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Grey E, Baber F, Corbett E, Ellis D, Gillison F, Barnett J. The use of technology to address loneliness and social isolation among older adults: the role of social care providers. BMC Public Health 2024; 24:108. [PMID: 38184519 PMCID: PMC10770975 DOI: 10.1186/s12889-023-17386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Addressing loneliness and social isolation among older adults remains a public health priority. The restrictions enforced during the COVID-19 pandemic simultaneously heightened the need for services to overcome social isolation and reduce loneliness among older adults, while also limiting social care providers' ability to deliver these. The aim of this study was to explore the experiences of social care providers in using technology to address loneliness and social isolation among older adults during the pandemic. METHODS This was a mixed methods study involving an online survey and interviews with providers of older adult social care in Wales, UK. Invitations to participate were sent to commissioners and providers of adult social care services, including those working in the voluntary and community sectors, across all local authorities in Wales. Data was collected between September 2021 and January 2022. RESULTS Sixty-one service providers completed the survey, 19 of whom also took part in an interview. Addressing loneliness and isolation among older adults was reported as a key concern by nearly all survey respondents. While telephone calls were the most common means of facilitating social interaction, many service providers also tried to support older adults to make more use of devices that they already had (e.g., smartphones to hold video calls). Where funding was available, organisations purchased devices, such as tablets and smart speakers, for older adults. Analysis of interviews resulted in three themes: (1) The potential and limitations of technology; (2) Individuals' capabilities, confidence, motivations and values; and (3) The wider system. CONCLUSIONS Technology was employed in a variety of ways during the pandemic to address loneliness and social isolation among older adults; many service providers continue to use technology in a hybrid system of care now that pandemic-related social restrictions have been lifted. Our findings emphasise a need for technology-assisted interventions to be designed and deployed in alignment with service users' values, motivations and capabilities. Further, there is a need to better support service providers to assess loneliness and social isolation among older adults, and to acknowledge the important role providers play in helping older adults to adopt technology-assisted interventions.
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Affiliation(s)
- Elisabeth Grey
- NIHR Applied Research Collaboration West & Bristol Medical School, University of Bristol, Bristol, UK
- Department for Health, University of Bath, Bath, UK
| | - Fran Baber
- Department of Psychology, University of Bath, Bath, UK
| | | | - David Ellis
- School of Management, University of Bath, Bath, UK
| | | | - Julie Barnett
- Department of Psychology, University of Bath, Bath, UK.
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Grey E, Griffin T, Jolly K, Pallan M, Parretti H, Retzer A, Gillison F. Extended brief interventions for weight management and obesity prevention in children: A rapid evidence review. Obes Rev 2023; 24:e13633. [PMID: 37604189 DOI: 10.1111/obr.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
Uptake of child weight management (CWM) support is typically low, and services are not available in all areas. Extended brief interventions (EBIs) have been proposed as an affordable way to provide enhanced support, at a level between one-off brief advice and intensive CWM programs. This rapid systematic review sought to synthesize evidence on the efficacy of EBIs for weight management and obesity prevention in children (2-18 years). Embase and Web of Science were searched from January 2012 to January 2022. Nineteen studies, reporting on 17 separate EBIs, were included. The quality of studies was variable, and the EBIs were heterogeneous. The majority of EBIs (n = 14) were based on motivational interviewing. Five of the included studies reported significant improvements in parent or child determinants of health behavior change. However, robust measures of behavioral determinants were rarely used. No studies reported significant positive effects on child weight. No clear patterns in outcomes were identified. There is currently insufficient evidence for EBIs to be adopted as part of CWM services. To improve the evidence base, EBIs that are currently being implemented by local health services, should be evaluated to establish the most effective content, how it should be delivered, and by whom.
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Affiliation(s)
- Elisabeth Grey
- NIHR Applied Research Collaboration West, Bristol Medical School, University of Bristol, Bristol, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Kate Jolly
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Miranda Pallan
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Helen Parretti
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ameeta Retzer
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
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Grey E, Brown F, Smith P, Springett D, Augustine D, Sengupta R, Peacock O, Gillison F. Patient-clinician dynamics in remote consultations: a qualitative study of cardiology and rheumatology outpatient clinics in the UK. BMJ Open 2023; 13:e070923. [PMID: 37253488 DOI: 10.1136/bmjopen-2022-070923] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Explore the experiences of patients and clinicians in rheumatology and cardiology outpatient clinics during the first year of the COVID-19 pandemic, focusing on the impact of remote consultations on interpersonal dynamics. DESIGN Qualitative study using semistructured interviews, conducted between February and June 2021. SETTING The rheumatology and cardiology departments of a general hospital in England, UK. PARTICIPANTS All clinicians and a convenience sample of 100 patients in each department who had taken part in a remote consultation in the past month were invited to take part. Twenty-five interviews were conducted (13 with patients, 12 with clinicians). RESULTS Three themes were developed through the analysis: adapting to the dynamics of remote consultations, impact on the patient's experience and impact on the clinician's experience. The majority of remote consultations experienced by both patients and clinicians had been via telephone. Both clinicians and patients found remote consultations to be more business-like and focused, with the absence of pauses restricting time for reflection. For patients with stable, well-managed conditions, remote consultations were felt to be appropriate and could be more convenient than in-person consultations. However, the loss of visual cues meant some patients felt they could not give a holistic view of their condition and limited clinicians' ability to gather and convey information. Clinicians adjusted their approach by asking more questions, checking understanding more frequently and expressing empathy verbally, but felt patients still shared fewer concerns remotely than in person; a perception with which patients concurred. CONCLUSIONS These findings highlight the importance of ensuring, for each patient, that remote care is appropriate. Future research should focus on developing ways to support both clinicians and patients to gather and provide all information necessary during remote consultations, to enhance communication and trust.
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Affiliation(s)
- Elisabeth Grey
- Department for Health, University of Bath, Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | | | - Dan Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Raj Sengupta
- The Royal National Hospital for Rheumatic Diseases, Bath, UK
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Brown F, Sanders I, Watkins R, Grey E, Smith P, Springett D, Welsh T, Gillison F. "A disembodied voice over the telephone": a qualitative study of healthcare practitioners' experiences in geriatric medicine. BMC Geriatr 2023; 23:270. [PMID: 37142989 PMCID: PMC10159677 DOI: 10.1186/s12877-023-03909-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES This study explored the experience of delivering care remotely among practitioners in a UK geriatric medicine clinic. METHODS Nine semi-structured interviews were conducted with consultants (n = 5), nurses (n = 2), a speech and language and an occupational therapist, and thematically analysed. RESULTS Four themes developed; Challenges of remote consultations; Perceived advantages of remote consultations; Disruption of involvement of family members; Impact on care staff. Participants felt that rapport and trust had been more feasible to develop remotely than they had anticipated, although this was more challenging for new patients and those with cognitive or sensory impairments. While practitioners identified advantages of remote consultations, including involving relatives, saving time, and reducing anxiety, they also experienced disadvantages such as consultations feeling like a 'production line', missing visual cues and reduced privacy. Some participants felt their professional identity was threatened by the lack of face-to-face contact, linked to feeling that remote consultations are not suitable for frail older adults or those with cognitive deficits. DISCUSSION Staff perceived barriers to remote consultations that went beyond practical concerns, and suggest support for building rapport, involving families, and protecting clinician identity and job satisfaction may be warranted.
