the association of ST/MVPA with placental mRNAs (P > 0.05). Additionally, placental FATP2 expression was inversely associated with cord blood triglycerides and free fatty acids (FFAs; P < 0.01). No cord blood marker mediated neonatal adiposity except for cord blood leptin, which mediated the effects of PPAR-γ on neonatal sum of skinfolds (P < 0.05). CONCLUSIONS In early to middle pregnancy, ST is associated with the expression of placental genes linked to lipid transport. PA is hardly related to transporter mRNAs. Strategies aimed at reducing sedentary behaviour during pregnancy could modulate placental gene expression, which may help to prevent unfavourable fetal and maternal pregnancy outcomes. TWEETABLE ABSTRACT Reducing sedentary behaviour in pregnancy might modulate placental expression of genes related to lipid metabolism in women who are obese.
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Affiliation(s)
- P Acosta-Manzano
- PA-HELP 'Physical Activity for Health Promotion, CTS-1018' Research Group, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - B Leopold-Posch
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - D Simmons
- Western Sydney University, Campbelltown, New South Wales, Australia
| | - R Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - S Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - R Corcoy
- CIBER Bioengineering, Biomaterials and Nanomedicine, Instituto de Salud Carlos III, Zaragoza, Spain
| | - J M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Dunne
- Galway Diabetes Research Centre (GDRC) and National University of Ireland, Galway, Ireland
| | - J Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - P Damm
- Departments of Endocrinology and Obstetrics, Rigshospitalet and Department of Clinical Medicine, Centre for Pregnant Women with Diabetes, University of Copenhagen, Copenhagen, Denmark
| | - E R Mathiesen
- Departments of Endocrinology and Obstetrics, Rigshospitalet and Department of Clinical Medicine, Centre for Pregnant Women with Diabetes, University of Copenhagen, Copenhagen, Denmark
| | - D M Jensen
- Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - L L Andersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - M Tanvig
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - A Lapolla
- Department of Medical and Surgical Sciences, Università degli Studi di Padova, Padua, Italy
| | - M G Dalfra
- Department of Medical and Surgical Sciences, Università degli Studi di Padova, Padua, Italy
| | - A Bertolotto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | - A Zawiejska
- Chair of Medical Education, Department of Medical Simulation, Poznan University of Medical Sciences, Poznan, Poland
| | - D J Hill
- Lawson Health Research Institute, London, Ontario, Canada
| | - F J Snoek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, VU University, Amsterdam, the Netherlands
| | - Jgm Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - G Desoye
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - Mnm van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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Jo J, Hendrickson J, Almutairi M, Alnezary FS, Beyda N, Gonzales-Luna AJ, Tran TT, Simmons D, Garey KW. 157. A Multicenter, Mixed-Method Evaluation of Delayed Hospital Discharge in Patients with Invasive Candidiasis Receiving Echinocandins. Open Forum Infect Dis 2021. [PMCID: PMC8645004 DOI: 10.1093/ofid/ofab466.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Patients with systemic candidiasis often receive prolonged echinocandin therapy in the inpatient or outpatient setting. Rezafungin is a novel echinocandin currently in clinical trials characterized by once-weekly dosing interval. In order to understand the potential benefit of rezafungin to facilitate earlier hospital discharge, the purpose of this project was to better understand barriers to discharge in patients with proven or suspected invasive candidiasis. Methods Electronic health records from two large health systems (20+ hospitals) were reviewed to identify patients given an echinocandin. Patients given an echinocandin until hospital discharge were evaluated for outpatient use as well as barriers that prevented earlier discharge. Identified barriers were developed into a quantitative framework and a qualitative interview guide. Using a constant comparative method, the framework for hospital discharge barriers was constructed using a series of open-ended questions and axial coding to identify discharge barrier themes. Results were integrated to produce a mixed-method model. Results A total of 1,665 echinocandin courses were evaluated. Five hundred and thirty-four patients (32%) received echinocandin therapy until at least the day of hospital discharge of which 328 of 534 (61%) patients were either discharged to home or transferred to another facility. Significant predictors for outpatient echinocandin use were osteomyelitis (OR 4.07, 95% CI: 1.06-15.66; p=0.041) and other deep-seated infection (OR 4.44; 95% CI: 1.65-11.96; p=0.003). Stewardship analysis identified the majority of patients (54%) had the possibility for at least one day earlier discharge (potential earlier discharge:1.65±1.16 days). The quantitative model identified major barriers to be transition of care-, other medical care-, and infectious diseases-related. The qualitative model largely agreed with the quantitative model with additional psychosocial and health care access variables identified. Conclusion Using a mixed method approach, barriers to hospital discharge and potential use of new antifungal therapies were identified. These data could be used to assist transitions of care in patients with invasive candidiasis. Disclosures Truc T. Tran, PharmD, Merck (Grant/Research Support) Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support)
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Affiliation(s)
- Jinhee Jo
- University of Houston, Houston, Texas
| | | | | | | | | | | | - Truc T Tran
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, Houston, TX, Houston, TX
| | - Debora Simmons
- University of Texas Health Science Center, Houston, Texas
| | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, Texas
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12
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Abstract
BACKGROUND Runt-related transcription factor 1 (RUNX1T1) isoforms are involved in adipogenesis. RUNX1T1 is mediated by the fat mass and obesity-associated (FTO). However, the extent to which RUNX1T1 single-nucleotide polymorphisms (SNPs) are associated with obesity risk or metabolic abnormalities in a community population basis is unknown. METHODS Samples were obtained from the Australian Crossroads study bio-bank. SNPs located in the coding region and 3'untranslated regions of RUNX1T1 with minor allele frequency ≥0.05 were analysed using Taqman genotyping assays. RESULTS Eight candidate SNPs were genotyped successfully in 1440 participants. Of these SNPs only rs34269950 located in the 'RRACH' motif, the most common N6-methyladenosine (m6A) methylation modification site (recognized by FTO), was significantly associated with obesity risk and metabolic abnormalities. Specifically, compared to AA genotype, rs34269950 del/del genotype was associated with a 1.47 [95% confidence interval (CI): 1.01-2.14, P = 0.042] fold higher rate of obesity risk. Additionally, the del/del genotype was associated with a 60% increased risk of metabolic syndrome (MetS) [odds ratio (OR) = 1.60, 95% CI: 1.10-2.32, P = 0.015], in comparison to the AA genotype. Finally, rs34269950 del/del increased the risk of a larger waist circumference (OR = 1.65, 95% CI: 1.15-2.36, P = 0.007), but not other components of MetS. CONCLUSION Our study demonstrates that RUNX1T1 rs34269950, located in a potential FTO recognition motif, is significantly associated with waist circumference. This provides novel evidence to suggest SNPs located in RRACH motif may be involved in RNA m6A modification and mechanistic pathways that influence abdominal obesity.
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Affiliation(s)
- Y Zhou
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361016, China
- The School of Economics, Xiamen University, Xiangan South Road, Xiangan District, Xiamen 361102, China
| | - B D Hambly
- Discipline of Pathology and Bosch Institute, University of Sydney, Charles Perkins Centre, John Hopkins Drive, NSW 2006, Australia
| | - D Simmons
- Department of Rural Health, University of Melbourne, Level 2 West, Medical Building (181) Shepparton, VIC 3010, Australia
- School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW 2751, Australia
| | - C S McLachlan
- Health Vertical, Torrens University, 5/235 Pyrmont St, Pyrmont, NSW 2009, Australia
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Mariño R, Glenister K, Bourke L, Morgan M, Atala-Acevedo C, Simmons D. Patterns of use of oral health care services in Australian rural adults: the Crossroads-II Dental sub-study. Aust Dent J 2021; 66:397-405. [PMID: 34152019 DOI: 10.1111/adj.12865] [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] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria. METHODS In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services. RESULTS Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00-1.03; OR = 1.08; 95% CI: 1.01-1.16; OR = 2.06; 95% CI: 1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36-0.58; OR = 0.95; 95% CI: 0.92-0.98, respectively). CONCLUSIONS Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers.
