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Sowamber R, Lukey A, Huntsman D, Hanley G. Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs. Curr Oncol 2023; 30:10179-10194. [PMID: 38132375 PMCID: PMC10742141 DOI: 10.3390/curroncol30120741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is a heterogeneous group of malignancies, including high-grade serous ovarian cancer (HGSC). HGSC is often diagnosed at advanced stages and is linked to TP53 variants. While BRCA variants elevate risk, most HGSC cases occur in individuals without known genetic variants, necessitating prevention strategies for people without known high-risk genetic variants. Effective prevention programs are also needed due to the lack of traditional screening options. An emerging primary prevention strategy is opportunistic salpingectomy, which involves removing fallopian tubes during another planned pelvic surgery. Opportunistic salpingectomy offers a safe and cost-effective preventative option that is gaining global adoption. With the publication of the first cohort study of patients who underwent salpingectomy, specifically for cancer prevention, attention has turned to broadening opportunities for salpingectomy in addition to more targeted approaches. Prevention opportunities are promising with increasing adoption of salpingectomy and the increased understanding of the etiology of the distinct histotypes of ovarian cancer. Yet, further research on targeted risk-reducing salpingectomy with thoughtful consideration of equity is necessary to reduce death and suffering from ovarian cancer.
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Affiliation(s)
- Ramlogan Sowamber
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V6T 1Z4, Canada
| | - Alexandra Lukey
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - David Huntsman
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V6T 1Z4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Gillian Hanley
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Oveisi N, Cheng V, Brotto LA, Peacock S, McTaggart-Cowan H, Hanley G, Gill S, Rayar M, Srikanthan A, Ellis U, De Vera MA. Sexual health outcomes among adolescent and young adult cancer patients: a systematic review and meta-analysis. JNCI Cancer Spectr 2023; 7:pkad087. [PMID: 37878813 PMCID: PMC10674049 DOI: 10.1093/jncics/pkad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Sexual health outcomes (SHO), which entail the physical, emotional, mental, and social impacts, are an important consideration for adolescent and young adults (AYA, ages 15-39) affected by cancer. The objective of this systematic review and meta-analysis is to summarize the current literature and evaluate AYA cancer impact on SHO. METHODS EMBASE and MEDLINE were searched from January 1, 2000 to September 28, 2022 to identify epidemiologic studies that used an analytic observational design, included individuals with AYA cancer and non-cancer control participants, and evaluated SHO. Odds ratios and prevalence ratios were calculated; random effects models were used to obtain pooled measures where possible. RESULTS Of 2621 articles, 8 were included that investigated 23 SHO in 9038 AYA cancer patients. Based on the sexual response cycle, outcomes were categorized as those occurring among males (desire = 1, arousal = 1, orgasm = 4, other = 3) and females (desire = 2, arousal = 1, orgasm = 2, pain = 6, other = 3). It was feasible to conduct meta-analysis for 3 female SHO and 5 male SHO. There were associations between AYA cancer and 3 SHO: vaginal dryness (pooled odds ratio = 3.94; 95% confidence interval (CI) = 2.02 to 7.70), ejaculatory dysfunction (pooled odds ratio = 3.66; 95% CI = 2.20 to 6.08), and testosterone level (pooled mean difference = -2.56 nmol/liter; 95% CI = -3.46 to -1.66; P = .00001). CONCLUSION This study found increased ejaculatory dysfunction and reduced testosterone levels in male AYA cancer patients and increased vaginal dryness in female AYA cancer patients, highlighting the need for sexual health resources in this population.
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Affiliation(s)
- Niki Oveisi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Vicki Cheng
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Lori A Brotto
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stuart Peacock
- BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Helen McTaggart-Cowan
- BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gillian Hanley
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sharlene Gill
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Meera Rayar
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amirrtha Srikanthan
- Faculty of Medicine University of Ottawa, Ottawa, ON, Canada
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ursula Ellis
- University of British Columbia Library, Vancouver, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
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3
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Pagès N, Gorgui J, Wang C, Wang X, Zhao JP, Tchuente V, Lacasse A, Côté S, King S, Muanda F, Mufike Y, Boucoiran I, Nuyt AM, Quach C, Ferreira E, Kaul P, Winquist B, O’Donnell KJ, Eltonsy S, Chateau D, Hanley G, Oberlander T, Kassai B, Mainbourg S, Bernatsky S, Vinet É, Brodeur-Doucet A, Demers J, Richebé P, Zaphiratos V, Bérard A. The Impact of COVID-19 on Maternal Mental Health during Pregnancy: A Comparison between Canada and China within the CONCEPTION Cohort. Int J Environ Res Public Health 2022; 19:12386. [PMID: 36231687 PMCID: PMC9566261 DOI: 10.3390/ijerph191912386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020-10 October 2020), Canada 2 and China (11 October 2020-16 February 2021). Overall, 2423 participants were recruited, with 1804 participants within Canada 1, 135 within Canada 2 and 484 in China. The mean EDPS scores were 8.1 (SD, 5.1) in Canada 1, 8.1 (SD, 5.2) in Canada 2 and 7.7 (SD, 4.9) in China (p-value Canada 2/China: p = 0.005). The mean GAD-7 scores were 2.6 (SD, 2.9) in China, 4.3 (SD, 3.8) in Canada 1 (p < 0.001) and 5.8 (SD, 5.2) in Canada 2 (p < 0.001). When adjusting for stress and anxiety, being part of the Chinese cohort significantly increased the chances of having maternal depression by over threefold (adjusted OR 3.20, 95%CI 1.77-5.78). Canadian and Chinese participants reported depressive scores nearly double those of other crises and non-pandemic periods. Lockdowns and reopening periods have an important impact on levels of depression and anxiety among pregnant persons.