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Affiliation(s)
- Frankie Brown
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | | | - Ross Watkins
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | | | - Tomas Welsh
- Research Institute for the Care of Older People, RICE, Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Fiona Gillison
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Griffin T, Grey E, Lambert J, Gillison F, Townsend N, Solomon-Moore E. Life in lockdown: a qualitative study exploring the experience of living through the initial COVID-19 lockdown in the UK and its impact on diet, physical activity and mental health. BMC Public Health 2023; 23:588. [PMID: 36991457 PMCID: PMC10052307 DOI: 10.1186/s12889-023-15441-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, the UK imposed a national lockdown prompting change to daily routines. Among behaviours impacted by the lockdown, diet and physical activity may be particularly important due to their association with mental health and physical health. The aim of this study was to explore people's experiences of how lockdown impacted their physical activity, dietary behaviours and mental health, with a view to informing public health promotion. METHODS This phenomenological qualitative study used semi-structured telephone interviews. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted, guided by the Framework Approach. RESULTS Forty participants (28 female) completed an interview (mean duration: 36 min) between May and July 2020. The overarching themes identified were (i) Disruption (loss of routines, social interaction and cues to physical activity) and (ii) Adaptation (structuring the day, accessing the outdoor environment, finding new ways for social support). The disruption to daily routines altered people's cues for physical activity and eating; some participants spoke of comfort eating and increased alcohol intake in the early days of lockdown, and how they consciously tried to change these when restrictions lasted longer than first anticipated. Others spoke of adapting to the restrictions using food preparation and meals to provide both routine and social time for families. Disruptions from the closure of workplaces resulted in flexible working times for some, allowing for physical activity to be built into the day. In later stages of restrictions, physical activity became an opportunity for social interaction and several participants reported intending to continue to replace sedentary means of socialising (e.g., meeting in cafes) with more active, outdoor activities (e.g., walking) once restrictions were lifted. Staying active and building activity into the day was seen as important to support physical and mental health during the challenging times of the pandemic. CONCLUSIONS Whilst many participants found the UK lockdown challenging, adaptations to cope with the restrictions presented some positive changes related to physical activity and diet behaviours. Helping people sustain their new healthier activities since restrictions have lifted is a challenge but presents an opportunity for public health promotion.
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Affiliation(s)
- Tania Griffin
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom.
| | - Elisabeth Grey
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
- Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Jeffrey Lambert
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Fiona Gillison
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Nick Townsend
- School for Policy Studies, University of Bristol, 8 Priory Rd, Bristol, BS8 1TZ, United Kingdom
| | - Emma Solomon-Moore
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
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Essery R, Pollet S, Bradbury K, Western MJ, Grey E, Denison-Day J, Smith KA, Hayter V, Kelly J, Somerville J, Stuart B, Becque T, Zhang J, Slodkowska-Barabasz J, Mowbray F, Ferrey A, Yao G, Zhu S, Kendrick T, Griffin S, Mutrie N, Robinson S, Brooker H, Griffiths G, Robinson L, Rossor M, Ballard C, Gallacher J, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Parallel randomized controlled feasibility trials of the "Active Brains" digital intervention to protect cognitive health in adults aged 60-85. Front Public Health 2022; 10:962873. [PMID: 36203694 PMCID: PMC9530972 DOI: 10.3389/fpubh.2022.962873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Multidomain interventions to address modifiable risk factors for dementia are promising, but require more cost-effective, scalable delivery. This study investigated the feasibility of the "Active Brains" digital behavior change intervention and its trial procedures. Materials and methods Active Brains aims to reduce cognitive decline by promoting physical activity, healthy eating, and online cognitive training. We conducted 12-month parallel-design randomized controlled feasibility trials of "Active Brains" amongst "lower cognitive scoring" (n = 180) and "higher cognitive scoring" (n = 180) adults aged 60-85. Results We collected 67.2 and 76.1% of our 12-month primary outcome (Baddeley verbal reasoning task) data for the "lower cognitive score" and "higher cognitive score" groups, respectively. Usage of "Active Brains" indicated overall feasibility and satisfactory engagement with the physical activity intervention content (which did not require sustained online engagement), but engagement with online cognitive training was limited. Uptake of the additional brief telephone support appeared to be higher in the "lower cognitive score" trial. Preliminary descriptive trends in the primary outcome data might indicate a protective effect of Active Brains against cognitive decline, but further investigation in fully-powered trials is required to answer this definitively. Discussion Whilst initial uptake and engagement with the online intervention was modest, it was in line with typical usage of other digital behavior change interventions, and early indications from the descriptive analysis of the primary outcome and behavioral data suggest that further exploration of the potential protective benefits of Active Brains are warranted. The study also identified minor modifications to procedures, particularly to improve online primary-outcome completion. Further investigation of Active Brains will now seek to determine its efficacy in protecting cognitive performance amongst adults aged 60-85 with varied levels of existing cognitive performance.
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Affiliation(s)
- Rosie Essery
- University of Southampton, Southampton, United Kingdom,*Correspondence: Rosie Essery
| | | | - Katherine Bradbury
- University of Southampton, Southampton, United Kingdom,NIHR ARC Wessex, Southampton, United Kingdom
| | | | | | | | | | | | - Joanne Kelly
- University of Southampton, Southampton, United Kingdom
| | | | - Beth Stuart
- University of Southampton, Southampton, United Kingdom,Queen Mary University of London, London, United Kingdom
| | - Taeko Becque
- University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- University of Southampton, Southampton, United Kingdom
| | | | | | - Anne Ferrey
- University of Oxford, Oxford, United Kingdom
| | - Guiqing Yao
- University of Leicester, Leicester, United Kingdom
| | - Shihua Zhu
- University of Southampton, Southampton, United Kingdom
| | - Tony Kendrick
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Gareth Griffiths
- NIHR Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- University of Southampton, Southampton, United Kingdom,University of Bristol, Bristol, United Kingdom
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Solomon-Moore E, Lambert J, Grey E, Gillison F, Townsend N, Busam B, Velemis K, Millen C, Baber F, Griffin T. Life in lockdown: a longitudinal study investigating the impact of the UK COVID-19 lockdown measures on lifestyle behaviours and mental health. BMC Public Health 2022; 22:1495. [PMID: 35932040 PMCID: PMC9354438 DOI: 10.1186/s12889-022-13888-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to the UK government enforcing lockdown restrictions to control virus transmission. Such restrictions present opportunities and barriers for physical activity and healthy eating. Emerging research suggests that in the early stages of the pandemic, physical activity levels decreased, consumption of unhealthy foods increased, while levels of mental distress increased. Our aims were to understand patterns of diet, physical activity, and mental health during the first lockdown, how these had changed twelve-months later, and the factors associated with change. METHODS An online survey was conducted with UK adults (N = 636; 78% female) during the first national lockdown (May-June 2020). The survey collected information on demographics, physical activity, diet, mental health, and how participants perceived lifestyle behaviours had changed from before the pandemic. Participants who provided contact details were invited to complete a twelve-month follow-up survey (May-June 2021), 160 adults completed the survey at both time-points. Descriptive statistics, T-tests and McNemar Chi Square statistics were used to assess patterns of diet, physical activity, and mental health at baseline and change in behaviours between baseline and follow-up. Linear regression models were conducted to explore prospective associations between demographic and psycho-social variables at baseline with change in healthy eating habit, anxiety, and wellbeing respectively. RESULTS Between baseline and follow-up, healthy eating habit strength, and the importance of and confidence in eating healthily reduced. Self-rated health (positively) and confidence in eating healthily (negatively) were associated with change in healthy eating habit. There were no differences between baseline and follow-up for depression or physical activity. Mean anxiety score reduced, and wellbeing increased, from baseline to follow-up. Living with children aged 12-17 (compared to living alone) was associated with an increase in anxiety, while perceiving mental health to have worsened during the first lockdown (compared to staying the same) was associated with reduced anxiety and an increase in mental wellbeing. CONCLUSIONS While healthy eating habits worsened in the 12 months since the onset of the pandemic, anxiety and mental wellbeing improved. However, anxiety may have increased for parents of secondary school aged children.