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Affiliation(s)
- R Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - K Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - L Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - M Morgan
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - C Atala-Acevedo
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia.,Centre for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - D Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, Australia.,Macarthur Clinical School, Western Sydney University, Sydney, Australia
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Simmons D. Failure to Act: Tubing Misconnections in the United States. AACN Adv Crit Care 2021; 32:11-13. [PMID: 33725098 DOI: 10.4037/aacnacc2021920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Debora Simmons
- Debora Simmons is Assistant Professor, University of Texas Health Science Center at Houston, School of Biomedical Informatics, 10915 Cory, Manvel, TX 77578
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Immanuel J, Simmons D, Harreiter J, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Dunne FP, Damm P, Mathiesen ER, Jensen DM, Andersen LLT, Hill DJ, Jelsma JGM, Kautzky-Willer A, Galjaard S, Snoek FJ, van Poppel MNM. Metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes. Diabet Med 2021; 38:e14413. [PMID: 32991758 DOI: 10.1111/dme.14413] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
AIMS To describe the metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes. METHODS We performed a post hoc analysis using data from the Vitamin D And Lifestyle Intervention for gestational diabetes prevention (DALI) trial conducted across nine European countries (2012-2014). In women with a BMI ≥29 kg/m2 , insulin resistance and secretion were estimated from the oral glucose tolerance test values performed before 20 weeks, using homeostatic model assessment of insulin resistance and Stumvoll first-phase indices, respectively. Women with early gestational diabetes, defined by the International Association of Diabetes and Pregnancy Study Groups criteria, were classified into three groups: GDM-R (above-median insulin resistance alone), GDM-S (below-median insulin secretion alone), and GDM-B (combination of both) and the few remaining women were excluded. RESULTS Compared with women in the normal glucose tolerance group (n = 651), women in the GDM-R group (n = 143) had higher fasting and post-load glucose values and insulin levels, with a greater risk of having large-for-gestational age babies [adjusted odds ratio 3.30 (95% CI 1.50-7.50)] and caesarean section [adjusted odds ratio 2.30 (95% CI 1.20-4.40)]. Women in the GDM-S (n = 37) and GDM-B (n = 56) groups had comparable pregnancy outcomes with those in the normal glucose tolerance group. CONCLUSIONS In overweight and obese women with early gestational diabetes, higher degree of insulin resistance alone was more likely to be associated with adverse pregnancy outcomes than lower insulin secretion alone or a combination of both.
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Affiliation(s)
- J Immanuel
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - D Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - J Harreiter
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - G Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - R Corcoy
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - J M Adelantado
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
| | - A Lapolla
- Universita Degli Studi di Padova, Padua, Italy
| | - M G Dalfra
- Universita Degli Studi di Padova, Padua, Italy
| | - A Bertolotto
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poland
| | - A Zawiejska
- Department of Reproduction, Poznan University of Medical Sciences, Poland
| | - F P Dunne
- National University of Ireland, Galway, Ireland
| | - P Damm
- Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - E R Mathiesen
- Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - L L T Andersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - D J Hill
- Recherche en Santé Lawson SA, St. Gallen, Switzerland
- Lawson Health Research Institute, London, Ontario, Canada
| | - J G M Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - A Kautzky-Willer
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
- Gender Institute Gars am Kamp, Vienna, Austria
| | - S Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - F J Snoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - M N M van Poppel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
- Institute of Sport Science, University of Graz, Graz, Austria
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Meek CL, Lindsay RS, Scott EM, Aiken CE, Myers J, Reynolds RM, Simmons D, Yamamoto JM, McCance DR, Murphy HR. Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic. Diabet Med 2021; 38:e14380. [PMID: 32750184 PMCID: PMC7436759 DOI: 10.1111/dme.14380] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c , during the COVID-19 pandemic. METHODS Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004-2008; 826 consecutive gestational diabetes pregnancies, 2014-2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large-for-gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver-operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance. RESULTS Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver-operating characteristic curve for both criteria 0.81 (95% CI 0.79-0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver-operating characteristic curve 0.75 (95% CI 0.65-0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver-operating characteristic curve 0.92 (95% CI 0.85-0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75-0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77-0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2-5.4 mmol/l (sensitivity 18-41%; specificity 97-98%). CONCLUSIONS Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.
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Affiliation(s)
- C. L. Meek
- Wellcome Trust‐MRC Institute of Metabolic ScienceMetabolic Research LaboratoriesUniversity of CambridgeCambridgeUK
- Diabetes in Pregnancy TeamCambridge University HospitalsCambridgeUK
- Department of Clinical BiochemistryCambridge University HospitalsAddenbrookes’s HospitalCambridgeUK
| | - R. S. Lindsay
- Institute of Cardiovascular and Medical SciencesBritish Heart Foundation Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - E. M. Scott
- Department of Population and Clinical SciencesLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - C. E. Aiken
- Wellcome Trust‐MRC Institute of Metabolic ScienceMetabolic Research LaboratoriesUniversity of CambridgeCambridgeUK
- Diabetes in Pregnancy TeamCambridge University HospitalsCambridgeUK
| | - J. Myers
- Maternal and Fetal Health Research CentreUniversity of ManchesterSt Mary's HospitalManchesterUK
| | - R. M. Reynolds
- Centre for Cardiovascular ScienceQueen's Medical Research InstituteEdinburghUK
| | - D. Simmons
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
| | - J. M. Yamamoto
- Departments of Medicine and Obstetrics and GynaecologyUniversity of CalgaryCalgaryCanada
| | - D. R. McCance
- Regional Centre for Endocrinology and DiabetesBelfastUK
| | - H. R. Murphy
- Diabetes in Pregnancy TeamCambridge University HospitalsCambridgeUK
- Norwich Medical SchoolBob Champion Research and Education BuildingUniversity of East AngliaNorwichUK
- Division of Women’s HealthKings College LondonLondonUK
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17
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Hildén K, Magnuson A, Hanson U, Simmons D, Fadl H. Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study. Diabet Med 2020; 37:2050-2057. [PMID: 32027045 DOI: 10.1111/dme.14266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
AIM To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time. METHODS Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score. RESULTS The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an odds ratio per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM. CONCLUSIONS This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.
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Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden
| | - U Hanson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - D Simmons
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - H Fadl
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
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18
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Yu D, Shang J, Cai Y, Wang Z, Zhao B, Zhao Z, Simmons D. A low-cost laboratory-based method for predicting newly diagnosed biopsy-proven diabetic nephropathy in people with type 2 diabetes. Diabet Med 2020; 37:1728-1736. [PMID: 31797436 DOI: 10.1111/dme.14195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 11/28/2022]
Abstract
AIMS To identify significant prognostic factors for newly diagnosed biopsy-proven diabetic nephropathy using routine laboratory measures, from which to derive a low-cost explanatory model, and to use this model to examine associations between the potential low-cost test panels and the risk of diabetic nephropathy in people with type 2 diabetes with normal kidney function. METHOD A population-based case-control study was undertaken to test the association between diabetic nephropathy and 47 laboratory variables using a 'hypothesis-free' strategy and five routinely recorded factors in diabetes care (BMI, systolic and diastolic blood pressure, HbA1c , fasting glucose). Factors that were significant after Bonferroni correction were included in different test panels and used to develop diabetic nephropathy (outcome) explanatory models. Models were derived using risk-set sampling among 950 biopsy-proven diabetic nephropathy cases newly diagnosed in the period between 2012 and 2018 and among 4750 age- and gender-matched controls. RESULTS A total of 15 Bonferroni-corrected significant laboratory predictors in the three test panels (blood cell, serum electrolytes and blood coagulation) were identified through multivariable analysis and used to develop the three explanatory models. The optimism-adjusted C-statistics and calibration slope were 0.725 (95% CI 0.723-0.728) and 0.978 (95% CI 0.912-0.999) for the blood cell model, 0.688 (95% CI 0.686-0.690) and 0.923 (95% CI 0.706-0.977) for the serum electrolytes model, 0.648 (95% CI 0.639-0.658) and 0.914 (95% CI 0.641-1.115) for the blood coagulation model, respectively. CONCLUSIONS A total of 15 predictors were significantly associated with newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes. The blood cell model appeared to be the low-cost model with the best predictive ability.
