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Cardwell K, Clyne B, Broderick N, Tyner B, Masukume G, Larkin L, McManus L, Carrigan M, Sharp M, Smith SM, Harrington P, Connolly M, Ryan M, O'Neill M. Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study. Public Health 2023; 225:343-352. [PMID: 37979311 DOI: 10.1016/j.puhe.2023.10.024] [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: 05/18/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Clyne
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - G Masukume
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L McManus
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Sharp
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Connolly
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Larkin L. Breast cancer genetics and risk assessment: an overview for the clinician. Climacteric 2023; 26:229-234. [PMID: 37011658 DOI: 10.1080/13697137.2023.2184254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Breast cancer is the most common cancer in women globally with enormous associated morbidity, mortality and economic impact. Prevention of breast cancer is a global public health imperative. To date, most of our global efforts have been directed at expanding population breast cancer screening programs for early cancer detection and not at breast cancer prevention efforts. It is imperative that we change the paradigm. As with other diseases, prevention of breast cancer starts with identification of individuals at high risk, and for breast cancer this requires improved identification of individuals who carry a hereditary cancer mutation associated with an elevated risk of breast cancer, and identification of others who are at high risk due to non-genetic, established modifiable and non-modifiable factors. This article will review basic breast cancer genetics and the most common hereditary breast cancer mutations associated with increased risk. We will also discuss the other non-genetic modifiable and non-modifiable breast cancer risk factors, available risk assessment models and an approach to incorporating screening for genetic mutation carriers and identifying high-risk women in clinical practice. A discussion of guidelines for enhanced screening, chemoprevention and surgical management of high-risk women is beyond the scope of this review.
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Affiliation(s)
- L Larkin
- MS.Medicine, Cincinnati, OH, USA
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Cardwell K, Broderick N, Tyner B, Masukume G, Harrington P, Connolly M, Larkin L, Clyne B, Ryan M, O'Neill M. High level review of configuration and reform of Public Health systems in selected countries. Eur J Public Health 2022. [PMCID: PMC9594392 DOI: 10.1093/eurpub/ckac129.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2). Methods Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations’ websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and. Results Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public health interventions; public participation, public messaging and communication; continuation of healthcare services; and workforce capacity and resilience. Conclusions When structuring Public Health systems, there is a need to identify which functions, and or which elements of a function, should be delivered at a national, regional or local level to ensure a sustainable and comprehensive Public Health system. Appropriate IT infrastructure, strong communication and an established evidence synthesis function are key to timely and informed decision making. Ideally, these functions should be established during periods of relative stability to permit a faster response during a pandemic or emergency situation.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - N Broderick
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Tyner
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - G Masukume
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Connolly
- School of Medicine, National University of Ireland Galway , Galway, Ireland
| | - L Larkin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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Lindberg R, Cirone K, Larkin L, Ball K, Laws R, Margerison C. Strategies used by schools to tackle food insecurity and hunger: a qualitative enquiry in 15 Victorian schools. Aust N Z J Public Health 2022; 46:444-449. [PMID: 35679018 DOI: 10.1111/1753-6405.13255] [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: 09/01/2021] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Food insecurity is a threat to children's development and in Australia 13.5% of households experience food insecurity. Universal school food programs, however, are not provided nationally. Teachers and not-for-profit organisations have instead mobilised to tackle hunger. The strategies used and their effects on students have limited empirical evidence. The aim of this study is to gain perspectives on the causes and consequences of children's food insecurity in schools and describe food security strategies adopted. METHOD One hundred schools in Victoria, which participate in a not-for-profit lunch program provided by Eat Up were invited to take part in the study. Fifteen staff (including school principals and welfare officers) from 15 schools were recruited for semi-structured interviews. Results: There was evidence that children experience adverse quantity, quality, social and psychological impacts of food insecurity whilst in school settings. Participants described employing multiple strategies including free meals (e.g. lunch, breakfast) and food (e.g. parcels) for food insecure students and their families. Conclusions and implications for public health: In our sample, multiple strategies were being employed by schools to reduce food insecurity, but there remains unmet need for additional wide-scale initiatives to address this critical issue and its causes and consequences.