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Affiliation(s)
- Emma Solomon-Moore
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Jeffrey Lambert
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Elisabeth Grey
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Fiona Gillison
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Nick Townsend
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Betty Busam
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
- Department of Psychology, University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany
| | - Kyriakos Velemis
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Christopher Millen
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Fran Baber
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Tania Griffin
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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Shahum A, Utesena M, Benca J, Polonova J, Bakos M, Jackulikova M, Bachyncova D, Hunyadiova S, Grey E, Hoin L. Minimal Occurrence of Suspected Tuberculosis among Immigrants of War from Ukraine Shelters and Orphanage in Comparison to HIV Positive Cambodian Children from Orphanage. CSWHI 2022. [DOI: 10.22359/cswhi_13_2_09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Armed conflicts are connected with huge migration and refugees of war transfer at borders often without appropriate checks for vaccination, or immunization calendars. Within the last 10 years due to war, sporadic cases of measles and polio have been exported from Syria to Israel or fromAfghanistan to Pakistan and vice versa (l2). The aim of this study was to compare occurrence of Tuberculosis in 2 shelters, 1 with refugees of war and 1 with orphans, 1 from Ukraine and the second in Cambodia and a shelter of homeless people in Jarna Slovakia (3 countries of different incidence of TB).
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Payne L, Ghio D, Grey E, Slodkowska-Barabasz J, Harris P, Sutcliffe M, Green S, Roberts HC, Childs C, Robinson S, Gudgin B, Holloway P, Kelly J, Wallis K, Dean O, Aveyard P, Gill P, Stroud M, Little P, Yardley L, Morrison L. Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study. BMC Fam Pract 2021; 22:219. [PMID: 34758733 PMCID: PMC8580738 DOI: 10.1186/s12875-021-01572-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01572-z.
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Affiliation(s)
- Liz Payne
- School of Psychology, University of Southampton, Southampton, UK.
| | - Daniela Ghio
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | | | - Philine Harris
- School of Psychology, University of Southampton, Southampton, UK
| | - Michelle Sutcliffe
- Dietetics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Green
- Department for Nursing Science, Bournemouth University, Poole, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Caroline Childs
- Human Development and Health, University of Southampton, Southampton, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bernard Gudgin
- Public and Patient Involvement, University of Southampton, Southampton, UK
| | - Pam Holloway
- Public and Patient Involvement, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kathy Wallis
- Wessex Academic Health Science Network, Southampton, UK
| | - Oliver Dean
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mike Stroud
- Clinical Nutrition, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK.,Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
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10
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Essery R, Pollet S, Smith KA, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Bradbury K, Grey E, Western MJ, Milton A, Hunter C, Ferrey AE, Müller AM, Stuart B, Mutrie N, Griffin S, Kendrick T, Brooker H, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Planning and optimising a digital intervention to protect older adults' cognitive health. Pilot Feasibility Stud 2021; 7:158. [PMID: 34407886 PMCID: PMC8371874 DOI: 10.1186/s40814-021-00884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| | - Sebastien Pollet
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Victoria Hayter
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | | | | | - Alexander Milton
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Centre for Sport & Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - John Niven
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
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Rusnak T, Ondrusova Z, Bryndzak P, Laca P, Schavel M, Giertliova D, Kimuli D, Vasko P, Duris I, Kmit I, Mulama K, Grey E. St. Philippe Rescue Center in an Area of high Prevalence of HIV Infection in Kisumu and Street Work for Street Boys in Nairobi. cswhi 2021. [DOI: 10.22359/cswhi_12_1_04] [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: 11/23/2022]
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12
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Smith KA, Bradbury K, Essery R, Pollet S, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Kelly J, Somerville J, Zhang J, Grey E, Western M, Ferrey AE, Krusche A, Stuart B, Mutrie N, Robinson S, Yao GL, Griffiths G, Robinson L, Rossor M, Gallacher J, Griffin S, Kendrick T, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18929. [PMID: 33216010 PMCID: PMC7718093 DOI: 10.2196/18929] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18929.
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Affiliation(s)
- Kirsten Ailsa Smith
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Sebastien Pollet
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Fiona Mowbray
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Victoria Hayter
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Jo Kelly
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Somerville
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, United Kingdom
| | - Max Western
- Department for Health, University of Bath, Bath, United Kingdom
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adele Krusche
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sian Robinson
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Louise Robinson
- Institute of Population Health Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Martin Rossor
- Dementia Research Centre, University College London, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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Essery R, Denison-Day J, Grey E, Priestley E, Bradbury K, Mutrie N, Western MJ. Development of the Digital Assessment of Precise Physical Activity (DAPPA) Tool for Older Adults. Int J Environ Res Public Health 2020; 17:ijerph17217949. [PMID: 33138167 PMCID: PMC7663633 DOI: 10.3390/ijerph17217949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/05/2022]
Abstract
Physical activity (PA) is central to maintaining health and wellbeing as we age. Valid, reliable measurement tools are vital for understanding, and evaluating PA. There are limited options for comprehensively, accurately and affordably measuring older adults’ PA at scale at present. We aimed to develop a digital PA measurement tool specifically for adults aged 65+ using a person-based approach. We collated evidence from target users, field experts and the relevant literature to learn how older adults comprehend PA and would accept a digital tool. Findings suggest that older adults’ PA is often integrated into their daily life activities and that commonly applied terminology (e.g., moderate and vigorous) can be difficult to interpret. We also found that there is increasing familiarity with digital platforms amongst older adults, and that technological simplicity is valued. These findings informed the development of a digital tool that asks users to report their activities across key PA domains and dimensions from the previous 7-days. Users found the tool easy to navigate and comprehensive in terms of activity reporting. However, real-world usability testing revealed that users struggled with seven-day recall. Further work will address the identified issues, including creating a single-day reporting option, before commencing work to validate this new tool.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - Elisabeth Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath BA2 7AY, UK;
| | - Emma Priestley
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - Nanette Mutrie
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK;
| | - Max J. Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath BA2 7AY, UK;
- Correspondence:
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West D, Mrazova M, Grey E. Latin American Immigration. Public Health Implications and Challenges. cswhi 2020. [DOI: 10.22359/cswhi_11_2_08] [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: 11/23/2022]
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Ali L, Grey E, Singh D, Mohammed A, Tripathi V, Gobin J, Ramnarine I. An evaluation of the public's Knowledge, Attitudes and Practices (KAP) in Trinidad and Tobago regarding sharks and shark consumption. PLoS One 2020; 15:e0234499. [PMID: 32516322 PMCID: PMC7282724 DOI: 10.1371/journal.pone.0234499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
There is a global lack of data concerning shark consumption trends, consumer attitudes, and public knowledge regarding sharks. This is the case in Trinidad and Tobago, where shark is a popular culinary delicacy. A Knowledge, Attitudes, and Practices (KAP) survey was conducted in Trinidad and Tobago. Six hundred and seven questionnaires were administered. Univariate and stepwise multivariate logistic regressions were performed to test the association between KAP and demographic categories. The response rate was 93.4% with 567 questionnaires returned (473 from Trinidad and 94 from Tobago). Two hundred and seventeen (38.3%) participants were knowledgeable, 422 (74.4%) displayed attitudes in favour of shark conservation and sustainable use, and 270 (47.6%) displayed practices promoting shark conservation and sustainable use. Island (AOR = 2.81, CI = 1.78, 4.46) and tertiary education (AOR = 2.31, CI = 1.20, 4.46) significantly influenced knowledge level. Gender (AOR = 1.50, CI = 1.02, 2.20) and island (AOR = 0.56, CI = 0.35, 0.90) significantly influenced attitude. Gender (COR = 1.59, CI = 1.14, 2.22) was significantly associated with practices. Over 70% of respondents ate shark, and 54.7% ate shark infrequently enough to avoid risks from heavy metal toxicity. Our results may be useful to develop public awareness and practice improvement initiatives in order to improve KAP regarding shark meat consumption.