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Affiliation(s)
- D Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - J Shang
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Y Cai
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Z Wang
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - B Zhao
- Second Division of Internal Medicine, Kejing Community Health Centre, Jiyuan, China
| | - Z Zhao
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - D Simmons
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Western Sydney University, Campbelltown, Sydney, NSW, Australia
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Brixey J, Salyer P, Simmons D. Nightingale power: The advent of nursing informatics. Nurs Manag (Harrow) 2020; 51:51-53. [PMID: 32618943 DOI: 10.1097/01.numa.0000669104.92938.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Juliana Brixey
- At the University of Texas Health Science Center at Houston School of Biomedical Science Cizik School of Nursing, Juliana Brixey is an associate professor and Debora Simmons is an assistant professor. Pamela Salyer is an IT process consultant at Houston (Tex.) Methodist
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20
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Zhou Y, Hambly BD, Simmons D, McLachlan CS. Sex-specific educational attainment is associated with telomere length in an Australian rural population. QJM 2020; 113:469-473. [PMID: 32073638 DOI: 10.1093/qjmed/hcaa031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is limited understanding on whether and how socioeconomic status (SES), particularly educational attainment and household income, impacts on telomere length in an Australian rural context. Additionally, it is unknown whether access to health services via the Australian public or private health system influences telomere length. AIM This study investigates whether there is a relationship between telomere length and SES indicators (income, education) as well as health insurance status in a rural Australian population. METHODS Samples were drawn from the Australian Rural Victoria cross-sectional Crossroads Study. Leucocyte telomere length (LTL) was measured using a multiplex quantitative polymerase chain reaction method. RESULTS Among 1424 participants, we did not find a significant main effect association with LTL across education, income level and health insurance. An exploratory finding was sex may influence the relationship between educational attainment and LTL (P = 0.021). In males, but not females, higher education was associated with longer LTL by 0.033 [95% confidence interval (CI) 0.002-0.063, P = 0.035]; in those with low education attainment, male participants had shorter LTL by 0.058 (95% CI -0.086 to -0.029) than female participants (P < 0.0001). CONCLUSION Being male and having lower education attainment was associated with shorter telomere length in our rural population. Evidence from our study supports the importance of education on LTL in males in rural Australia. Our studies also support previous findings that LTL in later life may not be closely associated with indicators of SES.
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Affiliation(s)
- Y Zhou
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361016, China
- The School of Economics, Xiamen University, Xiangan South Road, Xiangan District, Xiamen 361102, China
| | - B D Hambly
- Discipline of Pathology and Bosch Institute, University of Sydney, Charles Perkins Centre, John Hopkins Drive, NSW 2006, Australia
| | - D Simmons
- Department of Rural Health, University of Melbourne, Level 2 West, Medical Building (181) Shepparton, VIC 3010, Australia
- School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW 2751, Australia
| | - C S McLachlan
- Health Vertical, Torrens University, 5/235 Pyrmont St, Pyrmont, NSW 2009, Australia
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Meek CL, Devoy B, Simmons D, Patient CJ, Aiken AR, Murphy HR, Aiken CE. Seasonal variations in incidence and maternal-fetal outcomes of gestational diabetes. Diabet Med 2020; 37:674-680. [PMID: 31955458 PMCID: PMC8597396 DOI: 10.1111/dme.14236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
AIMS To determine whether the neonatal and delivery outcomes of gestational diabetes vary seasonally in the context of a relatively cool temperate climate. METHODS A retrospect cohort of 23 735 women consecutively delivering singleton, live-born term infants in a single tertiary obstetrics centre in the UK (2004-2008) was identified. A total of 985 (4.1%) met the diagnostic criteria for gestational diabetes. Additive dynamic regression models, adjusted for maternal age, BMI, parity and ethnicity, were used to compare gestational diabetes incidence and outcomes over annual cycles. Outcomes included: random plasma glucose at booking; gestational diabetes diagnosis; birth weight centile; and delivery mode. RESULTS The incidence of gestational diabetes varied by 30% from peak incidence (October births) to lowest incidence (March births; P=0.031). Ambient temperature at time of testing (28 weeks) was strongly positively associated with diagnosis (P<0.001). Significant seasonal variation was evident in birth weight in gestational diabetes-affected pregnancies (average 54th centile June to September; average 60th centile December to March; P=0.027). Emergency Caesarean rates also showed significant seasonal variation of up to 50% (P=0.038), which was closely temporally correlated with increased birth weights. CONCLUSIONS There is substantial seasonal variation in gestational diabetes incidence and maternal-fetal outcomes, even in a relatively cool temperate climate. The highest average birth weight and greatest risk of emergency Caesarean delivery occurs in women delivering during the spring months. Recognizing seasonal variation in neonatal and delivery outcomes provides new opportunity for individualizing approaches to managing gestational diabetes.
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Affiliation(s)
- C. L. Meek
- Institute of Metabolic ScienceAddenbrooke's HospitalCambridgeUK
- Department of Clinical BiochemistryCambridge University HospitalsAddenbrooke's HospitalCambridgeUK
- Wolfson Diabetes and Endocrinology ClinicCambridge University HospitalsAddenbrooke's HospitalCambridgeUK
- Department of ChemistryPeterborough City HospitalPeterboroughUK
| | - B. Devoy
- Department of Obstetrics and GynaecologyRosie HospitalCambridge University HospitalsCambridgeUK
| | - D. Simmons
- School of MedicineWestern Sydney University CampbelltownNSWAustralia
| | - C. J. Patient
- Department of Obstetrics and GynaecologyRosie HospitalCambridge University HospitalsCambridgeUK
| | - A. R. Aiken
- LBJ School of Public AffairsUniversity of Texas at AustinAustinTXUSA
| | - H. R. Murphy
- Wolfson Diabetes and Endocrinology ClinicCambridge University HospitalsAddenbrooke's HospitalCambridgeUK
- Norwich Medical SchoolBob Champion Research BuildingUniversity of East AngliaNorwichUK
- Department of Women's HealthKing's College LondonLondonUK
| | - C. E. Aiken
- Department of Obstetrics and GynaecologyRosie HospitalCambridge University HospitalsCambridgeUK
- University Department of Obstetrics and GynaecologyUniversity of CambridgeNIHR Cambridge Biomedical Research CentreCambridgeUK
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22
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Brause AR, Trucksess MW, Thomas FS, Page SW, Burke J, Tanner A, Hammack S, Woodward BB, Post S, Simmons D, Cherix G, Kennedy M, Lewis S, English N, Coppola ED, Kline L, Coopersmith A, Foos JF, Eisele TA, Krueger DA, Hofsommer HJ, MacDonald S, Hesford F, Lea A, Symonds P, Martin G, Acar J, Eksi A, Ardenghi R, Weiss J, Lee B, Woidich H. Determination of Patulin in Apple Juice by Liquid Chromatography: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.2.451] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
An AOAC International-International Union of Pure and Applied Chemistry-International Fruit Juice Union (AOAC-IUPAC-IFJU) collaborative study was conducted to evaluate a liquid chromatographic (LC) procedure for determination of patulin in apple juice. Patulin is a mold metabolite found naturally in rotting apples. Patulin is extracted with ethyl acetate, treated with sodium carbonate solution, and determined by reversed-phase LC with UV detection at 254 or 276 nm. Water, water-tetrahydrofuran, or water-acetonitrile was used as mobile phase. Levels determined in spiked test samples were 20, 50,100, and 200 μg/L. A test sample naturally contaminated at 31 μg/L was also included. Twenty-two collaborators in 10 countries analyzed 12 test samples of apple juice. Recoveries averaged 96%, with a range of 91-108%. Repeatability relative standard deviations (RSDr) ranged from 10.9 to 53.8%. The reproducibility relative standard deviation (RSDR) ranged from 15.1 to 68.8%. The LC method for determination of patulin in apple juice has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Allan R Brause
- Analytical Chemical Services of Columbia, Inc., 9151 Rumsey Rd, Columbia, MD 21045
| | - Mary W Trucksess
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
| | - Frederick S Thomas
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
| | - Samuel W Page
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
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Thevarajah A, Simmons D. Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3-year review. Diabet Med 2019; 36:1109-1117. [PMID: 30972790 DOI: 10.1111/dme.13962] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/27/2022]
Abstract
AIM To determine risk factors associated with neonatal hypoglycaemia and hyperbilirubinaemia, and assess their impact on neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). METHODS Retrospective review investigating all pregnancies complicated by GDM at Campbelltown Hospital (Sydney, Australia) between 1 January 2013 and 31 December 2015. Main outcomes measured were neonatal hypoglycaemia (capillary glucose levels < 1.8 mmol/l) and hyperbilirubinaemia (total serum bilirubin levels greater than age-appropriate thresholds for phototherapy). Adjusted odds ratios [95% confidence interval (CI)] are shown, calculated by multivariable logistic regression. RESULTS Some 60 (7.8%) infants developed hypoglycaemia, 58 (7.5%) developed hyperbilirubinaemia and 13 (1.7%) developed both. Risk of developing hypoglycaemia increased 1.8-fold (95% CI 1.3-2.6, P < 0.001) per gestational week at GDM diagnosis, 1.1-fold (95% CI 1.0-1.3, P = 0.04) per mmol/l maternal fasting glucose, 6.2-fold (95% CI 2.6-16.2, P < 0.001) with maternal history of macrosomia, 10.8-fold (95% CI 4.1-27.6, P < 0.001) with multiple pregnancy and 1.1-fold (95% CI 1.0-1.3, P = 0.04) per gestational week at birth. Risk of hyperbilirubinaemia increased with multiple pregnancy (26.4; 95% CI 11.7-59.7, P < 0.001), and 1.5-fold (95% CI 1.1-2.1, P = 0.01) per gestational week at GDM diagnosis. Hypoglycaemia was associated with a 2.8-fold (95% CI 1.1-7.1, P = 0.03) increased risk of macrosomia, a 5.4-fold (95% CI 1.1-27.3, P = 0.04) excess risk of shoulder dystocia and a 6.4-fold increased risk of 5-min APGAR ≤ 7 (95% CI 1.2-1.7, P < 0.001). Hyperbilirubinaemia was associated with an excess risk of polycythaemia (packed cell volume > 0.6; 97.1, 95% CI 38.9-241.5, P < 0.001). CONCLUSIONS Neonatal hypoglycaemia and hyperbilirubinaemia largely occur in different pregnancies. Both are associated with earlier GDM diagnosis; however, hypoglycaemia is more associated with maternal glycaemia and its sequelae, and hyperbilirubinaemia is associated with polycythaemia.