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Affiliation(s)
- Nicolas Pagès
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Jessica Gorgui
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Chongjian Wang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Xian Wang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Jin-Ping Zhao
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
| | - Vanina Tchuente
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
| | - Anaïs Lacasse
- Health Sciences Department, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada
| | - Sylvana Côté
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Medicine, School of Public Health, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Suzanne King
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Flory Muanda
- Department of Epidemiology & Biostatistics, Western University, London, ON N6A 5W9, Canada
- ICES Western, Western University, London, ON N6A 5W9, Canada
| | - Yves Mufike
- Department of Family Medicine, Protestant University in Congo, Kinshasa II, Kinshasa P.O. Box 4745, Democratic Republic of the Congo
| | - Isabelle Boucoiran
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, School of Public Health, University of Montreal, Montreal, QC H3N 1X9, Canada
| | - Anne Monique Nuyt
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Caroline Quach
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Ema Ferreira
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada
- Pharmacy Department, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Padma Kaul
- Department of Medicine, 4-120 Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AL T6G 2R7, Canada
| | - Brandace Winquist
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Kieran J. O’Donnell
- Yale Child Study Center, Department of OB/GYN and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- Douglas Research Center, Department of Psychiatry, McGill University, Montreal, QC H4H 1R3, Canada
| | - Sherif Eltonsy
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Dan Chateau
- Manitoba Center for Health Policy, Winnipeg, MB R3E 3P5, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tim Oberlander
- Department of Pediatrics, School of Population and Public Health, University of BC, Vancouver, BC V6T 1Z4, Canada
| | - Behrouz Kassai
- Faculty of Medicine, Université Claude Bernard Lyon 1, 69003 Lyon, France
- Department of Clinical Epidemiology, UMR 5558 CNRS, Clinical Investigation Centre, Inserm-Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France
| | - Sabine Mainbourg
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Clinical Epidemiology, UMR 5558 CNRS, Clinical Investigation Centre, Inserm-Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France
| | - Sasha Bernatsky
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, QC H3A 0G4, Canada
| | - Évelyne Vinet
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, QC H3A 0G4, Canada
| | - Annie Brodeur-Doucet
- Dispensaire Diététique de Montréal/Montreal Diet Dispensary, Montreal, QC H3H 1J3, Canada
| | - Jackie Demers
- Dispensaire Diététique de Montréal/Montreal Diet Dispensary, Montreal, QC H3H 1J3, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, CIUSSS de l’Est de l’Ile de Montreal, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC H1T 2M4, Canada
| | - Valerie Zaphiratos
- Department of Anesthesiology and Pain Medicine, CIUSSS de l’Est de l’Ile de Montreal, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC H1T 2M4, Canada
| | - Anick Bérard
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, 69003 Lyon, France
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada
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Bérard A, Kaul P, Eltonsy S, Winquist B, Chateau D, Hawken S, Sprague A, Walker M, Bernatsky S, Abrahamowicz M, Soares de Moura C, Vinet É, Carleton B, Hanley G, Oberlander T, Sheehy O, Gomez YH, Gorgui J, Savu A. The Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO): Comparisons between Quebec, Manitoba, Saskatchewan, and Alberta. PLoS One 2022; 17:e0274355. [PMID: 36126025 PMCID: PMC9488808 DOI: 10.1371/journal.pone.0274355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Given that pregnant women taking medications are excluded from clinical trials, real-world evidence is essential. We aimed to build a Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO) and compare frequency of prematurity, low-birth-weight (LBW), major malformations, multiplicity, and gestational medication use across four provinces. Methods CAMCCO is a collaborative research infrastructure that uses real-world data from large provincial health care databases in Canada; developed with standardized methods to similarly construct population-based pregnancy/child cohorts with longitudinal follow-up by linking administrative/hospital/birth databases. CAMCCO also includes a common repository to i) share algorithms and case definitions based on diagnostic and procedural codes for research/training purpose, and ii) download aggregate data relevant to primary care providers, researchers, and decision makers. For this study, data from Quebec (1998–2015), Manitoba (1995–2019), Saskatchewan (1996–2020), and Alberta (2005–2018) are compared (Chi-square tests, p-values), and trends are calculated using Cochran-Armitage trend tests. Results Almost two-thirds (61%) of women took medications during pregnancy, mostly antibiotics (26%), asthma drugs (8%), and antidepressants (4%). Differences in the prevalence of prematurity (5.9–6.8%), LBW (4.0–5.2%), and multiplicity (1.0–2.5%) were statistically significant between provinces (p<0.001). Frequency of major malformations increased over time in Quebec (7–11%; p<0.001), Saskatchewan (5–11%; p<0.001), and Alberta (from 7–8%; p<0.001), and decreased in Manitoba (5–3%; p<0.001). Cardiovascular and musculoskeletal malformations were the most prevalent. Interpretation Medications are often used among Canadian pregnancies but adverse pregnancy outcomes vary across provinces. Digitized health data may help researchers and care providers understand the risk-benefit ratios related to gestational medication use, as well as province-specific trends.
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Affiliation(s)
- Anick Bérard
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France
- * E-mail:
| | - Padma Kaul
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandace Winquist
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Dan Chateau
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Research School of Population Health, Australian National University College of Health and Medicine, Canberra, Australia
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, School of Global & Population Health, McGill University, Montreal, Quebec, Canada
| | - Cristiano Soares de Moura
- Faculty of Medicine, Department of Clinical Epidemiology, McGill University, Montréal, Québec, Canada
| | - Évelyne Vinet
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Canada
| | - Bruce Carleton
- Division of Translational Therapeutics Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim Oberlander
- University of British Columbia, School of Population and Public Health, Department of Pediatrics, Vancouver, British Columbia, Canada
| | - Odile Sheehy
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | | | - Jessica Gorgui
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Anamaria Savu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
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5
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Vigod SN, Ray JG, Cohen E, Wilton AS, Saunders NR, Barker LC, Berard A, Dennis CL, Holloway AC, Morrison K, Oberlander TF, Hanley G, Tu K, Brown HK. Maternal Schizophrenia and the Risk of a Childhood Chronic Condition. Schizophr Bull 2022; 48:1252-1262. [PMID: 35900007 PMCID: PMC9673258 DOI: 10.1093/schbul/sbac091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Maternal schizophrenia heightens the risk for certain perinatal complications, yet it is not known to what degree future childhood chronic health conditions (Childhood-CC) might arise. STUDY DESIGN This population-based cohort study using health administrative data from Ontario, Canada (1995-2018) compared 5066 children of mothers with schizophrenia to 25 324 children of mothers without schizophrenia, propensity-matched on birth-year, maternal age, parity, immigrant status, income, region of residence, and maternal medical and psychiatric conditions other than schizophrenia. Cox proportional hazard models generated hazard ratios (HR) and 95% confidence intervals (CI) for incident Childhood-CCs, and all-cause mortality, up to age 19 years. STUDY RESULTS Six hundred and fifty-six children exposed to maternal schizophrenia developed a Childhood-CC (20.5/1000 person-years) vs. 2872 unexposed children (17.1/1000 person-years)-an HR of 1.18, 95% CI 1.08-1.28. Corresponding rates were 3.3 vs. 1.9/1000 person-years (1.77, 1.44-2.18) for mental health Childhood-CC, and 18.0 vs. 15.7/1000 person-years (1.13, 1.04-1.24) for non-mental health Childhood-CC. All-cause mortality rates were 1.2 vs. 0.8/1000 person-years (1.34, 0.96-1.89). Risk for children exposed to maternal schizophrenia was similar whether or not children were discharged to social service care. From age 1 year, risk was greater for children whose mothers were diagnosed with schizophrenia prior to pregnancy than for children whose mothers were diagnosed with schizophrenia postnatally. CONCLUSIONS A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk particularly for physical health conditions, and what preventive and treatment efforts are needed for these children.