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Affiliation(s)
- Lauren Ali
- Department of Life Sciences, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
- * E-mail: ,
| | - Elisabeth Grey
- Department of Chemistry, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Delezia Singh
- Department of Life Sciences, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Azad Mohammed
- Department of Life Sciences, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Judith Gobin
- Department of Life Sciences, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Indar Ramnarine
- Department of Life Sciences, Faculty of Sciences and Technology, University of the West Indies, St. Augustine, Trinidad and Tobago
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Gillison F, Grey E, Griffin T. Parents' Perceptions and Responses to the UK Soft Drinks Industry Levy. J Nutr Educ Behav 2020; 52:626-631. [PMID: 31919006 DOI: 10.1016/j.jneb.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/31/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To record parents' awareness of the UK soft drinks industry levy (SDIL) and explore associations between negative psychological reactance to the levy and motivation and intentions to change consumption and purchasing. METHODS A cross-sectional online survey with UK-based parents of children aged 5-11 years (n = 237). Regression analyses were used to test associations between psychosocial responses to the levy and behavioral intentions to change family consumption and purchasing. RESULTS A total of 92% of responding parents were aware of the SDIL. Of the responding parents, 57% supported its aims, but 29% felt it threatened their freedom of choice. A total of 41% expressed intention to change shopping habits or restrict their child's intake as a result. Reactance and motivation were poorer in low-income families, and intentions to change were positively predicted by motivation. CONCLUSIONS AND IMPLICATIONS This snapshot suggests that the UK SDIL is largely supported by parents and associated with intentions to change their children's intake.
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Affiliation(s)
- Fiona Gillison
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom.
| | - Elisabeth Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom
| | - Tania Griffin
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom
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Prochazkova C, Grey E, Mikolasova G, Libova L, Hupkova I, Pauerova K, Hochman R, Jancovic M, Hofbauer B, Sramkova M, Stankova P, Bosnakova M, Murgova A, Katunska M, Tomanek P, Mikloskova M, Miklosko J, Vlcek R, Palenikova M, Drgova J, Kovac R, Kimuli D, Kalatova D, Kozon V, Konosova H, Popovicova M, Hrindova T, Otrubova J. Analysis of 9,896 Homeless Patients within an Urban Area in 2014 – 2019 – Social Pathology Leading to Poor Health. cswhi 2019. [DOI: 10.22359/cswhi_10_4_09] [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: 11/23/2022]
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Luliak M, Gulasova M, Bradbury R, Grey E, Libova L, Prochazkova K, Tomanek P, Hofabuerova B, Otrubova J, Hupkova I, Sramkova M, Topolska A, Jancovic M, Katunska M, Konosova H, Subramaniam S, Krcmery V. Intervention of National Economies to Health and Social Security: Antibiotic Policy as an Example of EU Solidarity with Migration Crisis or Social Pathology? (Note). cswhi 2019. [DOI: 10.22359/cswhi_10_4_06] [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: 11/23/2022]
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Trilisinskaya I, Simonek T, Jackulikova M, Prochazkova K, Jancovic M, Bielova M, Bydzovsky J, Vlcek R, Katunska M, Konosova H, Grey E, Ontrubova J, Radkova L, Gulasova M, Hrindova T, Libova L, Murgova A, Sramkova M, Hupkova I, Topolska A, Hofabuerova B, Popovicova M, Bakos M, Hardy M. Changing Spectrum of Migrants entering Greek Refugee Camp 2019 in Comparison to 2015/2016. (Psychological and social challenge) (Letter to The Editor). cswhi 2019. [DOI: 10.22359/cswhi_10_4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Simonek T, Jackulikova M, Topolska A, Jancovic M, Jancovicova L, Slusna L, Hardy M, Valach M, Sramkova M, Popovicova M, Barkasi D, Prochazkova K, Libova L, Mrazova M, Vlcek R, Gulasova M, Radkova L, Murgova A, Vansac P, Hochman R, Konosova H, Katunska M, Bakos M, Bielova M, Sasvary F, Grey E. Spectrum of Communicable Diseases in Lesbos Island UNHCR Refugee Camp. cswhi 2019. [DOI: 10.22359/cswhi_10_4_10] [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: 11/23/2022]
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Hoin L, Palun M, Gallo A, Sladeckova V, Durcova B, Benca J, Matulnikova L, Sramkova M, Cmorej P, Vansac P, Haj Ali P, Grey E. Orphan Status may be Protective Factor Against Severe Toxicity of HIV Therapy in Children from Resource-limited Settings (case report). cswhi 2018. [DOI: 10.22359/cswhi_9_3_10] [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: 11/23/2022]
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Weiss MC, Grey E, Family H, Tsuyuki R, Sutton J. Community pharmacists: members or bystanders of the primary care multidisciplinary team? J Pharm Health Serv Res 2018. [DOI: 10.1111/jphs.12214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marjorie C. Weiss
- School of Pharmacy and Pharmaceutical Sciences; Cardiff University; Cardiff UK
| | | | - Hannah Family
- Department of Pharmacy & Pharmacology; University of Bath; Bath UK
| | - Ross Tsuyuki
- Department of Medicine and Dentistry; Research Transition Faculty; University of Alberta; Edmonton Canada
| | - Jane Sutton
- Department of Pharmacy & Pharmacology; University of Bath; Bath UK
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Hajj P, Putekova S, Kabatova J, Martinkova J, Zollerova K, Bucko L, Radkova L, Vlcek R, Grey E, Olah M, Simonek T, Duricova G, Svitak R, Ondova P, Bibza M, Kolibab M, Mamova A, Palenikova M, Murgova A, Tkacova L, Kalatova D, Jankechova M, Bydzovsky J, Khalil I, Michalikova L, Mrazova M, Liskova A, Herdics G, Carnicky M, Krcmery V, Khaled I. Are migrants from Middle East carriers of multi-resistant bacteria? CSWHI 2016. [DOI: 10.22359/cswhi_7_3_02] [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: 11/23/2022]
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Grey E, Harris M, Rodham K, Weiss MC. Characteristics of good quality pharmaceutical services common to community pharmacies and dispensing general practices. International Journal of Pharmacy Practice 2016; 24:311-8. [DOI: 10.1111/ijpp.12253] [Citation(s) in RCA: 10] [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] [Received: 06/11/2015] [Revised: 10/20/2015] [Accepted: 01/07/2016] [Indexed: 12/01/2022]
Abstract
Abstract
Background
In the United Kingdom, pharmaceutical services can be delivered by both community pharmacies (CPs) and dispensing doctor practices (DPs). Both must adhere to minimum standards set out in NHS regulations; however, no common framework exists to guide quality improvement. Previous phases of this research had developed a set of characteristics indicative of good pharmaceutical service provision.
Objective
To ask key stakeholders to confirm, and rank the importance of, a set of characteristics of good pharmaceutical service provision.