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Affiliation(s)
- Rebecca Lindberg
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | - Kathryn Cirone
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | | | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
| | - Claire Margerison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria
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Larkin L, Mckenna S, Pyne T, Gallagher S, Glynn L, Fraser A, Esbensen BA, Kennedy N. POS1497-HPR FEASIBILITY OF A PHYSIOTHERAPIST LED, BEHAVIOUR CHANGE INTERVENTION TO IMPROVE PHYSICAL ACTIVITY IN PEOPLE WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.407] [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: 11/04/2022]
Abstract
BackgroundPhysical activity (PA) is an important component in the management of people with rheumatoid arthritis (RA) (1). Interventions incorporating Behaviour Change (BC) theory are needed to target physically inactive people with RA. The study Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis (PIPPRA) was designed using the Behaviour Change Wheel (BCW) and a pilot study of feasibility undertaken (ClinicalTrials.gov Identifier: NCT03644160).ObjectivesTo obtain reliable estimates regarding recruitment rates; participant retention; protocol adherence and possible adverse events, and to producing estimates of the potential effect sizes of the BC intervention on changes in outcomes of physical activity; fatigue; disability and quality of life.MethodsParticipants were recruited at University Hospital (UH) rheumatology clinics and randomly assigned to control group (physical activity information leaflet) or intervention group (four BC physiotherapy sessions in eight weeks). Inclusion criteria were diagnosis of RA (ACR/EULAR 2010 classification criteria), aged 18+ years and classified as insufficiently physically active. Ethical approval was obtained from the UH research ethics committee. Participants were assessed at baseline (T0), 8-weeks (T1), and 24-weeks (T2). Descriptive statistics and t-tests were used to analyse the data with SPSS v22.Results320 participants were identified through chart review with direct contact then with people meeting the inclusion criteria at rheumatology clinics. Of the clinic attendees n=183 (57%) were eligible to participate and n=58 (55%) of those consented to participate. The recruitment rate was 6.4 per month and refusal rate was 59%. Due to impact of COVID-19 on the study n=25 (43%) participants completed the study (n=11 (44%) in intervention and n=14 (56%) in control). Of the 25, n= 23 (92%) were female, mean age was 60 years (sd 11.5). Intervention group participants completed 100% of BC sessions 1 & 2, 88% session 3 and 81% session 4. No serious adverse events were reported. Secondary outcome measures data is Table 1.Table 1.Mean (sd) for secondary outcome measures in PIPPRA feasibility studyOutcomes and instrumentsInterventionControlBaseline Mean (sd)Time 1 Mean (sd)Time 2 Mean (sd)Baseline Mean (sd)Time 1 Mean (sd)Time 2 Mean (sd)Physical Activity – self report (YPAS1)146.27 (193.73)120.88 (70.80)132.00 (70.65)91.75 (85.86)58.03 (50.61)124.31 (69.75)Physical Activity – objective (Step Count)32,616.9132,190.0027,793.3330,476.1542,117.2534,288.77(11,415.85)(9,291.57)(7,426.92)(12,642.97)(21,714.67)(17,677.90)Pain (VAS2)4.184.904.503.715.104.79(2.40)(1.91)(1.90)(2.55)(2.77)(4.50)Disability (HAQDI3)0.850.941.030.710.711.52(0.57)(0.57)(0.65)(0.56)(0.52)(0.69)Fatigue (BRAF MDQ4)18.1814.82 (13.15)18.55 (11.84)15.71 (12.29)13.93 (15.27)20.21 (10.85)(8.98)Psychological Constructs (TPB5)22.0019.91 (7.76)20.27 (8.63)21.79 (5.67)15.50 (11.43)25.36 (6.86)(4.84)Quality of Life (RA QoL6)15.1814.73 (7.23)17.09 (7.33)18.4311.50 (10.02)14.86 (6.47)(6.08)(5.06)Sleep (PSQI7)11.558.509.9110.219.0910.14(3.56)(3.27)(3.62)(3.47)(4.32)(4.42)1YPAS – Yale Physical Activity Scale2VAS – Visual Analogue Scale3HAQDI – Health Assessment Questionnaire Disability Index4BRAF MDQ - Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire5TPB – Theory of Planned Behaviour Questionnaire6RA QoL – Rheumatoid Arthritis Quality of Life Scale7PSQI – Pittsburgh Sleep Quality IndexConclusionThe PIPPRA study designed using the BCW to improve promote physical activity was feasible and safe. This pilot study provides a framework for larger intervention studies and based on these findings a fully powered trial is recommended.References[1]Rausch Osthoff A, Niedermann K, Braun J, et al. (2018) EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases 77:1251-1260.Disclosure of InterestsNone declared
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Mckenna S, Larkin L, Pyne T, Gallagher S, Glynn L, Fraser A, Esbensen BA, Kennedy N. POS1511-HPR “I LEARNT SO MUCH ABOUT MY APPROACH TO BEING ACTIVE”: EXPERIENCES OF PEOPLE WITH RHEUMATOID ARTHRITIS ON THE IMPACT OF A PHYSIOTHERAPIST LED INTERVENTION TO PROMOTE PHYSICAL ACTIVITY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.87] [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: 11/04/2022]
Abstract
BackgroundPhysical activity is an important component in the management of people with rheumatoid arthritis (RA) [1]. A Physiotherapist-led Intervention to Promote Physical Activity in people with RA (PIPPRA) was undertaken using the Behaviour Change Wheel, with the aim of examining the feasibility of promoting physical activity in RA. This qualitative study involved participants and health care professionals who participated and were involved in a behaviour change pilot RCT intervention.ObjectivesTo determine, qualitatively, the acceptability of PIPPRA to participants with RA and health care professionals, in order to capture their reality.MethodsA qualitative study design of face-to-face semi-structured interviews was undertaken. The interview schedule explored the following areas: experience of the intervention; unintended consequences; experience and suitability of outcome measures used; views regarding the intervention; perceptions of behaviour change and physical activity. Interviews were transcribed verbatim by a professional transcriber. Thematic analysis was used as an analytical approach [2]. The research team searched for patterns, analysed and coded the data, and generated themes and sub-themes. Themes were reviewed by the research team to check if they worked in relation to the coded extracts and the entire data set. The COREQ checklist provided guidance throughout [3].ResultsFourteen participants [13 female/1 male; mean age of 59 (SD 6.3); mean RA diagnosis of 8.6 (SD 6.8) years; moderate to severe disability (HAQ-DI: 1.4 (SD 0.50)] and 8 healthcare staff [4 female/4 male; mean age of 41 (SD 5.6)] participated. Three main themes were generated from participants:- 1) Positive experience of behaviour change intervention - “I found it very knowledgeable to help you get stronger”; 2) Improvement in self-management - “…….motivate me maybe to go back to doing a little bit more exercise”; 3) Negative impact of COVID-19 on intervention – “I don’t think doing it online again would be really good at all”. Two main themes from health care professionals:- 1) Positive learning experience of behaviour change delivery – “Really made me realise the importance of discussing physical activity with patients”; 2) Positive approach to recruitment – “Very professional team showing the importance of having a study member on site”.ConclusionThe findings demonstrated that participants had a positive experience of being involved in a behaviour change intervention in order to improve their physical activity and found it acceptable as an intervention. However, if given the choice they would prefer the intervention delivery face to face rather than telehealth. Healthcare professionals also had a positive experience and in particular found it beneficial to their own development, in particular the importance of recommending PA to patients.References[1]Rausch Osthoff A, Niedermann K, Braun J, et al. (2018) EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases 77:1251-1260[2]Clarke, V. and Braun, V., 2014. Thematic analysis. In Encyclopedia of critical psychology (pp. 1947-1952). Springer, New York, NY[3]Tong, A., Sainsbury, P. and Craig, J., 2007. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care, 19(6), pp.349-357Disclosure of InterestsNone declared