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MESH Headings
- Adolescent
- Adult
- Birth Weight
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Diabetes, Gestational/epidemiology
- Female
- Fetal Macrosomia/epidemiology
- Humans
- Hyperbilirubinemia, Neonatal/epidemiology
- Hyperbilirubinemia, Neonatal/etiology
- Hypoglycemia/congenital
- Hypoglycemia/epidemiology
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Male
- Middle Aged
- Pregnancy
- Pregnancy Outcome/epidemiology
- Retrospective Studies
- Risk Factors
- Young Adult
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Affiliation(s)
- A Thevarajah
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - D Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Departmentt of Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia
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Abstract
Despite the widespread adoption of electronic health records (EHRs) in the U.S. over the past decade, significant improvements, especially in patient safety, have yet to be realized. This finding, along with health informatics workforce data and an identified gap in the offerings of an educational program, led to a proposed professional doctorate in health informatics. Developed via stakeholder focus groups, the program was approved by the public university system, the state-level educational authority, and the regional accreditation body, with final approval in July 2018. Unique features of the program include a prolonged practice project demonstrating a return on investment, as well as online and face-to-face delivery components. This program aims to develop evidence-based professionals who improve the health of people and populations through the application of health informatics. Applications and interest in the first class are high.
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Affiliation(s)
- Susan H Fenton
- The University of Texas School of Biomedical Informatics, Houston Texas, USA
| | - Angela Ross
- The University of Texas School of Biomedical Informatics, Houston Texas, USA
| | - Debora Simmons
- The University of Texas School of Biomedical Informatics, Houston Texas, USA
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25
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Abstract
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse outcomes for mother and infant both at birth and later in life. A large body of evidence is now available relating to antenatal prevention of GDM. Overall, despite some individual trials of a variety of lifestyle interventions revealing benefit, many more have shown no effect from the second trimester onwards, even with significant gestational weight gain limitation. At-risk women often seem reluctant to engage in lifestyle changes and frequently cannot adhere to recommended interventions even within a clinical trial setting. Many trials have not considered the heterogeneity of diabetes first discovered in pregnancy, something of importance into the future. Future work should focus on designing interventions acceptable to the population at risk, whether those taking place before or during the first trimester of pregnancy are effective, and whether greater individualization can identify those women most likely to benefit.
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Affiliation(s)
- A M Egan
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - D Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
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Hildén K, Hanson U, Persson M, Magnuson A, Simmons D, Fadl H. Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden. Diabet Med 2019; 36:151-157. [PMID: 30698864 PMCID: PMC6590111 DOI: 10.1111/dme.13843] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate the interaction effects of gestational diabetes (GDM) with obesity on perinatal outcomes. METHODS A population-based cohort study in Sweden excluding women without pre-gestational diabetes with a singleton birth between 1998 and 2012. Logistic regression was performed to evaluate the potential independent associations of GDM and BMI with adverse perinatal outcomes as well as their interactions. Main outcome measures were malformations, stillbirths, perinatal mortality, low Apgar score, fetal distress, prematurity and Erb's palsy. RESULTS Some 1,294,006 women were included, with a GDM prevalence of 1% (n = 14,833). The rate of overweight/obesity was 67.7% in the GDM-group and 36.1% in the non-GDM-group. No significant interaction existed. Offspring of women with GDM had significantly increased risk of malformations, adjusted odds ratio (aOR) 1.16 (95% confidence intervals 1.06-1.26), prematurity, aOR 1.86 (1.76-1. 98), low Apgar score, aOR 1.36 (1.10-1.70), fetal distress, aOR 1.09 (1.02-1.16) and Erb's palsy aOR 2.26 (1.79-2.86). No risk for stillbirth or perinatal mortality was seen. Offspring of overweight (BMI 25-29.9 kg/m2 ), obese (BMI 30-34.9 kg/m2 ) and severely obese women (BMI ≥ 35.0 kg/m2 ) had significantly increased risks of all outcomes including stillbirth 1.51 (1.40-1.62) to 2.85 (2.52-3.22) and perinatal mortality 1.49 (1.40-1.59) to 2.83 (2.54-3.15). CONCLUSIONS There is no interaction effect between GDM and BMI for the studied outcomes. Higher BMI and GDM are major independent risk factors for most serious adverse perinatal outcomes. More effective pre-pregnancy and antenatal interventions are required to prevent serious adverse pregnancy outcomes among women with either GDM or high BMI.
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Affiliation(s)
- K. Hildén
- Department of Obstetrics & GynaecologySchool of Medical SciencesÖrebro UniversityÖrebroSweden
| | - U. Hanson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - M. Persson
- Department of MedicineClinical Epidemiology UnitKarolinska UniversitetssjukhusetSolnaSweden
| | - A. Magnuson
- Clinical Epidemiology and BiostatisticsSchool of Medical SciencesÖrebro UniversityÖrebroSweden
| | - D. Simmons
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
| | - H. Fadl
- Department of Obstetrics & GynaecologySchool of Medical SciencesÖrebro UniversityÖrebroSweden
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Allen B, Simmons D, Drysdale TD, Coon J. Performance analysis of an orbital angular momentum multiplexed amplify-and-forward radio relay chain with inter-modal crosstalk. R Soc Open Sci 2019; 6:181063. [PMID: 30800358 PMCID: PMC6366228 DOI: 10.1098/rsos.181063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/31/2018] [Indexed: 06/09/2023]
Abstract
The end-to-end spectral efficiency and bit error rate (BER) of an amplify-and-forward (AF) radio relay chain employing orbital angular momentum (OAM) multiplexing is presented. The inherent divergence of a beam carrying OAM is overcome by means of a lens. Modelled and measured inter-modal crosstalk levels are incorporated into the analysis. The results show that an end-to-end spectral efficiency of up to 8 bits s-1 Hz-1 is achievable using four OAM modes to multiplex four parallel data streams over 20 hops, provided that the detrimental effects of inter-modal crosstalk are mitigated. The spectral efficiency is expected to scale further by using more OAM modes. The BER profile along the relay chain is analysed for each of the four OAM modes.