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Affiliation(s)
- Simone N Vigod
- To whom correspondence should be addressed; Department of Psychiatry, Women’s College Hospital, 76 Grenville Street, Toronto, ON, Canada; tel: 416-323-6400, ext. 4080, e-mail:
| | - Joel G Ray
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,St. Michael’s Hospital, Toronto, ON, Canada,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Natasha R Saunders
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lucy C Barker
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Anick Berard
- Universite de Montreal, Faculty of Pharmacy, Montreal, QC, Canada,CHU Ste-Justine, Montreal, QC, Canada
| | - Cindy-Lee Dennis
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Lawrence S. BloombergFaculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | | | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Gillian Hanley
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Karen Tu
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, North York General Hospital, Toronto Western Hospital Family Health Team-UHN, Toronto, ON, Canada
| | - Hilary K Brown
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
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6
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Berard A, Lacasse A, Gomez YH, Gorgui J, Côté S, King S, Tchuente V, Muanda F, Lumu Y, Boucoiran I, Nuyt AM, Quach C, Ferreira E, Kaul P, Winquist B, O’Donnell K, Eltonsy S, Château D, Zhao JP, Hanley G, Oberlander T, Kassai B, Mainbourg S, Bernatsky S, Vinet É, Brodeur-Doucet A, Demers J, Richebé P, Zaphiratos V, Wang C, Wang X. Impact of the COVID-19 pandemic on maternal mental health during pregnancy: The CONCEPTION study – Phase I. Eur Psychiatry 2022. [PMCID: PMC9564943 DOI: 10.1192/j.eurpsy.2022.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Mental health regional differences during pregnancy through the COVID-19 pandemic is understudied. Objectives We aimed to quantify the impact of the COVID-19 pandemic on maternal mental health during pregnancy. Methods A cohort study with a web-based recruitment strategy and electronic data collection was initiated in 06/2020. Although Canadian women, >18 years were primarily targeted, pregnant women worldwide were eligible. The current analysis includes data on women enrolled 06/2020-11/2020. Self-reported data included mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7)), stress. We compared maternal mental health stratifying on country/continents of residence, and identified determinants of mental health using multivariable regression models. Results Of 2,109 pregnant women recruited, 1,932 were from Canada, 48 the United States (US), 73 Europe, 35 Africa, and 21 Asia/Oceania. Mean depressive symptom scores were lower in Canada (EPDS 8.2, SD 5.2) compared to the US (EPDS 10.5, SD 4.8) and Europe (EPDS 10.4, SD 6.5) (p<0.05), regardless of being infected or not. Maternal anxiety, stress, decreased income and access to health care due to the pandemic were increasing maternal depression. The prevalence of severe anxiety was similar across country/continents. Maternal depression, stress, and earlier recruitment during the pandemic (June/July) were associated with increased maternal anxiety. Conclusions In this first international study on the impact of the COVID-19 pandemic, CONCEPTION has shown significant country/continent-specific variations in depressive symptoms during pregnancy, whereas severe anxiety was similar regardless of place of residence. Strategies are needed to reduce COVID-19’s mental health burden in pregnancy. Disclosure No significant relationships.
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Ip A, Poon BT, Hanley G, Guhn M, Oberlander TF. Developmental profiles of children at risk for autism spectrum disorder at school entry. Autism Res 2022; 15:1301-1310. [PMID: 35586913 PMCID: PMC9322442 DOI: 10.1002/aur.2742] [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: 10/06/2021] [Accepted: 04/28/2022] [Indexed: 11/11/2022]
Abstract
Functional abilities in children with autism spectrum disorder (ASD) are highly heterogenous, and impairments can overlap with non-ASD neurodevelopmental disorders. We compared the profiles of children assessed for ASD with and without an ASD diagnosis using a retrospective cohort study of 101,739 children born in British Columbia (2000-2008). The children were grouped into the following five comparison groups: (1) ASD- (n = 1131), (2) ASD+ (n = 1583), (3) Ministry of Education designated ASD+ (n = 654), (4) special need other than ASD (n = 11,663), and (5) typically developing (n = 86,708). Five developmental domains were assessed using the Early Development Instrument. ANCOVA was used to control for covariates, Tukey's HSD test for multiple comparisons, and Cohen's d for effect size. The ASD- group had slightly higher scores than the ASD+ group with small to medium effect sizes in all domains (d = 0.20-0.48). The ASD- group had slightly higher scores than the Ministry of Education ASD+ group in only three domains with small effect sizes (d = 0.21-0.25). The ASD- group had lower scores in all domains compared to the typically developing group with large effect sizes in all domains (d = 1.12-1.77). The ASD- group received less education funding at school entry than both ASD+ groups. Overall, only small to medium differences in development were detected between the ASD- and ASD+ groups. While these children differ diagnostically, they share similar functional profiles and have substantially more difficulties than typically developing children. Therefore, differences in levels of support at school entry raise critical questions of equity. LAY SUMMARY: Comparison of children in British Columbia who have been referred for an autism assessment, with or without a diagnosis, shows similarities in their functional and developmental profiles in kindergarten. Furthermore, both groups of children have more difficulties than typically developing children. However, children who have been referred for assessment without an autism diagnosis receive less financial support at school entry, raising important questions on equity.