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Raad T, Griffin A, Larkin L, Kennedy N, Tierney A. POS0243 THE EFFECT OF A MEDITERRANEAN DIET ON PHYSICAL FUNCTION AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS – THE MEDRA STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4259] [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: 11/03/2022]
Abstract
BackgroundThe immunomodulatory and anti-inflammatory effects of the Mediterranean Diet (MedDiet) suggest a protective role in rheumatic conditions1. A small but increasing body of evidence from randomised controlled trials demonstrates that increased adherence to a MedDiet in patients with Rheumatoid Arthritis (RA) can have a beneficial effect on disease activity, pain levels and physical function2.ObjectivesThe primary aim of the MEDRA study was to determine the effects of a MedDiet compared to the current food based dietary guidelines in Ireland (Healthy Eating Guidelines/HEG) on the physical function and quality of life in patients with RA.MethodsIn this randomised controlled trial, 44 patients with RA were randomly allocated to either the MedDiet or the HEG arm of the study. The 12-week dietary intervention study was delivered online by a Registered Dietitian (RD) and included data collection at three time points: baseline, mid-intervention (6 weeks) and post-intervention (12 weeks). Participants in both dietary intervention groups attended three video consultations with the RD, at baseline, weeks 6 and 12, and two follow up reviews by telephone at weeks 3 and 9. All participants were provided resources designed to specifically explain the assigned diet and how it can be successfully adhered to. Primary outcomes were changes in physical function and quality of life measured using the validated Health Assessment Questionnaire - Disability Index (HAQ-DI) and Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL), respectively. Secondary outcomes included changes in physical activity and patient-reported pain levels.ResultsForty patients with RA completed the study (mean age:47.5 SD10.9 years, females: 87.5%). No significant differences were found in the distribution of age, anthropometric measures, disease duration, physical activity, and quality of life between the two diet groups at baseline. However, the group assigned to the MedDiet had better mean values for quality of life compared to the HEG group; 0.9 ± 0.5 vs. 1.4 ±0.7, p<0.001, respectfully. Compared to baseline, there was a significant improvement in HAQ-DI scores in participants following both the MedDiet (0.9 ±0.5 to 0.5 ± 0.4, p<0.001) and HEG (1.4 ± 0.7 to 1.0 ± 0.6, p<0.001). Significant improvements in RAQoL scores were also seen in both the MedDiet (10.1 ±7.5 to 4.0 ± 4.7, p<0.001) and HEG (11.25 ± 7.2 to 7.9 ± 6.4, p=0.02) groups. At 12 weeks, participants in the MedDiet group reported a significantly better physical function status (mean difference -0.5, 95% CI -0.8 to -0.1, p=0.007) and quality of life (mean difference -3.9, 95% CI -7.5 to -0.2, p=0.04) compared to the HEG group. Participants in the MedDiet group demonstrated a significant increase in physical activity levels (56.7 ± 28.6 to 70.6 ± 33.5, p=0.01). Conversely, a non-significant decrease in physical activity levels was observed in the HEG group from baseline to post-intervention.ConclusionThe study indicates positive effects of a Mediterranean and low-fat diet as per the Healthy Eating Guidelines on physical function and quality of life in patients with RA. The MedDiet may be superior in improving physical activity levels. Further studies and a larger cohort are needed to confirm these findings.References[1]Oliviero, F., Spinella, P., Fiocco, U., Ramonda, R., Sfriso, P. and Punzi, L., 2015. How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Swiss medical weekly, 145(4546).[2]Forsyth, C., Kouvari, M., D’Cunha, N.M., Georgousopoulou, E.N., Panagiotakos, D.B., Mellor, D.D., Kellett, J. and Naumovski, N., 2018. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatology international, 38(5), pp.737-747.AcknowledgementsThis work was funded by the School of Allied Health Postgraduate scholarship at the University of Limerick.Disclosure of InterestsNone declared
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Simon J, Shapiro M, Larkin L, Kim N, Patel S, Kingsberg S. Onset of Flibanserin Treatment Effect in Postmenopausal Women Assessed by Subdomain Scores of the Female Sexual Function Index (FSFI). J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.050] [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: 10/18/2022]
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Lentine KL, Smith JM, Hart A, Miller J, Skeans MA, Larkin L, Robinson A, Gauntt K, Israni AK, Hirose R, Snyder JJ. OPTN/SRTR 2020 Annual Data Report: Kidney. Am J Transplant 2022; 22 Suppl 2:21-136. [PMID: 35266618 DOI: 10.1111/ajt.16982] [Citation(s) in RCA: 162] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The year 2020 presented significant challenges to the field of kidney transplantation. After increasing each year since 2015 and reaching the highest annual count to date in 2019, the total number of kidney trans- plants decreased slightly, to 23642, in 2020. The decrease in total kidney transplants was due to a decrease in living donor transplants; the number of deceased donor transplants rose in 2020. The number of patients waiting for a kidney transplant in the United States declined slightly in 2020, driven by a slight drop in the number of new candidates added in 2020 and an increase in patients removed from the waiting list owing to death-important patterns that correlated with the COVID-19 pandemic. The complexities of the pandemic were accompanied by other ongoing challenges. Nationwide, only about a quarter of waitlisted patients receive a deceased donor kidney transplant within 5 years, a proportion that varies dramatically by donation service area, from 14.8% to 73.0%. The nonutilization (discard) rate of recovered organs rose to its highest value, at 21.3%, despite a dramatic decline in the discard of organs from hepatitis C-positive donors. Nonutilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. Due to pandemic-related disruption of living donation in spring 2020, the number of living donor transplants in 2020 declined below annual counts over the last decade. In this context, only a small proportion of the waiting list receives living donor transplants each year, and racial disparities in living donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft exceeded 250,000 in 2020. Pediatric transplant numbers seem to have been impacted by the COVID-19 pandemic. The total number of pediatric kidney transplants performed decreased to 715 in 2020, from a peak of 872 in 2009. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients, with continued racial disparities among recipients. Of concern, the rate of deceased donor transplant among pediatric waitlisted candidates continued to decrease, reaching its lowest point in 2020. While this may be partly explained by the COVID-19 pandemic, close attention to this trend is critically important. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease in the pediatric population. While most pediatric de- ceased donor recipients receive a kidney from a donor with KDPI less than 35%, most pediatric deceased donor recipients had four or more HLA mis- matches. Graft survival continues to improve, with superior survival for living donor recipients versus deceased donor recipients.