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Affiliation(s)
- B. Allen
- Network Rail, The Quadrant: MK, Elder Gate, Milton Keynes MK9 1ER, UK
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - D. Simmons
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - T. D. Drysdale
- School of Engineering, University of Edinburgh, Edinburgh EH9 3FG, UK
| | - J. Coon
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
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Yu D, Graffy J, Holman D, Robins P, Cai Y, Zhao Z, Simmons D. Impact of peer support on inpatient and outpatient payments among people with Type 2 diabetes: a prospective cohort study. Diabet Med 2018; 35:789-797. [PMID: 29575010 DOI: 10.1111/dme.13624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
Abstract
AIM To investigate the impact of a low-cost diabetes peer-support intervention, aimed at reducing inpatient and outpatient care utilization and healthcare payments, by conducting a cohort study that followed up a randomized controlled trial. METHODS A total of 1121 adults with Type 2 diabetes were recruited through general practices in Cambridgeshire and Hertfordshire, UK, and were followed up for 3.25 financial years after 8-12 months of one-to-one, group or combined diabetes peer support and usual care. Use of, and payments for inpatient and outpatient services were fully recorded in the follow-up. Adjusted mean inpatient and outpatient payments per person were estimated using a two-part model after adjusting for baseline characteristics. RESULTS The mean age of the recruited adults was 65.6±11.4 years, 60.4% were male, and 16.8% were insulin-treated. Compared with the control group, less healthcare utilization (especially non-elective inpatient care and outpatient consultations) was observed in each of the intervention groups, particularly the combined intervention group. Over the course of 3.25 financial years, significant reductions of 41% (£909.20 per head) were observed for overall inpatient payments (P<0.0001), 51% (£514.67 per head) for non-elective inpatient payments (P=0.005) in the combined intervention group, and 34% (£413.30 per head) and 32% (£388.99 per head) for elective inpatient payments in the one-to-one (P=0.029) and combined intervention (P=0.048) groups, respectively. CONCLUSIONS Type 2 diabetes peer support, whether delivered using a one-to-one, group or combined approach was associated with reduced inpatient care utilization (particularly non-elective admissions) and payments over 3.25 years.
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Affiliation(s)
- D Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Arthritis Research UK, Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - J Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - D Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - P Robins
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Y Cai
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Z Zhao
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - D Simmons
- Western Sydney University, Campbelltown, Sydney, NSW, Australia
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29
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Patterson ES, Sillars DM, Staggers N, Chipps E, Rinehart-Thompson L, Moore V, Simmons D, Moffatt-Bruce SD. Safe Practice Recommendations for the Use of Copy-Forward with Nursing Flow Sheets in Hospital Settings. Jt Comm J Qual Patient Saf 2017; 43:375-385. [PMID: 28738982 DOI: 10.1016/j.jcjq.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/30/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In early 2016 the Partnership for Health IT Patient Safety released safe practice recommendations for the use of copy-paste for electronic health record (EHR) documentation. These recommendations do not directly address nurses' use of copy-forward to document patient assessments in flow sheet software in hospital settings. Similar to clinicians' use of copy-paste and copy-forward with progress notes, concerns exist about patient safety issues from the use of potential inaccurate or outdated information to achieve increased efficiency of documentation. METHODS A multiple-methods approach-which included a literature review, litigation search, stakeholder analysis, and consensus opinion from experts from multiple disciplines-was employed. RESULTS Four recommendations correspond closely with copy-paste guidance for EHR documentation from the Partnership: (1) Provide a mechanism to make copied-forward content easily identifiable, (2) Ensure that the provenance of copied-forward content is readily available, (3) Ensure adequate staff training and education regarding the appropriate and safe use of copy-forward in flow sheet software, if available, and (4) Ensure that copy-forward practices are regularly monitored, measured, and assessed. A fifth additional recommendation is made to improve the efficiency of data entry mechanisms, which may reduce patient safety risk. Emerging promising areas for innovation are to optimize interface usability and flow sheet content, use templates, use digital photographs, and eliminate work-flow steps with better methods for authentication and data entry. CONCLUSIONS A thoughtful and measured approach to safe use of copy-forward in flow sheets by nurses in hospital settings is expected to result in improvements in efficiency of documentation, work flow, and accuracy of information.
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Zhou Y, Simmons D, Lai D, Hambly BD, McLachlan CS. rs9939609 FTO genotype associations with FTO methylation level influences body mass and telomere length in an Australian rural population. Int J Obes (Lond) 2017; 41:1427-1433. [PMID: 28559540 DOI: 10.1038/ijo.2017.127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/26/2017] [Accepted: 05/07/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The fat mass- and obesity-associated (FTO) gene influences energy homeostasis in humans. Although the obesity-related variant, rs9939609 has been replicated across a number of cohort studies, there remains significant variance and a low to modest association. Telomere length is another commonly reported obesity risk factor. We hypothesize understanding the associations between FTO rs9939609 with FTO methylation and telomere length will provide a more accurate assessment of obesity risk. METHODS Overall, 942 participants free of diabetes or pre-diabetes were included in the retrospective study. Leukocyte genomic DNA was analyzed for rs9939609 genotyping, FTO gene methylation and leukocyte telomere length (LTL) measurement. RESULTS In general linear models, rs9939609 AA genotypes were associated with increased fat percentage (3.15%, P=0.001), fat mass (4.16 kg, P=0.001), body mass index (BMI) (1.38, P=0.006) and waist circumference (3.35 cm, P=0.006), but not with FTO methylation or LTL in this overall population. However, when participants were stratified into higher and lower FTO methylation groups, the AA genotype possesses a 2.04-fold increased obesity risk in comparison to TT genotype (95%CI, 1.07-3.89, P=0.031) in participants with a higher FTO methylation level, but this association was absent in the lower FTO methylation sub-group. Moreover, AT and AA genotype carriers were associated with shorter LTL compared to TT carriers (P=0.020 and P=0.111, respectively) in the higher FTO methylation level group. However, this association was absent in the lower methylation group. Furthermore, FTO gene methylation level was significantly associated with LTL in the 942 samples (P=0.017). CONCLUSIONS FTO rs9939609 is associated with obesity risk and LTL in this study, where this association is only observed at higher, but not lower, FTO methylation levels of participants. Our data suggest association of multiple factors, including FTO methylation level, may be involved in one of several mechanisms underlying the commonly reported obesity risk of this FTO polymorphism.
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Affiliation(s)
- Y Zhou
- Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - D Simmons
- Rural Clinical School, University of MelbourneI, Shepparton, Victoria, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - D Lai
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - B D Hambly
- Discipline of Pathology and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - C S McLachlan
- Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Affiliation(s)
- D Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - S Hartnell
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Davenport
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Jenaway
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Abstract
Special consideration must be given to financial, legal and social welfare aspects of families where the breadwinner is burned. Some approaches to nursing assessment and intervention with families facing economic stress in addition to predictable emotional demands occurring with severe burns are elaborated through case illustration.
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Bianco-Miotto T, Blundell C, Buckberry S, Chamley L, Chong S, Cottrell E, Dawson P, Hanna C, Holland O, Lewis RM, Moritz K, Myatt L, Perkins AV, Powell T, Saffery R, Sferruzzi-Perri A, Sibley C, Simmons D, O'Tierney-Ginn PF. IFPA meeting 2015 workshop report I: placental mitochondrial function, transport systems and epigenetics. Placenta 2015; 48 Suppl 1:S3-S6. [PMID: 26693894 DOI: 10.1016/j.placenta.2015.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2015 there were twelve themed workshops, three of which are summarized in this report. These workshops covered areas of placental regulation and nutrient handling: 1) placental epigenetics; 2) placental mitochondrial function; 3) placental transport systems.