Methods
A two-round Delphi-type survey was conducted in south-west England and was sent to participants representing three stakeholder groups: DPs, CPs and patients/lay members. Participants were asked to confirm, and rank, the importance of these characteristics as representing good quality pharmaceutical services.
Key Findings
Thirty people were sent the first round survey; 22 participants completed both rounds. Median ratings for the 23 characteristics showed that all were seen to represent important aspects of pharmaceutical service provision. Participants’ comments highlighted potential problems with the practicality of the characteristics. Characteristics relating to patient safety were deemed to be the most important and those relating to public health the least important.
Conclusions
A set of 23 characteristics for providing good pharmaceutical services in CPs and DPs was developed and attained approval from a sample of stakeholders. With further testing and wider discussion, it is hoped that the characteristics will form the basis of a quality improvement tool for CPs and DPs.
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Affiliation(s)
| | | | - Karen Rodham
- School of Psychology, Sport and Exercise Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Marjorie C Weiss
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
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Sokolova J, Krcmery V, Liskova A, Streharova A, Piesecka L, Holeckova K, Kulkova N, Grey E, Mrazova M. Changing etiology and risk factors of nosocomial bacterial meningitis: a nationwide multicenter study 1993-2010 in Slovakia. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mrazova M, Docze A, Buckova E, Bucko L, Kacmarikova M, Grey E, Korcova J, Koprnova J, Saboova Z, Beno P, Karvaj M, Svetlansky I, Ondrus A, Benca J, Taziarova M, Rudinsky B, Krcmery V. Prospective national survey of viridans streptococcal bacteraemia risk factors, antibacterial susceptibility and outcome of 120 episodes. ACTA ACUST UNITED AC 2009; 37:637-41. [PMID: 16126562 DOI: 10.1080/00365540510043266] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to prospectively investigate 120 cases of viridans streptococcal bacteraemia (VSB) in 117 patients in major university hospitals in Slovakia in 2000-2002 (3 y) for antibacterial susceptibility, risk factors and outcome. From 127 episodes, 16 (13%) of VSB were caused by PEN-R strains and 13 (10%) by ERY-R strains. 32 cases had cancer as underlying disease (20 haematological), 41 had endocarditis and 35 were elderly (>65 y of age) patients. Concerning mortality, 29 of 127 patients died (24%). There were several risk factors associated with mortality. Solid tumour as underlying disease (p<0.02), stroke (p<0.002), concomitant lung infection (p<0.01), endoscopic procedure (p<0.036), intubation (p<0.0008), ventilatory support (p<0.002), and coma (p<0.009) were associated with more deaths. A comparison of 115 bacteraemias to 13 bacteraemias caused by erythromycin-resistant strains of Streptococcus viridans was performed. There were no significant differences in underlying disease, risk factors and mortality. Erythromycin resistance in bacteraemias caused by S. viridans did not have significant impact on outcome of the patients, nor did it show specific relation to analysed risk factors in our study. 14.5% of VSB were cause by PEN-resistant viridans streptococci. Risk factors for penicillin resistance were ventilatory support (p<0.01), intubation (p<0.001) and resistance to other antibiotics: 8 of 16 (50%) of PEN-R VSB were resistant also to erythromycin or cotrimoxazole or tetracycline compared with 9% of PEN-R VSB (p<0.005). Endoscopic procedures in the upper respiratory system were at risk for development of PEN-R VSB. There was also difference in outcome; 71% vs 22.5% (p<0.0002) of cases infected with PEN-R VSB died compared to PEN-S VSB. PEN-R is therefore clinically significant in VSB.
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Affiliation(s)
- M Mrazova
- Slovak Medical University, Bratislava, SK
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Streharova A, Krcmery V, Kisac P, Kalavsky E, Holeckova K, Lesnakova A, Luzinsky L, Adamkovicova E, Pavlikova Z, Spilakova N, Kacunova B, Dovalova V, Wiczmandyova O, Spanik S, Liskova A, Chovancova D, Kovac M, Ondrusova A, Bauer F, Benca J, Rudinsky B, Sramka M, Kralova J, Krsakova J, Krumpolcova M, Findova L, Svabova V, Sladeckova V, Seckova S, Saniova J, Pavlicova B, Taziarova M, Bukovinova P, Kolenova A, Horvathova E, Hvizdak F, Luzica R, Rolnikova B, Bocakova A, Grey E, Bielova M, Huttova M, Sabo I, Jalili N. Predictors of inferior outcome in community acquired bacterial meningitis. Neuro Endocrinol Lett 2007; 28 Suppl 3:2-4. [PMID: 18030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 08/12/2007] [Indexed: 05/25/2023]
Abstract
The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).
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Affiliation(s)
- A Streharova
- St. Elizabeth University Tropical Projects, Slovakia, Slovakia
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Ondrusova A, Grey E, Benca J, Rudinsky B, Huttova M, Bauer F, Kovac M, Sramka M. Is combination therapy with betalactam plus aminoglycoside (AGL) improving the outcome of nosocomial meningitis in children? Neuro Endocrinol Lett 2007; 28 Suppl 2:17-8. [PMID: 17558368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 05/31/2007] [Indexed: 05/15/2023]
Abstract
We have been unable to document a benefit of a combination of aminoglycosides with betalactam or carbapenem antibiotics in nosocomial meningitis. This was similar to the cases of sepsis, where survival of patients did not improve with combination therapy. Combination therapy did not increase the chance of appropriateness of the therapy. 30% of those on combination therapy were considered as inappropriately treated in comparison to 2.8% of those on monotherapy (p<0.01).
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Affiliation(s)
- A Ondrusova
- St. Elisabeth University, College of Health and Social Sciences, Bratislava, Slovakia
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29
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Bauer F, Huttova M, Rudinsky B, Benca J, Taziarova M, Kovac M, Balent I, Sulla I, Jarcuska P, Kalavsky E, Kisac P, Holeckova K, Ondrusova A, Kralinsky K, Stankovic I, Steno J, Pevalova L, Grey E, Mrazova M, Spanik S. Nosocomial meningitis caused by Staphylococcus other than S. aureus in children: multicentre study. Neuro Endocrinol Lett 2007; 28 Suppl 2:34-5. [PMID: 17558376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Accepted: 06/01/2007] [Indexed: 05/15/2023]
Abstract
Analysing 101 cases of nosocomial meningitis due to staphylococci other than S. aureus within last 15 years, coagulase negative staphylococci represented the commonest pathogen. Major risk factor for staphylococcal meningitis was prior neurosurgery, mainly ventriculoperitoneal shunt insertion. Ten of 101 cases were caused by glycopeptide intermediate resistant strains in patients pretreated with multiple combination of antibiotics including vancomycin and shunt exchanges: 76% of strains were also oxacillin resistant.