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Affiliation(s)
- Angie Ip
- Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Brenda T Poon
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim F Oberlander
- Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Doyle S, Hanley G, Boland MR, Balasubramanian I, McCartan D, Geraghty J, Evoy D, Prichard RS, McDermott EW. O79: THE ROLE OF SENTINEL LYMPH NODE BIOPSY IN BREAST CANCER PATIENTS OVER THE AGE OF 80 – HOW MUCH IS ENOUGH? Br J Surg 2021. [DOI: 10.1093/bjs/znab117.079] [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: 11/12/2022]
Abstract
Abstract
Introduction
Recent studies have suggested that sentinel lymph node biopsy (SLNB) can be omitted in newly diagnosed elderly breast cancer (BC) patients as it may not influence decisions regarding further therapeutic intervention. The aim of this study was to assess the impact of SLNB on further surgical intervention as well as adjuvant treatments in patients over the age of 80.
Method
A retrospective study was performed involving all BC patients over the age of 80 diagnosed between 2008 and 2017 who underwent SLNB as part of their initial surgery. Patient/tumour characteristics and adjuvant treatments were recorded.
Result
127 patients underwent SLNB in the study period. The median age was 82 (Range: 80-95). 91/127 (71.6%) had ductal pathology, median tumour grade was 2, and oestrogen receptor positivity was seen in 89% of patients. The median number of sentinel nodes removed was 2 (Range: 1-6). 45 patients (35.4%) had a positive sentinel node (median positive nodes = 1). Of the 45 patients, 11 proceeded to axillary lymph node dissection (ALND) (11/127; 8.6%). The median number of nodes excised during ALND was 14 (Range:7-25) and 6 patients (6/11) had further positive nodes. 9% of patients with a positive node received adjuvant chemotherapy, 87% received adjuvant radiotherapy and 79% received hormonal therapy.
Conclusion
Although SLNB positivity is still used in the elderly patients, only a few patients (<10%) proceed to ALND or receive adjuvant chemotherapy. Hence performing a SLNB should be carefully considered when treating patients over the age of 80
Take-home message
The use of SLNB in elderly patients needs to be considered in node negative patients
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Greening K, Karnezis A, Cochrane D, Farnell D, Hoang L, Hanley G, Huntsman D. Abstract B30: The effect of OCP use on the incidence of precancerous p53 lesions in fallopian tube fimbria. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.ovca19-b30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: High-grade serous ovarian carcinoma (HGSOC) accounts for >70% of ovarian cancer-related deaths and is the most common ovarian cancer histotype, most originating from precancerous p53 lesions in the fallopian tube (FT) fimbria. Use of oral contraceptive pills (OCPs) for 5 years or more is associated with a >40% reduction in risk of HGSOC, but the mechanism is unknown. We hypothesize that OCP use reduces the incidence of p53 lesions. Our preliminary data show higher incidence of p53 lesions in post- compared to premenopausal women; therefore we aim to quantify p53 lesions in postmenopausal women who previously did or did not use OCPs. This will provide insight into the protective effects of OCPs against HGSOC.
Preliminary Results: We determined the presence of p53 lesions by immunohistochemistry (IHC) in FT of women up to 40 years old (n=27) and >60 years old (n=24) who underwent salpingectomies for noncancer reasons. p53 lesions were identified in 3/27 cases of the younger cohort (11%) and in 10/24 of the older cohort (42%). Thus, we conclude an increased incidence of p53 lesions in older compared to younger women.
Proposed Design: IHC for p53 will be performed on FT fimbria of women >55 years old who received salpingectomy for noncancer reasons. Based on an assumed reduction in p53 lesions of 35% in women who used OCPs for 5 years or more compared to nonusers (25 vs. 42%), analysis of 190 cases from each group will provide >80% power (p<0.05). Cases will be identified through Population Data BC and blind analysis by p53 IHC will be performed at the Vancouver General Hospital. Data will be flowed back to Pop Data BC to compare to OCP data.
Conclusion: Our preliminary study found that 42% of postmenopausal women had p53 lesions, informing this study design. The study registered through this abstract will be the first to examine the impact of OCPs on the earliest known precursors of HGSOC.
Citation Format: Kendall Greening, Anthony Karnezis, Dawn Cochrane, David Farnell, Lien Hoang, Gillian Hanley, David Huntsman. The effect of OCP use on the incidence of precancerous p53 lesions in fallopian tube fimbria [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr B30.
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Affiliation(s)
| | | | | | | | - Lien Hoang
- 1BC Cancer Research Center, Vancouver, BC, Canada,
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Greening K, Karnezis A, Cochrane D, Hanley G, Huntsman D. Abstract DP-006: THE EFFECT OF AGE AND OCP USE ON THE INCIDENCE OF PRE-CANCEROUS P53 LESIONS AND THE DEVELOPMENT OF HIGH GRADE SEROUS OVARIAN CARCINOMA. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-dp-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: High grade serous ovarian cancer (HGSOC) accounts for >70% of ovarian cancer related deaths and is the most common ovarian cancer histotype, most originating from pre-cancerous p53 lesions in the fallopian tube (FT) fimbria. Use of oral contraceptive pills (OCPs) for 5 years or more is associated with >40% reduction in risk of HGSOC, but the mechanism is unknown. We hypothesize that OCP use reduces the incidence of p53 lesions. Our preliminary data show higher incidence of p53 lesions in post- compared to pre-menopausal women, therefore we aim quantify p53 lesions in post-menopausal women who previously did or did not use OCPs. This will provide insight into the protective effects of OCPs against HGSOC.