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Affiliation(s)
| | - C Blundell
- University of Pennsylvania, Philadelphia, PA, USA
| | - S Buckberry
- The University of Western Australia, WA, Australia
| | | | - S Chong
- Mater Research Institute, University of Queensland, QLD, Australia
| | - E Cottrell
- Maternal and Fetal Health Research Centre, Institute of Human Development, The University of Manchester, Manchester Academic Health Science Centre, St. Mary's Hospital, Manchester, United Kingdom
| | - P Dawson
- Mater Research Institute, University of Queensland, Australia
| | - C Hanna
- University of British Columbia, Vancouver, BC, Canada
| | - O Holland
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - R M Lewis
- Faculty of Medicine, University of Southampton, UK
| | - K Moritz
- School of Biomedical Sciences, University of Queensland, QLD, Australia
| | - L Myatt
- Center for Pregnancy and Newborn Research, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - A V Perkins
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - T Powell
- University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | | | - A Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - C Sibley
- Maternal and Fetal Health Research Centre, University of Manchester, UK
| | - D Simmons
- University of Queensland, QLD Australia
| | - P F O'Tierney-Ginn
- Center for Reproductive Health, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Simmons D, Hartnell S, Watts J, Ward C, Davenport K, Gunn E, Jenaway A. Effectiveness of a multidisciplinary team approach to the prevention of readmission for acute glycaemic events. Diabet Med 2015; 32:1361-7. [PMID: 25865087 DOI: 10.1111/dme.12779] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Abstract
AIMS To describe the effect of a combined diabetes specialist/mental health team approach to prevent readmissions for acute glycaemic events among patients with diabetes. METHODS Consecutive patients with diabetes, readmitted to a single hospital for an acute glycaemic condition, were offered one or more diabetes (including assessment, education, medication, technology use and intensive support) and mental health (including assessment, training and therapies) interventions. The pilot service took place over 11 months, with the preceding 24 months and subsequent 8 months serving as control periods. RESULTS Of the 58 patients admitted, 50 had Type 1 diabetes and were from within the hospital catchment area, and were discharged home. Of these, 32 (64%) had a pre-existing mental health issue and 14 (28%) had a complex social situation. In all, 96% of patients were met as an inpatient by a team member, and 94% accepted at least one intervention. The mean ±sd number of admissions per patient/month dropped from 0.12 ± 0.10 to 0.05 ± 0.10 (P < 0.001) during the intervention, increasing, once the intervention ended, to 0.16 ± 0.36 (P = 0.002). The mean ± sd length of stay similarly decreased and increased (0.6 ± 0.9 to 0.2 ± 0.7 days; P < 0.001 to 0.006) to 0.6 ± 1.4 days (P = 0.003) per patient/month) across the three periods, as did the mean ±sd tariff paid per patient/month (₤258.0 ± 374.0 vs ₤92.1 ± 245.0 vs ₤287.3 ± 563.8; P < 0.001 and P = 0.018, respectively). The mean ± sd HbA1c level dropped from 99 ± 22 to 92 ± 24 mmol/mol (11.2 ± 4.2% vs 10.6 ± 4.3%; P = 0.014) but did not increase after the intervention [89 ± 26 mmol/mol (10.4 ± 4.5%)]. CONCLUSIONS The cost and long-term risks of hospitalization among patients with Type 1 diabetes and recurrent admissions can be reduced by a combined specialist diabetes/mental health team approach.
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Affiliation(s)
- D Simmons
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Hartnell
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Watts
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Ward
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Davenport
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E Gunn
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - A Jenaway
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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35
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Abstract
Gestational diabetes mellitus (GDM) is increasing at a rapid rate, driven by the increasing proportion of the population that is overweight/obese from a young age. More than 25 randomized controlled trials testing whether GDM can be prevented have now reported their findings, but only four different interventions have shown a reduction in the proportion of women with GDM (healthy eating alone, healthy eating with physical activity, myoinositol supplementation and probiotic treatment), and these results have not been replicated. The interventions tested to date include different diets and different forms of physical activity, in combination or alone, vitamin D, myoinositol, probiotics and metformin. Studies could be improved by using the International Association of Diabetes and Pregnancy Study Group criteria for GDM (which are probably more sensitive to change because of their multiple time points), targeting and tailoring interventions to subgroups most likely to benefit, and separating those with GDM early in pregnancy from those developing GDM de novo. The greatest societal benefit is likely to arise from population-based lifestyle approaches which include those women yet to become pregnant and those who are already pregnant and their families; an approach that is yet to be fully tested.
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Affiliation(s)
- D Simmons
- Macarthur Clinical School, University of Western Sydney, Campbelltown, New South Wales, Australia
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36
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Yu D, Simmons D. Association between pulse pressure and risk of hospital admissions for cardiovascular events among people with Type 2 diabetes: a population-based case-control study. Diabet Med 2015; 32:1201-6. [PMID: 25594137 DOI: 10.1111/dme.12693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 01/03/2023]
Abstract
AIM To investigate the association between pulse pressure and risk of hospitalization for cardiovascular events among people with Type 2 diabetes. METHODS A population-based case-control study was carried out using data from medical databases. A total of 588 people with Type 2 diabetes from 18 general practices in Cambridgeshire recorded a first hospitalization for a cardiovascular event between 2009 and 2011, and a total of 2920 age-matched, gender-matched and practice-matched control subjects with Type 2 diabetes were selected based on risk-set sampling. Pulse pressure was assessed before admission in 2008-2009. Further dose-response relationships between pulse pressure and risks were explored using spline models. RESULTS There was a non-linear relationship between pulse pressure and the risk of hospitalization for a cardiovascular event (P < 0.001 for linearity test). The pulse pressure associated with the lowest risk of hospitalization for a cardiovascular event was 61 (95% CI 57-63) mmHg. CONCLUSION In people with Type 2 diabetes, pulse pressure is a good predictor of risk of hospitalization for cardiovascular events. The risk is lowest with a pulse pressure of 57-63 mmHg.
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Affiliation(s)
- D Yu
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Simmons
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Harding J, Sooriyakumaran M, Anstey KJ, Adams R, Balkau B, Briffa T, Davis TME, Davis WA, Dobson A, Giles GG, Grant J, Knuiman M, Luszcz M, Mitchell P, Pasco JA, Reid C, Simmons D, Simons L, Tonkin A, Woodward M, Shaw JE, Magliano DJ. The metabolic syndrome and cancer: Is the metabolic syndrome useful for predicting cancer risk above and beyond its individual components? Diabetes Metab 2015; 41:463-9. [PMID: 26037090 DOI: 10.1016/j.diabet.2015.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/22/2015] [Indexed: 11/17/2022]
Abstract
AIMS The metabolic syndrome (MetS) is a risk factor for cancer. However, it is not known if the MetS confers a greater cancer risk than the sum of its individual components, which components drive the association, or if the MetS predicts future cancer risk. MATERIALS AND METHODS We linked 20,648 participants from the Australian and New Zealand Diabetes and Cancer Collaboration with complete data on the MetS to national cancer registries and used Cox proportional hazards models to estimate associations of the MetS, the number of positive MetS components, and each of the five MetS components separately with the risk for overall, colorectal, prostate and breast cancer. Hazard ratios (HR) and 95% confidence intervals (95%CI) are reported. We assessed predictive ability of the MetS using Harrell's c-statistic. RESULTS The MetS was inversely associated with prostate cancer (HR 0.85; 95% CI 0.72-0.99). We found no evidence of an association between the MetS overall, colorectal and breast cancers. For those with five positive MetS components the HR was 1.12 (1.02-1.48) and 2.07 (1.26-3.39) for overall, and colorectal cancer, respectively, compared with those with zero positive MetS components. Greater waist circumference (WC) (1.38; 1.13-1.70) and elevated blood pressure (1.29; 1.01-1.64) were associated with colorectal cancer. Elevated WC and triglycerides were (inversely) associated with prostate cancer. MetS models were only poor to moderate discriminators for all cancer outcomes. CONCLUSIONS We show that the MetS is (inversely) associated with prostate cancer, but is not associated with overall, colorectal or breast cancer. Although, persons with five positive components of the MetS are at a 1.2 and 2.1 increased risk for overall and colorectal cancer, respectively, and these associations appear to be driven, largely, by elevated WC and BP. We also demonstrate that the MetS is only a moderate discriminator of cancer risk.