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Affiliation(s)
- F Bauer
- School of Medicine and School of Health, Department of Neurology, Neurosurgery, Bratislava, Kosice, Banska Bystrica, Nitra, Slovakia
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Rudinsky B, Stankovic I, Kacerova A, Holecko K, Pevalova L, Kalavsky M, Sagat T, Beno P, Grey E, Herbanska M, Balik V, Sulla I, Harnicar A, Jarcuska P, Bauer F, Kralinsky K, Babela O, Krcmery V. Nosocomial postsurgical meningitis in children: a 12-year survey comparing data from 1993-1998 with data from 1999-2004. Infect Control Hosp Epidemiol 2006; 27:788-90. [PMID: 16807864 DOI: 10.1086/505098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Koprnova J, Beno P, Korcova J, Mrazova M, Grey E, Liskova A, Harnicarova A, Karvaj M, Koval S, Zak V, Danaj M, Streharova A, Mitterpachova E, Miklosko J, Ondrusova A, Riedl J, Kaiserova E, Prokopova V, Hornova M, Payer J, Rudinsky B, Pevalova L, Bencelova M, Hanzen J, Macekova L, Csölleyova J, Krcmery V. Bacteremia due to Pseudomonas aeruginosa: results from a 3-year national study in the Slovak Republic. J Chemother 2006; 17:470-6. [PMID: 16323434 DOI: 10.1179/joc.2005.17.5.470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Risk factors, mortality and antimicrobial susceptibility of Pseudomonas aeruginosa bacteremias isolated from 148 patients from all University Hospitals in Slovakia were analyzed. Only 1.2% of 169 strains of P. aeruginosa were resistant to meropenem, 4.1% to piperacillin/tazobactam, 7.7% to ceftazidime as well as cefepime and 12% to amikacin. More than 30% of P. aeruginosa were resistant to ciprofloxacin. Our analysis of risk factors for antimicrobial resistance to the particular antimicrobials, indicated no difference in risk factors and outcome in cases infected with P. aeruginosa bacteremias resistant to amikacin, piperacillin/tazobactam or ceftazidime in comparison to episodes caused by P. aeruginosa due to susceptible isolates. When comparing risk factors for P. aeruginosa bacteremia in children vs. adults, cancer vs. non-cancer patients, several differences in risk factors were observed. Neither antimicrobial resistance to amikacin, ceftazidime or piperacillin/tazobactam, nor appropriateness of therapy according to two separate analyses were associated with better outcome.
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Affiliation(s)
- J Koprnova
- Dept of Medicine, University of Trnava, School of Public Health, Slovak Republic
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Spanik S, Trupl J, Kunova A, Botek R, Sorkovska D, Grey E, Studena M, Lacka J, Oravcova E, Krchnakova A, Rusnakova V, Svec J, Krupova I, Grausova S, Stopkova K, Koren P, Krcmery V. Viridans streptococcal bacteraemia due to penicillin-resistant and penicillin-sensitive streptococci: analysis of risk factors and outcome in 60 patients from a single cancer centre before and after penicillin is used for prophylaxis. Scand J Infect Dis 2001; 29:245-9. [PMID: 9255883 DOI: 10.3109/00365549709019036] [Citation(s) in RCA: 35] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
60 patients with 60 viridans streptococcal bacteraemic episodes (42 due to penicillin-sensitive and 18 due to penicillin-resistant viridans streptococci) were analysed in a population of 12,185 admissions and 1,380 bacteraemic episodes during a 7-year period in a National Cancer Institute. The incidence of viridans streptococci among bacteraemias decreased from 11.5% in 1989 to 2.5% in 1995 after penicillin was introduced for prophylaxis of febrile neutropenia in acute leukaemia in 1993. However, the proportion of penicillin-resistant viridans streptococcal bacteraemias increased from 0 in 1989 and 1990 before any prophylaxis was given, to 12.9-16.7% after quinolones were used for prophylaxis in 1991 and 1992, and to 44.4-81.8% in 1993-1995 after penicillin was added to the quinolones. Mortality rate was higher in the subgroup of penicillin-resistant viridans streptococcal bacteraemias (p < 0.05). Statistically significant risk factors in patients with penicillin-resistant (compared with penicillin-sensitive) viridans streptococcal bacteraemia were: acute leukaemia (p < 0.03), high doses of cytarabine (p < 0.05), mucocutaneous lesions (p < 0.004), breakthrough bacteraemia during prophylaxis with ofloxacine plus penicillin (p < 0.001). Multiple logistic regression analysis showed that only acute leukaemia (OR 2.05, CI 0.85-1.85, p < 0.00452) and penicillin-resistance (OR 0.71, CI 0.103-4.887, p < 0.0209) were significant independent predictors of inferior outcome. Breakthrough bacteraemia during empiric therapy with vancomycine occurred in 5 of 116 patients treated with vancomycine, and during therapy with ampicillin plus gentamicin in 6 patients of 18 treated.
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Affiliation(s)
- S Spanik
- St. Elizabeth Cancer Institute, Bratislava, Slovak Republic
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33
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Trupl J, Kunová A, Oravcová E, Pichna P, Kukucková E, Grausova S, Grey E, Spanik S, Demitrovicová A, Kralóvicová K, Lacka J, Krupova I, Svec J, Koren P, Krcméry V. Resistance pattern of 2816 isolates isolated from 17631 blood cultures and etiology of bacteremia and fungemia in a single cancer institution. Acta Oncol 2001; 36:643-9. [PMID: 9408157 DOI: 10.3109/02841869709001329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The resistance pattern of 2816 isolates from 17631 blood cultures and the etiology of isolates causing bacteremia and fungemia among 14591 admissions were investigated in an 80-bed single cancer institute during seven years (1990-1996) under the same empiric therapeutic antibiotic policy but with different prophylactic strategies. No change was found in the proportion of Gram-positive versus Gram-negative bacteria isolated from bacteremias (70% vs. 30%) during the past seven years. Furthermore, the proportion of coagulase-negative staphylococci and enterococci was about the same before and after the introduction of ofloxacin in prophylaxis. However, the proportion of Pseudomonas aeruginosa and Stenotrophomonas maltophilia causing bacteremia increased. There was no increase in Candida krusei and Candida glabrata after the introduction of fluconazole into our prophylactic regimen in 1992. Penicillin-resistance in viridans streptococci increased after penicillin was introduced into prophylaxis in acute leukemia in 1993. Until 1995 no quinolone-resistant Enterobacteriaceae were observed. Susceptibility to quinolones did not significantly change within the past seven years in Enterobacteriaceae after their introduction to prophylaxis in 1991, but Pseudomonas aeruginosa decreased from 90 to 58.2%. Glycopeptide resistance in enterococci and staphylococci was minimal in the observed period (0.9-4.3%).
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Affiliation(s)
- J Trupl
- Department of Microbiology, National Cancer Institute, Trnava, Slovak Republic
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34
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Kunova A, Trupl J, Demitrovicova A, Jesenska Z, Grausova S, Grey E, Pichna P, Kralovicova K, Sorkovska D, Krupova I, Spanik S, Studena M, Koren P, Krcmery V. Eight-year surveillance of non-albicans Candida spp. in an oncology department prior to and after fluconazole had been introduced into antifungal prophylaxis. Microb Drug Resist 2000; 3:283-7. [PMID: 9271000 DOI: 10.1089/mdr.1997.3.283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
From 1989 until 1996, during the last 8 years, the proportion of Candida (C.) krusei, and other non-albicans Candida spp. isolated from surveillance cultures and from sterile body sites, was analyzed among 13,758 admissions in a National Cancer Institute. During these admissions a total of 9,042 isolates were prospectively collected from surveillance cultures, and 126 from blood cultures. The proportion of C. krusei among all organisms was 12.7% to 16.5% in 1989 through 1991, i.e., before fluconazole was introduced into prophylactic protocols. After the introduction of fluconazole into prophylaxis in acute leukemia in 1992 the incidence of C. krusei was 7.9% to 8.6% during 1994 to 1996. After 5 years of using this drug for prophylaxis, the incidence of C. krusei was lower than before this drug was introduced in our institute. Among yeasts, the most frequently isolated pathogen was still Candida albicans (72.2% of all isolated fungal organisms). Among molds, Aspergillus spp. was the most frequently isolated agent. Analyzing the etiology of proven fungal infections (fungemias) confirmed by positive blood cultures, C. albicans was the most common causative organism in 53.8% of cases. The incidence of fungemia due to Torulopsis (C.) glabrata and C. krusei before and after fluconazole introduction did not change. Of 126 organisms isolated from blood cultures, there was no increase in T. (C.) glabrata or C. krusei after introduction of fluconazole for prophylaxis and therapy, and the quoted 6.4% of fungemic episodes remained stable with an incidence of 1 fungemia/year since 1991. The proportion of C. krusei and C. glabrata among Candida spp. was decreasing in our center between 1989 and 1996. Also, the proportion of non-albicans Candida spp. among isolates decreased from 25.7% in 1990 to 11.9% in 1996.