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Affiliation(s)
- K L Lentine
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - J M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Pediatrics, University of Washington, Seattle, WA
| | - A Hart
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, Minneapolis, MN
| | - J Miller
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - L Larkin
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - A Robinson
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - K Gauntt
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - R Hirose
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Surgery, University of California San Francisco, San Fran- cisco, CA
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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Kasiske BL, Lentine KL, Ahn Y, Skeans MA, Eberhard T, Folken C, Wainright J, Larkin L, Nystedt C. OPTN/SRTR 2020 Annual Data Report: Living Donor Collective. Am J Transplant 2022; 22 Suppl 2:553-586. [PMID: 35266611 DOI: 10.1111/ajt.16983] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The first successful solid organ transplant was a living donor kidney transplant in 1954. Since then, living donation has been an important source of organs for kidney and liver transplants in the United States. Unfortunately, the demand for organs has not kept pace with the supply, and unlike deceased donor transplant, there has been little growth in the number of living donor transplants over the past decade. To better understand possible barriers to living donation and long-term risks attributable to donation, the Health Resources and Services Administration (HRSA) directed the Scientific Registry of Transplant Recipients (SRTR) to establish a national registry of all living donor candidates and donors evaluated at US transplant programs to acquire lifetime follow-up information. Other goals include understanding the factors associated with candidate approval and variation in approval practices across centers. A pilot program was conducted from June 2018 through September 2020 to inform baseline data collection and registration processes. In September 2020, the registry began recruiting additional sites evaluating candidates for living donation. Here, we describe candidates registered at participating living donor kidney and liver programs, from June 2018 through the end of 2020. Not all programs submitted data throughout the whole period. Data for kidney and liver living donor candidates are presented separately.
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Affiliation(s)
- B L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - K L Lentine
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN.,Center for Abdominal Transplantation, Saint Louis University School of Medicine, St Louis, MO
| | - Y Ahn
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN
| | - M A Skeans
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN
| | - T Eberhard
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN
| | - C Folken
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN
| | - J Wainright
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - L Larkin
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - C Nystedt
- Scientific Registry of Transplant Recipients, Hennepin Health care Research Institute, Minneapolis, MN
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Douglas A, Sandmann FG, Allen DJ, Celma CC, Beard S, Larkin L. Impact of COVID-19 on national surveillance of norovirus in England and potential risk of increased disease activity in 2021. J Hosp Infect 2021; 112:124-126. [PMID: 33716087 DOI: 10.1016/j.jhin.2021.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/06/2021] [Indexed: 01/08/2023]
Affiliation(s)
- A Douglas
- Gastrointestinal Pathogens Unit, National Infection Service, Public Health England, London, UK.
| | - F G Sandmann
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology and NIHR Health Protection Research Unit in Modelling and Health Economics, London School of Hygiene and Tropical Medicine, London, UK
| | - D J Allen
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - C C Celma
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, UK
| | - S Beard
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, UK
| | - L Larkin
- Gastrointestinal Pathogens Unit, National Infection Service, Public Health England, London, UK
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Larkin L, Moses A, Raad T, Tierney A, Kennedy N, Costello W. OP0191-PARE DEVELOPMENT OF A PUBLIC AND PATIENT INVOLVEMENT (PPI) RESEARCH NETWORK FOR PEOPLE WHO HAVE RHEUMATIC CONDITIONS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.442] [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: 11/04/2022]
Abstract
Background:Public and patient involvement (PPI) improves quality and relevance of research (1). PPI is advocated by policy makers and funding bodies and is supported by EULAR (2). Arthritis Research Limerick (ARL) is a partnership between researchers at the University of Limerick and clinicians at University Hospitals Limerick. PPI representatives have been involved in ARL projects, however no formal PPI network had been established prior to 2020. The need for a formal PPI network to collaborate with ARL was identified by both ARL and patient representatives. This need arose from a joint ambition to promote meaningful involvement of the public and patients in ARL projects and to develop a platform through which researchers and PPI representatives could collaboratively set research priorities.Objectives:The aim of this project was to create a formal PPI network to engage with people living with rheumatic and musculoskeletal diseases (RMDs) and their families and to identify collaborative research opportunities between ARL and PPI representatives.Methods:A face-to-face PPI seminar was planned for October 2020. The seminar consisted of speakers from ARL providing an overview of research projects and a World Café research ideas session. Funding was obtained through a competitive, peer-review funding call from the PPI Ignite group at the University of Limerick to support the PPI seminar. The funding application was a joint application between ARL members and a PPI partner (iCAN - Irish Children’s Arthritis Network). The seminar was advertised through national patient organisations (iCAN and Arthritis Ireland), social media and ARL research