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Affiliation(s)
- J Harding
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - M Sooriyakumaran
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - K J Anstey
- Research School of Population Health, the Australian National University, Canberra, Australia
| | - R Adams
- The Health Observatory Discipline of Medicine, the University of Adelaide, Adelaide, Australia
| | - B Balkau
- Inserm, U1018, Centre for Research in Epidemiology and Population Health, France
| | - T Briffa
- School of Population Health, the University of Western Australia, Crawley, Australia
| | - T M E Davis
- School of Medicine and Pharmacology, the University of Western Australia, Fremantle, Australia
| | - W A Davis
- School of Medicine and Pharmacology, the University of Western Australia, Fremantle, Australia
| | - A Dobson
- School of Population Health, the University of Queensland, Brisbane, Australia
| | - G G Giles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Cancer Epidemiology Centre, the Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, School of Population and Global Heath, the University of Melbourne, Melbourne, Australia
| | - J Grant
- Population Research & Outcome Studies, the University of Adelaide, Adelaide, Australia
| | - M Knuiman
- School of Population Health, the University of Western Australia, Crawley, Australia
| | - M Luszcz
- Flinders Centre for Ageing Studies, Flinders University, Adelaide, Australia
| | - P Mitchell
- Westmead Millennium Institute, the University of Sydney, Sydney, Australia
| | - J A Pasco
- IMPACT Strategic Research Centre School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, Department of Medicine, the University of Melbourne, St Albans, Australia
| | - C Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - D Simmons
- School of Medicine, University of Western Sydney, Campbelltown, Australia; Department of Rural Health, the University of Melbourne, Shepparton, Australia
| | - L Simons
- UNSW Australia Lipid Research Dept, St Vincent's Hospital, Sydney, Australia
| | - A Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M Woodward
- The George Institute for Global Health, the University of Sydney, Sydney, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, UK
| | - J E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Simmons D, Deakin T, Walsh N, Turner B, Lawrence S, Priest L, George S, Vanterpool G, McArdle J, Rylance A, Terry G, Little P. Diabetes UK Position Statement. Competency frameworks in diabetes. Diabet Med 2015; 32:576-84. [PMID: 25611804 DOI: 10.1111/dme.12702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
The quality, skills and attitudes of staff working in the healthcare system are central to multidisciplinary learning and working, and to the delivery of the quality of care patients expect. Patients want to know that the staff supporting them have the right knowledge and attitudes to work in partnership, particularly for conditions such as diabetes where 95% of all care is delivered by the person with diabetes themselves. With the current changes in the NHS structures in England, and the potential for greater variation in the types of 'qualified provider', along with the recent scandal at Mid-Staffordshire Hospital, staff need to be shown to be competent and named/accredited or recognized as such. This will help to restore faith in an increasingly devolved delivery structure. The education and validation of competency needs to be consistently delivered and assured to ensure standards are maintained for different roles and disciplines across each UK nation. Diabetes UK recommends that all NHS organizations prioritize healthcare professional education, training and competency through the implementation of a National Diabetes Competency Framework and the phased approach to delivery to address this need.
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Affiliation(s)
- D Simmons
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Abstract
The rate of surgical site infection after elective foot and ankle surgery is higher than that after other elective orthopaedic procedures. Since December 2005, we have prospectively collected data on the rate of post-operative infection for 1737 patients who have undergone elective foot and ankle surgery. In March 2008, additional infection control policies, focused on surgical and environmental risk factors, were introduced in our department. We saw a 50% reduction in the rate of surgical site infection after the introduction of these measures. We are, however, aware that the observed decrease may not be entirely attributable to these measures alone given the number of factors that predispose to post-operative wound infection. Cite this article: Bone Joint J 2015;97-B:516–19.
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Affiliation(s)
- P. Ralte
- Aintree University Hospital, Liverpool
L9 7AL, UK
| | - A. Molloy
- Aintree University Hospital, Liverpool
L9 7AL, UK
| | - D. Simmons
- Aintree University Hospital, Liverpool
L9 7AL, UK
| | - C. Butcher
- Aintree University Hospital, Liverpool
L9 7AL, UK
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Simmons D, Hlaing T. Interpretation of HbA1c : association with mean cell volume and haemoglobin concentration. Diabet Med 2014; 31:1387-92. [PMID: 24910286 DOI: 10.1111/dme.12518] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 04/10/2014] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
Abstract
AIM The utility of HbA1c in diabetes diagnosis is reduced in settings associated with altered haemoglobin glycation. We have studied whether HbA1c varies with mean cell volume and mean cell haemoglobin concentration as measures of haemoglobin metabolism. METHODS Randomly selected adults from rural Victoria, Australia, were invited for biomedical assessment. After excluding patients with known diabetes and/or serum creatinine ≥ 0.12 mmol/l, 1315 adults were included. Demography, arthropometric measurements, oral glucose tolerance test, analyses of full blood count and HbA1c were undertaken. RESULTS After adjusting for age, sex, ethnicity, BMI, town and socio-economic status, there were no significant differences in haemoglobin, mean cell volume or mean cell haemoglobin concentration by glycaemic status (defined by oral glucose tolerance test). HbA1c was significantly and independently associated with fasting glucose, town, mean cell haemoglobin concentration, ethnicity, age and BMI among men < 50 years (R² = 33.8%); fasting glucose, 2-h glucose, mean cell haemoglobin concentration and town among men ≥ 50 years (R² = 47.9%); fasting glucose, mean cell volume, mean cell haemoglobin concentration, town, 2-h glucose and age among women < 50 years (R² = 46.3%); fasting glucose, mean cell haemoglobin concentration, mean cell volume and 2-h glucose among women ≥ 50 years (R² = 51.6%). A generalized linear model showed a gradient from an adjusted mean HbA1c of 36 (95% CI 34-38) mmol/mol with a mean cell haemoglobin concentration of ≤ 320 g/l to 30 (95% CI 29-31) mmol/mol with a mean cell haemoglobin concentration of > 370 g/l. The gradient across mean cell volume was negative, but only by 1 mmol/mol (0.1%) HbA1c . CONCLUSION A mean HbA1c difference of 5 mmol/mol (0.5%) across the mean cell haemoglobin concentration reference range suggests that an accompanying full blood count examination may be required for its use in the diagnosis of diabetes. Further studies are required to confirm this.
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MESH Headings
- Adult
- Aged
- Anemia, Hemolytic/complications
- Anemia, Hemolytic/epidemiology
- Anemia, Iron-Deficiency/complications
- Anemia, Iron-Deficiency/epidemiology
- Cohort Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Erythrocyte Indices
- Female
- Glycated Hemoglobin/analysis
- Health Surveys
- Hemoglobins/analysis
- Hemolysis
- Humans
- Male
- Middle Aged
- Rural Health
- Sex Characteristics
- Victoria/epidemiology
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Affiliation(s)
- D Simmons
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Rural Health, University of Melbourne Shepparton, Vic., Australia
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Church D, Simmons D. More evidence of the problems of using HbA1c for diagnosing diabetes? The known knowns, the known unknowns and the unknown unknowns. J Intern Med 2014; 276:171-3. [PMID: 24443985 DOI: 10.1111/joim.12200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- D Church
- The Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
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Lowry SZ, Ramaiah M, Patterson ES, Brick D, Gurses AP, Ozok A, Simmons D, Gibbons MC. Integrating Electronic Health Records into Clinical Workflow. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/2327857914031028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Issues with workflow integration have contributed to slow rates of EHR adoption in ambulatory outpatient care settings. In response to workflow integration challenges with EHRs, clinicians often develop workarounds to complete clinical tasks in ways other than were intended by system designers. Based on the insights generated during collegial discussions with physician Subject Matter Experts (SMEs) and three interdisciplinary team meetings with clinical and human factors experts, we created process map visualizations. A wide range of opportunities to improve workflow through enhanced functionality with the EHR were identified. Targeted recommendations for EHR developers and ambulatory (outpatient) care centers are proposed to increase efficiency, allow for better eye contact between the physician and patient, improve physician’s information workflow, and reduce alert fatigue. These recommendations provide a first step in moving from a billing-centered perspective to a clinician-centered perspective.
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Affiliation(s)
- Svetlana Z. Lowry
- Information Access Division, National Institute of Standards and Technology, Gaithersburg, MD
| | - Mala Ramaiah
- Information Access Division, National Institute of Standards and Technology, Gaithersburg, MD
| | - Emily S. Patterson
- School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH
| | | | - Ayse P. Gurses
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ant Ozok
- University of Maryland, Baltimore County, Baltimore, MD
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Yu D, Simmons D. Association between lung capacity measurements and abnormal glucose metabolism: findings from the Crossroads study. Diabet Med 2014; 31:595-9. [PMID: 24151940 DOI: 10.1111/dme.12346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/17/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023]
Abstract
AIM To examine the association between lung function and metabolic syndrome/Type 2 diabetes. METHODS A total of 1454 adults from rural Victoria, Australia, from randomly selected households included in the Crossroads study, provided spirometric measurements including forced vital capacity, forced expiratory volume in 1 s, predicted percentage value of forced expiratory volume in 1 s and forced vital capacity predicted percentage value. Assessments also included HbA(1c), metabolic syndrome components and a 75-g oral glucose tolerance test. The area under the receiver-operating characteristic curves for waist circumference were compared with those for combinations of waist circumference and raw spirometric measures (forced vital capacity and forced expiratory volume in 1 s) for identifying metabolic syndrome or Type 2 diabetes. RESULTS Partipants with a greater number of metabolic syndrome components were more likely to have reduced lung function, particularly if Type 2 diabetes was present: the predicted value of forced expiratory volume in 1 s decreased by 5-6% for participants with 2-4 metabolic syndrome components, and by 9% for those with Type 2 diabetes. The risk of metabolic syndrome or Type 2 diabetes was inversely associated with higher spirometry values (forced expiratory volume in 1 s percentage predicted value: odds ratio for 2-4 metabolic syndrome components 0.36-0.21 in women and 0.32-0.30 men; the odds ratio for Type 2 diabetes was 0.36 in women and 0.28 in men). Receiver-operating characteristic curve analysis for identifying metabolic syndrome and Type 2 diabetes revealed significant differences between the area under the receiver-operating characteristic curve with waist circumference alone and that for the combination of waist circumference with lung capacity measures. CONCLUSION Pulmonary function is lower in people with metabolic syndrome and Type 2 diabetes. Spirometry variables are independent predictors of metabolic syndrome and Type 2 diabetes.