PRELIMINARY RESULTS: We determined the presence of p53 lesions by immunohistochemistry (IHC) in FT of women up to 40 years old (n=27) and >60 years old (n=24) who underwent salpingectomies for non-cancer reasons. p53 lesions were identified in 3/27 cases of the younger cohort (11%) and in 10/24 of the older cohort (42%). Thus, we conclude an increased incidence of p53 lesions in older compared to younger women.
PROPOSED DESIGN: IHC for p53 will be performed on FT fimbria of women >55 years old who received salpingectomy/hysterectomy for non-cancer reasons. Based on an assumed reduction in p53 lesions of 35% in women who used OCPs for 5 years or more compared to non-users (25 vs. 42%), analysis of 190 cases from each group will provide >80% power (p<0.05). Cases will be identified through Population Data BC and blind analysis by tp53 IHC will be performed at the Vancouver General Hospital. Post-menopausal status will be confirmed by endometrium histology and data flowed back to Pop Data BC to compare to OCP data.
CONCLUSION: Our preliminary study found that 42% of post menopausal women had p53 lesions, informing this study design. The study registered through this abstract will be the first to examine the impact of OCPs on the earliest known precursors of HGSOC.
Citation Format: Kendall Greening, Anthony Karnezis, Dawn Cochrane, Gillian Hanley, David Huntsman. THE EFFECT OF AGE AND OCP USE ON THE INCIDENCE OF PRE-CANCEROUS P53 LESIONS AND THE DEVELOPMENT OF HIGH GRADE SEROUS OVARIAN CARCINOMA [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr DP-006.
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Affiliation(s)
- Kendall Greening
- 1Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- 2BC Cancer Research Center, Vancouver, BC, Canada
| | - Anthony Karnezis
- 1Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- 2BC Cancer Research Center, Vancouver, BC, Canada
| | - Dawn Cochrane
- 1Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- 2BC Cancer Research Center, Vancouver, BC, Canada
| | - Gillian Hanley
- 3Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - David Huntsman
- 1Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- 2BC Cancer Research Center, Vancouver, BC, Canada
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Tsao NW, Lynd LD, Sayre EC, Sadatsafavi M, Hanley G, De Vera MA. Use of biologics during pregnancy and risk of serious infections in the mother and baby: a Canadian population-based cohort study. BMJ Open 2019; 9:e023714. [PMID: 30787081 PMCID: PMC6398640 DOI: 10.1136/bmjopen-2018-023714] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To investigate the association between exposure to biologics during pregnancy and serious infections in mothers and infants. DESIGN Retrospective cohort study. SETTING Population-based. PARTICIPANTS Women with one or more autoimmune diseases identified by International Classification of Diseases 9th/10th revision codes in healthcare administrative databases in British Columbia, Canada, who had pregnancies ending in a live or stillbirth between 1 January 2002 and 31 December 2012. Women were defined as exposed if they had at least one biologic prescription during pregnancy, and infants born to these women were considered exposed in utero. Disease-matched women with no biologics prescriptions during pregnancy, and their infants, comprised the unexposed groups. PRIMARY OUTCOME MEASURES Serious infections requiring hospitalisation. RESULTS Over the 10-year study period, there were 6218 women (8607 pregnancies) who had an autoimmune disease diagnosis, of which 90 women were exposed to biologics during pregnancy, with 100 babies born to these women. Among women exposed to biologics during pregnancy, occurrence of serious postpartum infections were low, ranging from 0% to 5%, depending on concomitant exposures to immunosuppressants. In multivariable models using logistic regression, the OR for the association of biologics exposure with serious maternal postpartum infections was 0.79 (95% CI 0.24 to 2.54). In infants exposed to biologics in utero, occurrence of serious infections during the first year of life ranged from 0% to 7%, depending on concomitant exposures to immunosuppressants in utero. Multivariable models showed no association between biologics exposure in utero and serious infant infections (OR 0.56, 95% CI 0.17 to 1.81). CONCLUSIONS These population-based data suggest that the use of biologics by women with autoimmune diseases during pregnancy is not associated with an increased risk of serious infections in mothers, during post partum or in infants during the first year of life.
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Affiliation(s)
- Nicole W Tsao
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Tsao NW, Lynd LD, Sadatsafavi M, Hanley G, De Vera MA. Patterns of Biologics Utilization and Discontinuation Before and During Pregnancy in Women With Autoimmune Diseases: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:979-986. [DOI: 10.1002/acr.23434] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/26/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Nicole W. Tsao
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada, and Arthritis Research Canada; Richmond British Columbia Canada
| | - Larry D. Lynd
- University of British Columbia, Faculty of Pharmaceutical Sciences, and Centre for Health Evaluation and Outcomes Sciences; Vancouver British Columbia Canada
| | - Mohsen Sadatsafavi
- University of British Columbia, Faculty of Pharmaceutical Sciences, and Centre for Clinical Epidemiology and Evaluation; Vancouver British Columbia Canada
| | - Gillian Hanley
- University of British Columbia, Faculty of Medicine; Vancouver British Columbia Canada
| | - Mary A. De Vera
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada, and Arthritis Research Canada; Richmond British Columbia Canada
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13
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Tsao NW, Sayre EC, Hanley G, Sadatsafavi M, Lynd LD, Marra CA, De Vera MA. Risk of preterm delivery and small-for-gestational-age births in women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study. Ann Rheum Dis 2018; 77:869-874. [PMID: 29496718 DOI: 10.1136/annrheumdis-2018-213023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the risk of preterm delivery and small-for-gestational-age (SGA) births in women with autoimmune diseases using biologics before or during pregnancy. METHODS Using population-based administrative data in British Columbia, Canada, women with one or more autoimmune diseases who had pregnancies between 1 January 2002 and 31 December 2012 were included. Exposure to biologics was defined as having at least one biologic prescription 3 months before or during pregnancy. Each exposed pregnancy was matched with five unexposed pregnancies using high-dimensional propensity scores (HDPS). Logistic regression modelling was used to evaluate the association between biologics use and preterm delivery and SGA. RESULTS There were 6218 women with 8607 pregnancies who had an autoimmune disease diagnosis; of which 109 women with 120 pregnancies were exposed to biologics 3 months before or during pregnancy. In unadjusted analyses, the ORs for the association of biologics exposure with preterm deliveries were 1.64 (95% CI 1.02 to 2.63) and 1.34 (95% CI 0.72 to 2.51) for SGA. After HDPS matching with 600 unexposed pregnancies, the ORs for the association of biologics exposure and preterm deliveries were 1.13 (95% CI 0.67 to 1.90) and 0.91 (95% CI 0.46 to 1.78) for SGA. Sensitivity analyses using HDPS deciles, continuous HDPS covariate or longer exposure window did not result in marked changes in point estimates and CIs. CONCLUSIONS These population-based data suggest that the use of biologics before and during pregnancy is not associated with an increased risk of preterm delivery or SGA births.