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Affiliation(s)
- A Kunova
- National Cancer Institute Department of Microbiology, Department of Medicine, Bratislava, Slovak Republic
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35
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Krcmery V, Mrazova M, Kunova A, Grey E, Mardiak J, Jurga L, Sabo A, Sufliarsky J, Sevcikova L, Sorkovska D, West D, Trupl J, Novotny J, Mateicka F. Nosocomial candidaemias due to species other than Candida albicans in cancer patients. Aetiology, risk factors, and outcome of 45 episodes within 10 years in a single cancer institution. Support Care Cancer 1999; 7:428-31. [PMID: 10541986 DOI: 10.1007/s005200050304] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Forty-five cases of fungaemia due non-albicans Candida spp. (NAC) in a single National Cancer Institution within 10 years were analysed for aetiology, risk factors and outcome. There had been 12 cases of fungaemia that were due to C. krusei, 14 due to C. parapsilosis, 7 due to C. (T.) glabrata, 6 to C. tropicalis, 2 to C. guillermondii, 2 to C. lusitaniae, 1 to C. stellatoidea, and 1 to C. rugosa. Comparison of 45 NAC fungaemia with 75 episodes of C. albicans fungaemia revealed differences only in two risk factors: previous empiric therapy with amphotericin B (16.0 vs 2.2%, P<0.01) appeared more frequently in cases of C. albicans fungaemia, and prior prophylaxis with fluconazole (8.9 vs 0%, P<0.02) was conversely more frequently observed with NAC. The incidence of other risk factors, such as underlying disease, chemotherapy, antibiotic prophylaxis or therapy, treatment with corticosteroids, catheter insertion, mucositis, cytotoxic chemotherapy, and neutropenia, was similar in both groups. There was no difference either in attributable or in overall mortality between NAC and C. albicans fungaemia in our cancer patients.
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Affiliation(s)
- V Krcmery
- Department of Microbiology, Department of Oncology, National Cancer and St. Elizabeth's Cancer Institutes, Klenova 10, 833 10 Bratislava, Slovak Republic
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36
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Krcmery V, Spanik S, Kunova A, Trupl J, Grausova S, Krupova I, Mateicka F, Pichnova E, Grey E, Sabo A. Nosocomial Candida krusei fungemia in cancer patients: report of 10 cases and review. J Chemother 1999; 11:131-6. [PMID: 10326744 DOI: 10.1179/joc.1999.11.2.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The risk factors, therapy and outcome of ten cases of fungemia due to Candida krusei, appearing during the last 10 years in a single national cancer institution, are analyzed. Univariate analyses did not find any specific risk factors in comparison to 51 Candida albicans fungemias appearing at the same institution and with a similar antibiotic policy. Association with prior fluconazole prophylaxis was not confirmed because only one case appeared in a patient previously treated with fluconazole. However, attributable and crude mortality due to C. krusei fungemias was higher than for C. albicans fungemia. The authors review 172 C. krusei fungemias published within the last 10 years to compare with the incidence, therapy and outcome of C. krusei fungemia from our cancer institute.
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Affiliation(s)
- V Krcmery
- National and St. Elizabeth Cancer Institutes, Bratislava, Slovak Republic.
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37
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Spanik S, Trupl J, Kunova A, Drgona L, Salek T, Mardiak J, Kukuckova E, Studena M, Pichna P, Oravcova E, Grey E, Koren P, Svec J, Lacka J, Sufliarsky J, Krcmery V. Risk factors, aetiology, therapy and outcome in 123 episodes of breakthrough bacteraemia and fungaemia during antimicrobial prophylaxis and therapy in cancer patients. J Med Microbiol 1997; 46:517-23. [PMID: 9350206 DOI: 10.1099/00222615-46-6-517] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
One hundred and twenty-three breakthrough bacteraemias (BB) were defined during a 5-year period in a National Cancer Centre, among 9986 admissions and a total of 979 bacteraemic episodes analysed. Of 123 bacteraemias in 103 patients, 77 were polymicrobial and 116 of the 323 organisms isolated were resistant to currently administered antimicrobial agents. Sixty-seven of the bacteraemic episodes were catheter-associated, as confirmed by the isolation of the same organisms from both blood and catheter tip. The strains isolated most frequently were coagulase-negative staphylococci (30.5%), corynebacteria (10%), Pseudomonas aeruginosa (10%), Enterococcus faecalis (9%) and viridans streptococci (8.5%). Gram-positive aerobes accounted for two-thirds of all micro-organisms isolated during breakthrough bacteraemic and fungaemic episodes. Polymicrobial episodes were associated more frequently with vascular catheters and neutropenia, and had a less favourable outcome than monomicrobial infections. Relapse was associated more frequently with catheter-related episodes, but the overall mortality rate was similar and independent of catheter insertion. Breakthrough bacteraemic and fungaemic episodes were associated more frequently with acute leukaemia. Catheter removal, as an independent variable, and modification of antimicrobial therapy were essential for better outcome.
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Affiliation(s)
- S Spanik
- St Elizabeth National Cancer Institute, Bratislava, Slovak Republic
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38
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Kukuckova E, Spanik S, Ilavska I, Helpianska L, Oravcova E, Lacka J, Krupova I, Grausova S, Koren P, Bezakova I, Grey E, Balaz M, Studena M, Kunova A, Torfs K, Trupl J, Korec S, Stopkova K, Krcmery V. Staphylococcal bacteremia in cancer patients: risk factors and outcome in 134 episodes prior to and after introduction of quinolones into infection prevention in neutropenia. Support Care Cancer 1996; 4:427-34. [PMID: 8961473 DOI: 10.1007/bf01880640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A total of 134 episodes of staphylococcal bacteremia (SBE) appearing among 9987 admissions, and 979 episodes of bacteremia in cancer patients within 5 years, were analyzed for risk factors, clinical course and outcome; 64 were monomicrobial and 70 polymicrobial. The most frequent risk factors were acute leukemia, catheter insertion, long-lasting neutropenia, and prior prophylaxis with quinolones. There was no significant difference between polymicrobial and monomicrobial SBE in risk factors. The two groups differed only in the source of bacteremia (gastrointestinal and respiratory-tract infections were more common in monomicrobial SBE) and etiology-Staphylococcus aureus appeared more frequently in monomicrobial than in polymicrobial bacteremia (20.3% compared to 4.3%, P < 0.05). More complications (14.3%) such as abscesses, endocarditis, etc. appeared in the group of polymicrobial SBE (P < 0.05). No difference was observed in clinical course and outcome between monomicrobial and polymicrobial SBE. The incidence of SBE has increased since 1991, when quinolones were first used in prophylaxis in afebrile neutropenia at our center; however, the infection-associated mortality in monomicrobial SBE was low (4.3%).