networks.Results:Due to Covid-19 public health restrictions the PPI seminar was held virtually. The ARL PPI inaugural seminar was attended by N=19 researchers and people living with RMDs. The seminar speakers included ARL researchers and a PPI representative. The World Café event was modified to adapt to the virtual seminar delivery. Research ideas were noted by the seminar organiser and summarised for attendees at the end of the research ideas and priorities session. An ARL PPI mailing list was set-up post seminar as a means of communicating with seminar attendees and will serve as a formal PPI network for ARL. Research updates and opportunities will be communicated via this formal network to people living with RMDs and researchers alike.Conclusion:This was the first PPI seminar organised by ARL in collaboration with a PPI seminar, and has led to the creation of a formal PPI network. Delivery mode of the PPI seminar was changed due to Covid-19 public health restrictions. This change may also have impacted engagement and attendance at the PPI seminar, given that virtual events are not accessible to all of the RMD population. Future PPI seminars will consider a hybrid approach of face-to-face and virtual attendance, to enhance accessibility. A formal PPI communication network has been established. Future work will focus future collaborative opportunities between the PPI panel and the ARL group, including project development, co-led research funding applications and joint research dissemination.References:[1]INVOLVE. (2012). Briefing notes for researchers: Involving the public in NHS, public health and social care research. Retrieved from www.invo.org.uk 7th January 2020.[2]de Wit MPT, Berlo SE, Aanerud GJ, et al (2011). European League Against Rheumatism recommendations for the inclusion of patient representatives in scientific projects. Annals of the Rheumatic Diseases 70:722-726Disclosure of Interests:None declared
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Kelly N, Hawkins E, O’leary H, Quinn K, Murphy G, Larkin L. POS1465-HPR THE RELATIONSHIP BETWEEN SEDENTARY BEHAVIOR AND SLEEP IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.641] [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: 11/03/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory condition that affects 0.5% of the adult population worldwide (1). Sedentary behavior (SB) is any waking behavior characterized by an energy expenditure of ≤1.5 METs (metabolic equivalent) and a sitting or reclining posture, e.g. computer use (2) and has a negative impact on health in the RA population (3). Sleep is an important health behavior, but sleep quality is an issue for people living with RA (4, 5). Poor sleep quality is associated with low levels of physical activity in RA (4) however the association between SB and sleep in people who have RA has not been examined previously.Objectives:The aim of this study was to investigate the relationship between SB and sleep in people who have RA.Methods:A cross-sectional study was conducted. Patients were recruited from rheumatology clinics in a large acute public hospital serving a mix of urban and rural populations. Inclusion criteria were diagnosis of RA by a rheumatologist according to the American College of Rheumatology criteria age ≥ 18 and ≤ 80 years; ability to mobilize independently or aided by a stick; and to understand written and spoken English. Demographic data on age, gender, disease duration and medication were recorded. Pain and fatigue were measured by the Visual Analogue Scale (VAS), anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index. SB was measured using the ActivPAL4™ activity monitor, over a 7-day wear period. Descriptive statistics were calculated to describe participant characteristics. Relationships between clinical characteristics and SB were examined using Pearson’s correlation coefficients and regression analyses.Results:N=76 participants enrolled in the study with valid data provided by N=72 participants. Mean age of participants was 61.5years (SD10.6) and the majority 63% (n = 47) were female. Participant mean disease duration was 17.8years (SD10.9). Mean SB time was 533.7 (SD100.1) minutes (8.9 hours per day/59.9% of waking hours). Mean sleep quality score was 7.2 (SD5.0) (Table 1). Correlation analysis and regression analysis found no significant correlation between sleep quality and SB variables. Regression analysis demonstrated positive statistical associations for SB time and body mass index (p-value=0.03846, R2 = 0.05143), SB time and pain VAS (p-value=0.009261, R2 = 0.07987), SB time and HADS (p-value = 0.009721, R2 = 0.08097) and SB time and HADSD (p-value = 0.01932, R2 = 0.0643).Conclusion:We found high levels of sedentary behavior and poor sleep quality in people who have RA, however no statistically significant relationship was found in this study. Future research should further explore the complex associations between sedentary behavior and sleep quality in people who have RA.References:[1]Carmona L, et al. Rheumatoid arthritis. Best Pract Res Clin Rheumatol 2010;24:733–745.[2]Anon. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab = Physiol Appl Nutr Metab 2012;37:540–542.[3]Fenton, S.A.M. et al. Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity. BMC Musculoskelet Disord 18, 131 (2017).[4]McKenna S, et al. Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis. Rheumatol Int. 2018 May;38(5):845-853.[5]Grabovac, I., et al. 2018. Sleep quality in patients with rheumatoid arthritis and associations with pain, disability, disease duration, and activity. Journal of clinical medicine, 7(10)336.Table 1.Sleep quality in people who have RASleep variableBed Time N(%) before 10pm13(18%) 10pm-12pm43 (60%) after 12pm16 (22%)Hours Sleep mean(SD)6.56 (1.54)Fall Asleep minutes mean(SD)33.3(27.7)Night Waking N(%)45(63%)Self-Rate Sleep mean(SD)2.74 (0.90)Hours Sleep mean(SD)6.56 (1.54)Disclosure of Interests:None declared
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Larkin L, Moses A, Gallagher S, Fraser A, Esbensen BA, Green J, Glynn L, Kennedy N. AB0872-HPR IMPACT OF COVID-19 ON A PHYSICAL ACTIVITY FEASIBILITY PILOT STUDY: THE PIPPRA EXPERIENCE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.162] [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: 11/03/2022]
Abstract