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Affiliation(s)
- Nicole W Tsao
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Gillian Hanley
- University of British Columbia Faculty of Medicine, Department of Obstetrics and Gynecology, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.,Centre for Health Evaluation & Outcomes Sciences, Vancouver, Canada
| | | | - Mary A De Vera
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
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Smolina K, Morgan S, Mintzes B, Hanley G, Oberlander T. Response to "use of domperidone and risk of ventricular arrhythmia in the postpartum period: Getting to the heart of the matter". Pharmacoepidemiol Drug Saf 2017; 26:865-866. [PMID: 28671317 DOI: 10.1002/pds.4229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/05/2017] [Accepted: 04/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Smolina
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Steve Morgan
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Gillian Hanley
- Division of Gynaecologic Oncology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Tim Oberlander
- Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
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Hanley G, McAlpine J, Pearce L. Abstract B20: Uptake and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.ovca15-b20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Ovarian cancer is the leading cause of death due to gynecologic malignancy and the fifth most common cause of cancer deaths in developed countries. Recent evidence has indicated that the most common and lethal form of ovarian cancer originates in the distal fallopian tube, making surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal ligation) a potential ovarian cancer prevention strategy. We aimed to assess the uptake and perioperative safety of bilateral salpingectomy (BS) as an ovarian cancer risk-reduction strategy in the United States and to examine the factors associated with increased likelihood of getting a BS with benign gynecologic surgery.
The Nationwide Inpatient Sample was used to identify all women 15 years or older who underwent inpatient hysterectomy or tubal sterilization between 2008 and 2012. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Safety was assessed by examining rates of blood transfusions, perioperative complications, post procedural infection and fever, and adjusted odds ratios were calculated comparing hysterectomy with salpingectomy with hysterectomy alone.
There was an increase in the uptake of hysterectomy with BS of 129% across the study period; however, this represented only 1.9% of total hysterectomies. There were only 233 salpingectomies for sterilization, thus no further comparisons were possible in this group. In the hysterectomy with BS women, there was no statistically significantly increased risk for blood transfusion (aOR, 0.89; 95%CI 0.79, 1.00) post-operative complications (aOR, 0.94; 95%CI 0.83, 1.07), post-operative infections (aOR, 1.44; 95%CI 0.97, 2.14) or fevers (aOR, 1.33; 1.00, 1.77) compared with women undergoing hysterectomy alone. Being younger, having more chronic conditions, being in a private, for profit hospital, indication for hysterectomy, and not being operated on in a small hospital were all associated with increased likelihood of getting a hysterectomy with BS compared to getting a hysterectomy alone.
Our results suggest that, despite some significant growth, relatively few patients were receiving BS in the United States between 2008 and 2012. Given that the Society for Gynecologic Oncology and the American College of Obstetrics and Gynecology published recommendations to discuss BS with patients undergoing hysterectomy or tubal ligation in 2013 and 2015 respectively, and that our data extends only to 2012 we expect that rates may have risen more dramatically following those recommendations. Despite not reaching statistical significance, the aORs for both post-operative infection and fever were suggestive of an increased risk in women undergoing hysterectomy with BS. We hypothesize this is related to indication for BS,including hydrosalpinx and pelvic inflammatory disease, but recommend further research.
Citation Format: Gillian Hanley, Jessica McAlpine, Leigh Pearce. Uptake and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B20.
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Morgan S, Hanley G, Cunningham C, Quan H. Ethnic differences in the use of prescription drugs: a cross-sectional analysis of linked survey and administrative data. Open Med 2011; 5:e87-93. [PMID: 21915239 PMCID: PMC3148005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/07/2010] [Accepted: 09/07/2010] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence from the United States and Europe suggests that the use of prescription drugs may vary by ethnicity. In Canada, ethnic disparities in prescription drug use have not been as well documented as disparities in the use of medical and hospital care. We conducted a cross-sectional analysis of survey and administrative data to examine needs-adjusted rates of prescription drug use by people of different ethnic groups. METHODS For 19 370 non-Aboriginal people living in urban areas of British Columbia, we linked data on self-identified ethnicity from the Canadian Community Health Survey with administrative data describing all filled prescriptions and use of medical services in 2005. We used sex-stratified multivariable logistic regression analysis to measure differences in the likelihood of filling prescriptions by drug class (antihypertensives, oral antibiotics, antidepressants, statins, respiratory drugs and nonsteroidal anti-inflammatory drugs [NSAIDs]). Models were adjusted for age, general health status, treatment-specific health status, socio-economic factors and recent immigration (within 10 years). RESULTS We found evidence of significant needs-adjusted variation in prescription drug use by ethnicity. Compared with women and men who identified themselves as white, those who were South Asian or of mixed ethnicity were almost as likely to fill prescriptions for most types of medicines studied; moreover, South Asian men were more likely than white men to fill prescriptions for antibiotics and NSAIDs. The clearest pattern of use emerged among Chinese participants: Chinese women were significantly less likely to fill prescriptions for antihypertensives, antibiotics, antidepressants and respiratory drugs, and Chinese men for antidepressant drugs and statins. INTERPRETATION We found some disparities in prescription drug use in the study population according to ethnic group. The nature of some of these variations suggest that ethnic differences in beliefs about pharmaceuticals may generate differences in prescription drug use; other variations suggest that there may be clinically important disparities in treatment use.