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Affiliation(s)
- D Yu
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Yu D, Simmons D. Relationship between HbA1c and risk of all-cause hospital admissions among people with Type 2 diabetes. Diabet Med 2013; 30:1407-11. [PMID: 23692400 DOI: 10.1111/dme.12235] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/15/2013] [Accepted: 05/15/2013] [Indexed: 11/30/2022]
Abstract
AIM To investigate the relationship between HbA(1c) and the 2-year risk of hospitalization among people with Type 2 diabetes. METHODS In total, 4704 patients from 18 general practices in Cambridgeshire were included. Glycaemic exposure was assessed in 2008-2009. The primary outcome was all-cause hospital admissions in 2010-2011. Adjusted relative risks for each HbA(1c) quintile were estimated using Cox models. Further relationships between HbA(1c) and risks were explored using spline models. RESULTS There was a non-linear relationship between HbA(1c) and the risk of all-cause, diabetes and vascular admissions (all P < 0.001 for linearity test) with an HbA(1c) threshold of 61 (95% CI 55-66) mmol/mol [7.7 (95% CI 7.2-8.2)%]. For every 11 mmol/mol (1%) HbA(1c) above the threshold, the risks increased by 6.3% for all-cause admission, 6.4% for a diabetes admission and 15.9% for a cardiovascular admission (all P < 0.001). The overall hospitalization risks of having an HbA(1c) above, rather than at, the threshold, were 19.1 16.3 and 54.3% greater, respectively. There were non-significantly greater risks of hospital admission below the threshold. CONCLUSION In people with Type 2 diabetes, a non-linear relationship exists between HbA(1c) and the risk of hospitalization. A threshold of 61 mmol/mol (7.7%) was associated with the lowest rate of all-cause hospital admissions. Further research should investigate the causes of admissions below and above this threshold, with a view to developing strategies to reduce the excess hospitalization among patients with diabetes.
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Affiliation(s)
- D Yu
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Tan HY, Huang L, Simmons D, Veldhuis JD, Steyn FJ, Chen C. Hypothalamic distribution of somatostatin mRNA expressing neurones relative to pubertal and adult changes in pulsatile growth hormone secretion in mice. J Neuroendocrinol 2013; 25:910-9. [PMID: 23855876 DOI: 10.1111/jne.12078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 01/03/2023]
Abstract
The age-associated decline in growth hormone (GH) secretion may be a consequence of the reduction in the number of GH-releasing hormone (GHRH) positive neurones. However, it remains unclear whether an alteration in the number or distribution of somatostatin (SST) neurones contributes to this change. In the present study, we characterised the role of SST in modulating the change in pulsatile GH secretion in male C57Bl/6J mice throughout puberty and into early adulthood. We assessed pulsatile GH secretion in mice at 4, 8 and 16 weeks of age. These ages correspond to early pubertal, early adulthood and adulthood, respectively. We show an elevation in peak, total and pulsatile GH secretion coinciding with periods of rapid linear growth. Using in situ hybridisation and morphometric methods, we mapped the distribution of Sst mRNA expression within the mouse brain relative to this change in pulsatile GH secretion. The results obtained show that altered pulsatile GH secretion in male mice from 4-16 weeks of age does not coincide with a significant change in the number of Sst mRNA expressing neurones or an abundance of Sst mRNA expression throughout the arcuate nucleus (ARC) and periventricular nucleus (PeV). Rather, we observed a progressive decline in Sst mRNA expressing neurones within subnuclei of the paraventricular nucleus at this time. We conclude that structural changes in Sst expression within the PeV and ARC may not reflect the observed decline in pulsatile GH secretion in mice from puberty into early adulthood.
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Affiliation(s)
- H Y Tan
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
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Regener P, Love S, Petrini K, Simmons D, Pollick F. Audiovisual temporal integration in Autism Spectrum Disorder. J Vis 2013. [DOI: 10.1167/13.9.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rush E, Obolonkin V, McLennan S, Latimer K, Hamlin M, Simmons D, Graham D. Project Energize: 550m run time and relation to fatness and asthma. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIMS There are previous suggestions of increased C-peptide concentration in women with Type 1 diabetes during pregnancy. Our aim was to re-evaluate the hypothesis of a pregnancy-induced increase by measuring plasma C-peptide concentration in women with stable blood glucose control under standardized fasting and meal-stimulated conditions. METHODS Ten women with Type 1 diabetes; median age 31.1 years, median diabetes duration 19 years, median HbA(1c) 52 mmol/mol (6.9%) were admitted to a clinical research facility for two 24-h visits in early (12-16 weeks) and late (28-32 weeks) pregnancy. Women They ate standardized study meals - 80-g carbohydrate dinner, 60-g carbohydrate breakfast, and fasted between meals and overnight. Closed-loop insulin delivery maintained stable and comparable glycaemic conditions. Paired samples for plasma glucose and C-peptide were obtained. RESULTS Plasma glucose levels were comparable in early (median 6.5 mmol/l; interquartile range 5.6-8.6) and late pregnancy (median 7.0 mmol/l; interquartile range 6.1-7.8; P = 0.72). There was no change in fasting or meal-stimulated plasma C-peptide concentration from early to late pregnancy; mean difference 4.0 pmol/l (95% CI -6.0 to 7.0; P = 0.9). Four women had detectable C-peptide; peak (range) early vs. late pregnancy 48.5 (10-115) vs. 40.0 pmol/l (80-105); P = 0.5, which was weakly associated with plasma glucose; R(2) = 0.15, P < 0.0001. CONCLUSIONS We found no gestational changes in plasma C-peptide concentration. Previously reported increases may reflect differences in glucose control and/or exogenous insulin doses. This study highlights the importance and challenges of standardizing experimental conditions for accurate plasma C-peptide measurement during Type 1 diabetes pregnancy.
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Affiliation(s)
- H R Murphy
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
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Abstract
AIMS To determine whether a diabetes annual review, independently of other care processes, is followed by improved patient clinical measurements. METHODS Audits conducted independently of the diabetes annual review were analysed for a time-trend in patient clinical measures. An interaction variable between the review and the year of audit was used to test for a change in gradient before and after a diabetes annual review. Each patient formed their own control. RESULTS The data included 9471 audits on 3397 patients from 92 practices, and diabetes annual reviews from 2003 to mid-2008. Percentages of patients with raised HbA(1c) , systolic blood pressure and lipids improved from first to last audit. Predicted means after a diabetes annual review for HbA(1c) decreased by 0.13% (1.0 mmol/mol), for HDL cholesterol increased by 0.04 mmol/L and for triglyceride decreased by 0.2 mmol/L. Predicted systolic and diastolic blood pressure, total cholesterol and urinary albumin:creatinine ratio did not change significantly. CONCLUSIONS Metabolic control improved over time but this was largely independently of the diabetes annual review, which appears to add little clinical value to existing New Zealand general practice care processes. Currently, general practitioners are paid to undertake a diabetes annual review and report the measurements collected. We would argue that payment needs to be directed to demonstrating appropriate changes in clinical management or achieving meaningful clinical goals, and that the annual review results should be part of systematic feedback to general practitioners, particularly directed at clinical inertia.
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Affiliation(s)
- T Kenealy
- University of Auckland, South Auckland Clinical School, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
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Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, Vellinga A, Dunne F. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012; 29:844-54. [PMID: 22150506 DOI: 10.1111/j.1464-5491.2011.03541.x] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. METHODS The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. RESULTS Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. CONCLUSIONS Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis.
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Affiliation(s)
- B S Buckley
- School of Medicine, National University of Ireland, Galway, Ireland.
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