Background:The PIPPRA (Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis) project is a feasibility project examining the impact of a physical activity behaviour change intervention in people who have rheumatoid arthritis (RA). The PIPPRA study recruitment commenced in October 2019, with participant assessment and intervention commencing in November 2019. In the Republic of Ireland people who have RA are categorised as high risk category for Covid-19, due to immunosuppression [1], although this categorisation contrasts with EULAR’s provisional recommendations [2].Objectives:To examine the impact of the Covid-19 pandemic and public health restrictions on a pilot randomised controlled feasibility study in 2020.Methods:Participants (aged 18 years+, diagnosis of RA, independently mobile and low levels of physical activity [3]) were recruited from a rheumatology clinic at an urban hospital. Target recruitment was four participants per month for one year (N=48). Assessments were planned at baseline, eight and twenty-four weeks (N=144). Participants were randomised to intervention group or control group. The intervention group received four 1:1 sixty minute sessions with a physiotherapist (N=96). The intervention was delivered over eight weeks. Intervention and control groups received a physical activity information leaflet.Results:The Covid-19 pandemic and associated public health restrictions forced the study to be formally paused in April 2020 and the study formally resumed in August 2020. N=48 participants were recruited between October 2019 and March 2020 (six months). N=20 participants have commenced in the study, N=16 are awaiting baseline assessment, N=6 withdrew and N=6 were lost to follow-up prior to baseline. Trial protocol planned for the delivery of N=55 assessments and N=36 intervention sessions for participants who had commenced in the study. N=22 assessments and N=26 intervention sessions were delivered between November 2019 and March 2020. N=5 assessments and N=6 intervention sessions were conducted between August and October 2020. No assessment or intervention delivery occurred in November-December 2020 due to participant hesitancy in attending for assessment and/or intervention with increased public health restrictions. The impact of Covid-19 restrictions resulted in N=33 (60%) deviations from assessment protocol and N=10 (27%) deviations from intervention delivery protocol (Figure 1).Figure 1.Deviations from assessment and intervention protocol in the PIPPRA studyConclusion:The Covid-19 pandemic has had a significant impact on the delivery of the PIPPRA study. Feasibility study outcomes, including participant retention rate, and study delivery as per protocol, have been affected due to the Covid-19 pandemic. Participant reluctance to attend face-to-face sessions demonstrates the need to consider alternative methods of delivery, e.g. virtual delivery of interventions, where attending in person is not acceptable to participants [4], in future studies.References:[1]Health Service Executive. (2019). People at higher risk from COVID-19.Accessed 5th Jan 2020 https://www2.hse.ie/conditions/coronavirus/people-at-higher-risk.html.[2]Landewé RB et al (2020). EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Annals of the Rheumatic Diseases 79:851-858.[3]Godin, G. (2011). The Godin-Shephard leisure-time physical activity questionnaire. The Health & Fitness Journal of Canada, 4(1):18-22.[4]Inan, OT et al. (2020). Digitizing clinical trials. npj Digit. Med. 3:10.Disclosure of Interests:None declared
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O Donoghue K, Larkin L. AB1334-HPR BARRIERS AND FACILITATORS TO PHYSICAL ACTIVITY IN JUVENILE IDIOPATHIC ARTHRITIS (JIA): A SCOPING REVIEW. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3550] [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: 11/03/2022]
Abstract
Background:Physical activity is an important aspect in the management of JIA (1). However physical activity levels are low in this population (2). Limited research has been conducted to identify definitive barriers and facilitators to physical activity in children and adolescents who have JIA.Objectives:The objective of this scoping review was to identify the common barriers and facilitators to physical activity in JIA.Methods:Original studies, either quantitative or qualitative, including participants with a diagnosis of JIA, who were under 18 years of age were included. Two independent reviewers carried out a search of the literature and full text reviews of papers to determine eligibility for inclusion. The Critical Skills Appraisal Programme (CASP), Appraisal tool for Cross-Sectional Studies (AXIS) and Downs and Black critical appraisal tools were used to assess the quality of the included research articles.Results:Eighteen studies were included in the review. The included studies were of a variety of low, moderate and high quality. The synthesis of the data identified pain to be the most common barrier and the modification of physical activities to the need of the individual to be the most common facilitator to physical activity in JIA.Conclusion:Identifying the most common barriers and facilitators to physical activity allows clinicians to apply better management strategies when treating an individual with JIA. Our findings demonstrate the need for further research in this area to assist increasing physical activity participation for children and adolescents who have JIA.References:[1]Kuntze, G., Nesbitt, C., Whittaker, J.L., Nettel-Aguirre, A., Toomey, C., Esau, S., Doyle-Baker, P.K., Shank, J., Brooks, J., Benseler, S., Emery, C.A. (2018) ‘Exercise Therapy in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis’,Archives of Physical Medicine and Rehabilitation, 99(1), 178-193[2]Bos, G.J.F.J., Lelieveld, O.T.H.M., Armbrust, W., Sauer, P.J.J., Geertzen, J.H.B., Dijkstra, P.U. (2016) ‘Physical activity in children with Juvenile Idiopathic Arthritis compared to controls’, Pediatric Rheumatology, 14(1), 42.Disclosure of Interests:None declared