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Morgan S, Hanley G, Greyson D. Comparison of tiered formularies and reference pricing policies: a systematic review. Open Med 2009; 3:e131-9. [PMID: 21603047 PMCID: PMC3090119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/14/2008] [Accepted: 12/04/2008] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To synthesize methodologically comparable evidence from the published literature regarding the outcomes of tiered formularies and therapeutic reference pricing of prescription drugs. METHODS We searched the following electronic databases: ABI/Inform, CINAHL, Clinical Evidence, Digital Dissertations & Theses, Evidence-Based Medicine Reviews (which incorporates ACP Journal Club, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Database of Abstracts of Reviews of Effectiveness, Health Technology Assessments and NHS Economic Evaluation Database), EconLit, EMBASE, International Pharmaceutical Abstracts, MEDLINE, PAIS International and PAIS Archive, and the Web of Science. We also searched the reference lists of relevant articles and several grey literature sources. We sought English-language studies published from 1986 to 2007 that examined the effects of either therapeutic reference pricing or tiered formularies, reported on outcomes relevant to patient care and cost-effectiveness, and employed quantitative study designs that included concurrent or historical comparison groups. We abstracted and assessed potentially appropriate articles using a modified version of the data abstraction form developed by the Cochrane Effective Practice and Organisation of Care Group. RESULTS From an initial list of 2964 citations, 12 citations (representing 11 studies) were deemed eligible for inclusion in our review: 3 studies (reported in 4 articles) of reference pricing and 8 studies of tiered formularies. The introduction of reference pricing was associated with reduced plan spending, switching to preferred medicines, reduced overall drug utilization and short-term increases in the use of physician services. Reference pricing was not associated with adverse health impacts. The introduction of tiered formularies was associated with reduced plan expenditures, greater patient costs and increased rates of non-compliance with prescribed drug therapy. From the data available, we were unable to examine the hypothesis that tiered formulary policies result in greater use of physician services and potentially worse health outcomes. CONCLUSION The available evidence does not clearly differentiate between reference pricing and tiered formularies in terms of policy outcomes. Reference pricing appears to have a slight evidentiary advantage, given that patients' health outcomes under tiered formularies have not been well studied and that tiered formularies are associated with increased rates of medicine discontinuation.
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Morgan S, Hanley G, Raymond C, Blais R. Breadth, Depth and Agreement among Provincial Formularies in Canada. Healthc Policy 2009. [DOI: 10.12927/hcpol.2009.20685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Morgan S, Hanley G, Raymond C, Blais R. Breadth, Depth and Agreement among Provincial Formularies in Canada. Healthc Policy 2009; 4:e162-e184. [PMID: 20436800 PMCID: PMC2700711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Previous studies have concluded that there is significant variation in drug coverage across Canadian provinces because conventional measures of inter-rater reliability for formulary listings are low. We sought to investigate whether conventional methods are appropriate for formulary concordance measurement by testing the hypotheses that (a) conventionally measured variations in provincial formularies are driven by disagreement over large numbers of drugs that represent very small segments of the market and (b) patterns in coverage levels and agreement across therapeutic categories might provide evidence of "potentially legitimate" variation in provincial formularies. METHODS We studied December 2006 formulary listings for general pharmacare programs in all but the smallest Canadian province. We characterized formularies in terms of the simple percentage of all available drugs that were listed on them and by a similar percentage that weighted each drug by its total national retail sales during 2006. We measured agreement among formularies using conventional inter-rater reliability scores (Kappa statistics) and a simple coverage-agreement measure. RESULTS Provincial formularies studied here listed between 55% and 73% of the 796 drugs analyzed. When formulary listings were weighted by national retail sales, the measure of formulary coverage exceeded 86% in all provinces studied. Conventional inter-rater reliability scores (Kappa statistics) indicate that coverage agreement among most provincial formularies was low to moderate; however, drugs that were listed on all nine provincial formularies studied accounted for 77% of total retail spending in Canada. When analyzed by therapeutic category, the extent of coverage offered was relatively consistent across provinces in all but three leading categories: anti-migraine drugs, anti-dementia drugs and sedatives. CONCLUSION While variations in coverage for specific drug classes and drug products remain important areas for investigation and policy consideration, Canada is currently operating with a significant "implicit national formulary" by way of the fact that provincial formularies independently yet mutually list most of the top-selling medicines in the marketplace.
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Affiliation(s)
- Steve Morgan
- Associate Professor & Associate Director, Centre for Health Services and Policy Research, School of Population & Public Health, University of British Columbia, Vancouver, BC
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Zhao M, Zhou G, Zhang Y, Chen T, Sun X, Stuart C, Hanley G, Li J, Zhang J, Yin D. β-arrestin2 inhibits opioid-induced breast cancer cell death through Akt and caspase-8 pathways. Neoplasma 2009; 56:108-13. [DOI: 10.4149/neo_2009_02_108] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Morgan S, Hanley G, McMahon M, Barer M. Influencing Drug Prices through Formulary-Based Policies: Lessons from New Zealand. ACTA ACUST UNITED AC 2007. [DOI: 10.12927/hcpol.2007.19097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Morgan S, Hanley G, McMahon M, Barer M. Influencing Drug Prices through Formulary-Based Policies: Lessons from New Zealand. Healthc Policy 2007; 3:e121-e140. [PMID: 19305747 PMCID: PMC2645129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
A national formulary has been proposed as a priority element of Canada's National Pharmaceuticals Strategy. We review a variety of formulary-based policies that might be used in conjunction with a national formulary, drawing on the policies and practices of the Pharmaceutical Management Agency of New Zealand. We consider the potential price impact of an actively managed national formulary by conducting a Canada-New Zealand price comparison for equivalent products in the four largest drug classes: statins, angiotensin-coverting enzyme (ACE) inhibitors, selective serotonin reuptake inhibitors (SSRIs) and proton pump inhibitors (PPIs). The results suggest that potential price savings for Canada in these drug classes are on the order of 21% to 79%. Such price differences would translate into billions of dollars in annual savings if applied across Canada, potentially offsetting the costs of the expansion of pharmacare coverage necessary to achieve both equity and efficiency goals in this sector.