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Affiliation(s)
- E Kukuckova
- Department of Medicine, University of Trnava, Slovak Republic
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Lacka J, Straková A, Grey E, Král'ovicová K, Krcméry V. [The role of penicillins in the treatment of respiratory system infections]. BRATISL MED J 1996; 97:673-4. [PMID: 9117431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The development of antimicrobial resistance in main pathogens of respiratory system infections (S. pneumoniae, H. Influenzae, B. catarrhalis) reduces the range of unprotected penicillins indications. The inhibitors of beta-lactamase rendered back the original spectrum of antimicrobial activity to aminopenicillins and ureidopenicillins, and withheld them within the most frequently used armamentarium of antimicrobial drugs for the therapy of more severe infections. The prescription of penicillins is ruled according to the localization of infection, most frequent pathogens and by the epidemiologic situation. A combined antibiotic therapy is indicated in severe infections. An important indication area is the prophylactic administration of penicillins in recurring tonsilopharyngitis, recurring otitis media and eradication of meningococcal carriership. (Tab. 1, Ref. 3.).
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Affiliation(s)
- J Lacka
- Onkologická klinika v Bratislave Clinic of Oncology, Bratislava, Slovakia
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Spánik S, Krcméry V, Trupl J, Ilavská I, Hel'pianska L, Drgona L, Salek T, Mardiak J, Kukucková E, Studená M, Pichna P, Oravcová E, Grey E, Koren P, Minárik T, Lacka J, Sufliarsky J. Breakthrough bacteraemic and fungaemic episodes during antimicrobial prophylaxis and therapy in cancer patients: analysis of risk factors, etiology, therapy and outcome in 123 episodes. BRATISL MED J 1996; 97:652-9. [PMID: 9117428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One hundred twenty three breakthrough bacteraemias (BB) during 5 years in a National Cancer Institute, among 9986 admissions and 979 bacteraemic episodes were analysed. 123 BB were caused by 323 microbes, only 116 were resistant (31.5%) to currently administered antimicrobials. Sixty seven of 123 bacteraemic episodes were catheter associated confirmed by isolation of the same organisms from the blood and catheter tip. 77/123 BE were polymicrobial. The most frequently isolated strains were coagulase negative staphylococci (30.5%), Corynebacteria (10%), Ps. aeruginosa (10%), Str. faecalis (9%) and Viridans streptococci (8.5%). Gram-positive aerobes accounted for two-thirds of all organisms isolated during breakthrough bacteraemic and fungaemic episodes. Mixed polymicrobial breakthrough bacteraemic and fungaemic episodes were more frequently associated with vascular catheter insertion and neutropenia, and had a less favourable outcome in comparison to monomicrobial infections. The relapse was associated more frequently with catheter related bacteraemic and fungaemic episodes, but the overall mortality rate was similar independently from catheter insertion. Breakthrough bacteraemic and fungaemic episodes were associated more frequently with acute leukaemia. Polymicrobial breakthrough bacteraemic and fungaemic episodes were associated more frequently in neutropenic episodes and in venous catheters. Regarding the outcome, an extraction of the catheter with no dependence on variable and modification of antimicrobial therapy were essential for the improvement in the prognosis. (Tab. 5, Ref. 20.).
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Affiliation(s)
- S Spánik
- Department of Medicine, Tyrnaviensis University, Trnava, Bratislava
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Oravcova E, Lacka J, Drgona L, Studena M, Sevcikova L, Spanik S, Svec J, Kukuckova E, Grey E, Silva J, Krcméry V. Funguria in cancer patients: analysis of risk factors, clinical presentation and outcome in 50 patients. Infection 1996; 24:319-23. [PMID: 8875285 DOI: 10.1007/bf01743368] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fifty cancer patients with funguria of > 10(5) CFU/ml, dysuria and leukocyturia were retrospectively analyzed for etiology, risk factors and outcome. In 72% of cases Candida albicans and in 28% non-albicans Candida spp. (Candida krusei, Candida tropicalis) and non-Candida spp. yeasts (Blastoschizomyces capitatus) were isolated. Torulopsis glabrata was not found among these patients. The most frequent risk factors were: antibiotic therapy with more than one antibiotic agent (96%), concomitant fungal infection in other localizations than the urinary tract (36%), colonization with the same species (48%), catheterization with urinary catheter or nephrostomy (46%), prophylaxis with quinolones (50%) and previous therapy with corticosteroids (72%). Structural or anatomic malformations of the urinary tract (26%), neutropenia (28%), antifungal prophylaxis with azoles (22%), and diabetes mellitus (12%) were less frequently seen. Thirty of 36 patients treated with systemic antifungals were cured and six were not.
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Affiliation(s)
- E Oravcova
- Dept. of Medicine, University of Trnava, Slovak Republic
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Lacka J, Oravcova E, Sevcikova L, Studena M, Bachanova V, Kukuckova E, Spanik S, Sufliarsky J, Helpianska L, Trupl J, Kunova A, Vochyanova I, Sycova Z, Grey E, Krcméry V. Vancomycin plus imipenem ceftazidime or ciprofloxacin in second line therapy in patients with febrile neutropenia not responding to first line therapy. Chemotherapy 1996; 42:146-9. [PMID: 8697890 DOI: 10.1159/000239434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
137 patients with febrile neutropenia after cytotoxic therapy not responding to ceftazidime plus or ceftriaxone plus netilmicin in received additionally to the previous combination either vancomycin alone or combined with another anti-gram-negative compound: imipenem in those treated prophylactically with ofloxacin and ciprofloxacin in those without prophylaxis. The addition of vancomycin to the previously ineffective combination of a third generation cephalosporin plus aminoglycoside, and replacement of ceftriaxone plus netilmicin with ceftazidime plus amikacin plus vancomycin or with ceftazidime plus vancomycin seems to be less effective (71.8-75 vs. 87.5-90.9%, p < 0.02) and more toxic (20.5-7.2 vs. 0-5%, p < 0.0005) than vancomycin in combination with a different anti-gram-negative compound as previously used: imipenem or ciprofloxacin.
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Affiliation(s)
- J Lacka
- Department of Chemotherapy, Postgraduate Medical School, Bratislava, Republic of Slovakia
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Abstract
In order to determine the efficacy of type 1C agents (flecainide, encainide, propafenone) in patients with atrial fibrillation who have failed to maintain sinus rhythm with type 1A agents (quinidine, procainamide, disopyramide), 147 patients, that were admitted into the John Dempsey Hospital with new or recurrent atrial fibrillation between 1987-1991, were studied retrospectively. Out of the total, 29 patients converted spontaneously to sinus rhythm, 14 patients were left in atrial fibrillation, and 104 patients were given a type 1A antiarrhythmic. Sixty-five of these patients remained in sinus rhythm (54% converted on drug alone, 46% required electrical cardioversion) for at least 6 months. Of the remaining 39 patients, 28 were given a type 1C antiarrhythmic; 13 were successfully converted (61% chemical, 39% electrical) to and remained in sinus rhythm for at least 6 months; the remaining 15 either failed to convert or reverted to atrial fibrillation. New onset atrial fibrillation had a significantly lower incidence of congestive heart failure (10%) than recurrent atrial fibrillation (33%; P < 0.01). No differences in digoxin, beta blocker use, or other clinical characteristics were seen either between type 1A or type 1C successes or failures. Similarly, echocardiographic dimensions did not predict success or failure with either class of agent. In conclusion, type 1C antiarrhythmics for suppression of recurrent atrial fibrillation represent a reasonable therapeutic alternative for suppression of atrial fibrillation in patients who have failed type 1A agents. Prognostic factors predicting success or failure remain undetermined.
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Affiliation(s)
- E Grey
- Cardiology Division of Department of Medicine, University of Connecticut School of Medicine, Farmington 06030
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Grey E. Underweight breast-fed babies. West J Med 1977. [DOI: 10.1136/bmj.1.6063.776-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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