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Mckenna S, Larkin L, Donnelly A, Fraser A, Esbensen BA, Kennedy N. OP0267-HPR “I NEVER THOUGHT EXERCISE COULD HELP IMPROVE MY SLEEP”: EXPERIENCES OF PEOPLE WITH RHEUMATOID ARTHRITIS ON THE IMPACT OF EXERCISE ON SLEEP. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:OMERACT has identified sleep quality as one of the key outcomes for people with RA [1]. Poor sleep and reduced total sleep time (TST) are common complaints among people with RA. Poor sleep can in turn lead to deterioration in function, reduce activity levels and also impact mental health. Although sleep and mental health outcomes have been identified as important, they are frequently not measured in clinical trials. Involving key stakeholders, like people with RA, is important when designing exercise interventions as it allows consideration of particular issues that may influence future intervention delivery. This study involved people with RA who participated in a pilot RCT group exercise class to improve sleep quality.Objectives:To explore participants experiences of an exercise intervention in improving sleep quality and TST, to capture their reality.Methods:A descriptive qualitative study design of face-to-face semi-structured interviews was employed. The interview schedule explored a number of areas: experience of the intervention; outcome measures used; views regarding the intervention; perceptions regarding exercise and sleep and the impact on sleep. Interviews were transcribed verbatim by a professional transcriber. Inductive thematic analysis was used as an analytical approach. Interview transcripts were read, notes made, and ideas formulated to facilitate coding. The research team searched for patterns, analysed and coded the data, and generated themes and sub-themes. Themes were reviewed by the research team to check if they worked in relation to the coded extracts and the entire data set. The COREQ checklist provided guidance.Results:Twelve females participated with a mean age of 58 (SD 7.4); mean RA diagnosis of 9.9 (SD 7.4) years; moderate to severe disability (HAQ-DI: 1.5 (SD 0.60). Four main themes were generated: 1) Positive impact of exercise on sleep -“I really didn’t think any type of exercise would help me sleep better if I’m honest.”;2) Positive experiences of exercise intervention to improve sleep-“I learnt so much regarding walking that I didn’t even think about.”;3) Clear mental health benefits –“If you don’t sleep well then it will have a knock-on effect to your mental health”; 4) Achieving empowerment and ownership when exercising -“I feel empowered now and confident that I’m not doing harm to myself”.The findings demonstrated that participants were clearly surprised that exercise could improve sleep.Conclusion:In a variety of inflammatory conditions exercise is recommended as an effective intervention for the treatment of sleeping disorders. Although there is a growing consensus that exercise will benefit sleep, research is severely lacking in those with RA. This study demonstrates that participants were clearly surprised that exercise could improve their sleep. Due to the multifactorial nature of RA, engaging in exercise may not only improve sleep quality but also mitigate some of its symptoms.References:[1]Kirwan JR, Boonen A, Harrison MJ, Hewlett SE, et al (2011) OMERACT 10 Patient Perspective Virtual Campus: Valuing health; measuring outcomes in rheumatoid arthritis fatigue, RA sleep, arthroplasty, and systemic sclerosis; and clinical significance of changes in health. The Journal of Rheumatology;38:1728–34.Disclosure of Interests:None declared
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Kingsberg S, Faubion S, Larkin L, Graham S, Bernick B, Mirkin S. 060 Women’s Perspectives on Aging and Menopause and Symptom Treatment. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McLauchlin J, Aird H, Andrews N, Chattaway M, de Pinna E, Elviss N, Jørgensen F, Larkin L, Willis C. Public health risks associated with Salmonella contamination of imported edible betel leaves: Analysis of results from England, 2011-2017. Int J Food Microbiol 2019; 298:1-10. [PMID: 30889473 DOI: 10.1016/j.ijfoodmicro.2019.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/05/2018] [Revised: 02/10/2019] [Accepted: 03/09/2019] [Indexed: 01/06/2023]
Abstract
Fresh betel leaves (Piper betle L.), imported into the UK are a traditional ready-to-eat food consumed by Asian populations. We report here the consolidation of routinely collected data to model the public health risks from consumption of this food. Amongst 2110 samples collected at Border Inspection, wholesale, catering or retail, Salmonella was detected in 488 (23%) of samples tested between 2011 and 2017 and was the most commonly Salmonella-contaminated ready-to-eat food examined by Public Health England during this period. Using data from multiple samples (usually 5) tested per consignment sampled at Border Inspection, contamination levels were calculated by most probable number: seasonal, temporal and country specific differences were detected. Quantitative contamination data was used to estimate the levels present at retail, and a β-Poisson dose response model the probability of illness was calculated. Using data for products imported from India, the probability of acquiring infection following a single exposure (comprising of a single leaf) was estimated to be between 0.00003 (January-March) and 0.0001 (July-September). Using British Asian population data for individuals over 30 years of age in England in 2011, two estimates of consumption were modelled as 2.1 and 12.8 million servings per annum. Results from the model estimated 160 cases (range 102 to 242) and 960 cases (range 612 to 1456) per year in England for the two consumption estimates and equated to 34 (range 22 to 51) and 204 (range 130 to 310) salmonellosis cases per year reported to national surveillance. Salmonella from 475 of the contaminated samples were further characterised which showed a heterogeneous population structure with 46 S. enterica subsp. Enterica serovars, together with S. enterica subs diarizonae and salamae identified. Isolates from individual consignments were diverse and close genetic relationships between independent isolates were very rare except from within an individual consignment. There were no outbreaks detected as associated with betel leaf consumption. However analysis by whole genome sequencing of the 2014-17 data identified two cases where the clinical isolate had <5 single nucleotide polymorphism differences to isolates from betel leaves which is indicative of a likely epidemiological link and common source of contamination. Due to the diversity of the Salmonella contaminating this product, associations between salmonellosis cases and betel leaf consumption will appear sporadic and unlikely to be detected by current surveillance strategies based on outbreak detection.