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Affiliation(s)
- Steve Morgan
- Centre for Health Services and Policy Research, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC
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Wagenaar-Miller RA, Hanley G, Shattuck-Brandt R, DuBois RN, Bell RL, Matrisian LM, Morgan DW. Cooperative effects of matrix metalloproteinase and cyclooxygenase-2 inhibition on intestinal adenoma reduction. Br J Cancer 2003; 88:1445-52. [PMID: 12778076 PMCID: PMC2741031 DOI: 10.1038/sj.bjc.6600867] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Matrix metalloproteinases (MMPs) and cyclooxygenase-2 (COX-2) are expressed in both sporadic and familial adenomatous colonic polyps and tumours and have been independently shown to play causal roles in intestinal tumour formation in mouse models of colon cancer. The apparent roles of these enzymes in intestinal tumorigenesis led us to examine, in the Min mouse model of colon cancer, if selective COX-2 and MMP inhibitors provide additive or synergistic therapeutic benefits in intestinal tumour prevention. The broad-spectrum MMP inhibitor (A-177430; MMPI) and the selective COX-2 inhibitor (A-285969; COX-2I) both showed dose-dependent inhibition of the number of adenomas in Min mice. Using suboptimal doses, the MMPI reduced tumour multiplicity by 32%, the COX-2I by 48% and, both agents in combination resulted in a 67% decrease compared to control demonstrating a cooperative effect on intestinal tumorigenesis. Apoptosis, proliferation, and angiogenesis were assayed in tumors from each treatment group. These agents in combination allowed for a lowered dosage to be administered to achieve significant biological effects. Clinically, this could potentially reduce side effects associated with currently used MMP and COX-2 inhibitors. Together, these compounds could represent an easily tolerated chemopreventive approach.
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Affiliation(s)
- R A Wagenaar-Miller
- Department of Cancer Biology, Vanderbilt University, Nashville TN 37232, USA
| | - G Hanley
- Division of Animal Care, Vanderbilt University, Nashville TN 37232, USA
| | - R Shattuck-Brandt
- Department of Cancer Biology, Vanderbilt University, Nashville TN 37232, USA
- Department of Medicine, Vanderbilt University, Nashville TN 37232, USA
| | - R N DuBois
- Department of Cancer Biology, Vanderbilt University, Nashville TN 37232, USA
- Department of Medicine, Vanderbilt University, Nashville TN 37232, USA
| | - R L Bell
- Abbott Laboratories, Abbott Park, IL 60064-3500, USA
| | - L M Matrisian
- Department of Cancer Biology, Vanderbilt University, Nashville TN 37232, USA
- Department of Cancer Biology, 771 Preston Research Building, Vanderbilt University, Nashville, TN 37232, USA. E-mail:
| | - D W Morgan
- TAP Pharmaceutical Products Inc., Lake Forest, IL 60045, USA
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Schiffenbauer J, Butfiloski E, Hanley G, Sobel ES, Streit WJ, Lazarovits A. Prevention of experimental allergic encephalomyelitis by an antibody to CD45RB. Cell Immunol 1998; 190:173-82. [PMID: 9878118 DOI: 10.1006/cimm.1998.1393] [Citation(s) in RCA: 6] [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: 11/22/2022]
Abstract
CD45 is involved in the regulation of lymphocyte activation, and it has been demonstrated that ligation of CD45 induces apoptosis of T and B lymphocytes. Recently anti-CD45RB antibody therapy was shown to block acute allograft rejection in a mouse model of transplantation. Therefore, we wanted to examine the effects of anti-CD45RB antibody treatment on the course of an autoimmune disorder, experimental allergic encephalomyelitis (EAE), a Th1-mediated process. Mice immunized with myelin basic protein and treated with anti-CD45RB antibody did not develop EAE. Histologically, there was no evidence of lymphocytic infiltrates in the central nervous system. T cell proliferation and TNF-alpha production were significantly decreased in anti-CD45RB-treated mice. Furthermore, there was a significant reduction in the production of other Th1 cytokines including interferon-gamma and IL-2, but not IL-4 or IL-6. However, levels of a number of adhesion markers or markers of activation such as VLA-4 and LFA-1 on T cells were no different in treated versus control animals. Thus, anti-CD45RB can prevent EAE and appears to do so by altering T cell proliferation and cytokine production.
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MESH Headings
- Animals
- Antibodies, Monoclonal/therapeutic use
- Cell Division
- Cytokines/biosynthesis
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Encephalomyelitis, Autoimmune, Experimental/prevention & control
- Encephalomyelitis, Autoimmune, Experimental/therapy
- Integrin alpha4beta1
- Integrins/biosynthesis
- Leukocyte Common Antigens/immunology
- Lymphocyte Function-Associated Antigen-1/biosynthesis
- Mice
- Rats
- Receptors, Lymphocyte Homing/biosynthesis
- T-Lymphocytes/immunology
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Affiliation(s)
- J Schiffenbauer
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, 32610, USA
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Abstract
The effects of exercise on the signal-averaged electrocardiogram (SAECG) were investigated in 52 patients with stable coronary artery disease. The SAECG was recorded before and immediately after the exercise test and analyzed at 25 to 250 Hz and 40 to 250 Hz. All patients had SAECG with noise level less than or equal 0.8 microV at 25 Hz and less than or equal to 0.6 microV at 40 Hz and with the difference in noise level between control SAECGs and SAECGs after exercise less than or equal to 0.2 to 0.3 microV. Twenty-eight patients developed ST changes consistent with transient subendocardial ischemia that persisted during the SAECG recording after exercise. There was no significant difference between control SAECGs and SAECGs after exercise in patients with or without a positive exercise test. The absence of significant change on the SAECG was not related to the presence or absence of prior myocardial infarction, site of infarction, development of exercise-induced ventricular arrhythmias or presence of an abnormal recording at baseline. These data suggest that exercise-induced electrophysiologic changes and ventricular arrhythmias may not be related to the anatomic-electrophysiologic substrate that underlies late potentials on the SAECG.
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Affiliation(s)
- E B Caref
- Department of Medicine, State University of New York Health Science Center, Brooklyn 11203
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