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Affiliation(s)
- J McLauchlin
- Public Health England Food Water and Environmental Microbiology Services, National Infection Service, Colindale, London NW9 5EQ, UK; University of Liverpool, Institute of Infection and Global Health, Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, UK.
| | - H Aird
- Public Health England Food Water and Environmental Microbiology Laboratory York, National Infection Service, National Agri-Food Innovation Campus, York YO41 1LZ, UK
| | - N Andrews
- Public Health England Statistics, Modelling and Economics Department, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK
| | - M Chattaway
- Public Health England Gastrointestinal Bacteria Reference Unit, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK
| | - E de Pinna
- Public Health England Gastrointestinal Bacteria Reference Unit, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK
| | - N Elviss
- Public Health England Food Water and Environmental Microbiology Laboratory London, National Infection Service, Colindale, London NW9 5EQ, UK
| | - F Jørgensen
- Public Health England Food Water and Environmental Microbiology Laboratory Porton, National Infection Service, Porton Down, Salisbury SP4 0JG, UK
| | - L Larkin
- Public Health England, Gastrointestinal Infections Department, National Infection Service, London, NW9 5EQ, UK
| | - C Willis
- Public Health England Food Water and Environmental Microbiology Laboratory Porton, National Infection Service, Porton Down, Salisbury SP4 0JG, UK
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McLauchlin J, Aird H, Charlett A, Chattaway M, Elviss N, Hartman H, Jenkins C, Jørgensen F, Larkin L, Sadler-Reeves L, Willis C. Imported edible leaves collected at retail sale in England during 2017 with an emphasis on betel and curry leaves: microbiological quality with respect toSalmonella, Shiga-toxin-producingE. coli(STEC) and levels ofEscherichia coli. J Appl Microbiol 2018; 125:1175-1185. [DOI: 10.1111/jam.13931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J. McLauchlin
- Public Health England Food Water and Environmental Microbiology Services; National Infection Service; London UK
- Institute of Infection and Global Health; University of Liverpool; Liverpool UK
| | - H. Aird
- Public Health England Food Water and Environmental Microbiology Laboratory York; National Infection Service; York UK
| | - A. Charlett
- Public Health England Statistics, Modelling and Economics Department; National Infection Service; London UK
| | - M. Chattaway
- Public Health England Gastrointestinal Bacteria Reference Unit; National Infection Service; London UK
| | - N. Elviss
- Public Health England Food Water and Environmental Microbiology Laboratory London; National Infection Service; London UK
| | - H. Hartman
- Public Health England Gastrointestinal Bacteria Reference Unit; National Infection Service; London UK
| | - C. Jenkins
- Public Health England Gastrointestinal Bacteria Reference Unit; National Infection Service; London UK
| | - F. Jørgensen
- Public Health England Food Water and Environmental Microbiology Laboratory Porton; National Infection Service; Salisbury UK
| | - L. Larkin
- Public Health England; Gastrointestinal Infections Department; National Infection Service; London UK
| | - L. Sadler-Reeves
- Public Health England Food Water and Environmental Microbiology Laboratory Porton; National Infection Service; Salisbury UK
| | - C. Willis
- Public Health England Food Water and Environmental Microbiology Laboratory Porton; National Infection Service; Salisbury UK
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Larkin L, Gallagher S, Fraser A, Kennedy N. AB1102-HPR “if A Joint Is Hot It's Not The Time”: Health Professionals' Views on Developing Physical Activity Interventions for People Who Have Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1670] [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: 11/04/2022]
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Larkin L, Kennedy N, Fraser A, Gallagher S. FRI0633-HPR “It Might Hurt, but Still It's Good”: People with Rheumatoid Arthritis Beliefs and Expectations about Physical Activity Interventions. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1667] [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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Larkin L, Nordgren B, Brand C, Fraser A, Kennedy N. THU0630-HPR Validation of the Activpal™ Activity Monitor for Sedentary and Physical Activity Patterns in People with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1808] [Citation(s) in RCA: 1] [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: 11/04/2022]
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Larkin L. SP0023 How to Measure Physical Activity in People with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6552] [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: 11/04/2022]
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O’Neill K, Lyons A, Larkin L, Kelly G. Muscle thickness and pennation angle of the medial gastrocnemius and tibialis anterior in spastic diplegia versus typically developing children. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3602] [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: 10/23/2022]
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Gosling RJ, Martelli F, Sayers R, Larkin L, Davies RH. A review of the official sampling of flocks of laying hens in the Salmonella National Control Programme in Great Britain. Br Poult Sci 2014; 55:569-75. [PMID: 25350727 DOI: 10.1080/00071668.2014.955081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In line with European legislation and the UK National Control Programme for Salmonella, poultry farms are sampled to establish their Salmonella status. Regular samples are collected by the farmer (operator), with annual routine (official) samples being collected by the competent authority to verify achievement of the Salmonella programme reduction target. To confirm sampling was being carried out effectively, a questionnaire-based survey was conducted. The aim was to identify any complicating factors the samplers encountered and the decisions made in these circumstances. There was good compliance with the official sampling visits, with few delays reported. However, farm-specific clothing/separate boots for non-caged houses were rarely provided by the operator, whereas boot dips and hand washing facilities were usually available. The collection of dust was often a problem for official samplers, operator boot swabs were not always moistened before sampling and both sampler groups did not always follow the recommended method for the collection of faeces from belts and scrapers. Overall, there was a good application of the sampling protocol, although a few areas for improvement were identified.
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Affiliation(s)
- R J Gosling
- a Department of Bacteriology , Animal Health and Veterinary Laboratories Agency , New Haw, Addlestone, Surrey KT15 3NB , UK
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Chuang D, Brainard A, Zeng I, Larkin L. 30 A Randomized Trial on the Ability to Tolerate, Level of Discomfort, and Adverse Effects Associated with Higher-Flow and Lower-Flow Oxygen via a Standard Nasal Cannula. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cornell P, Trehane A, Thompson P, Rahmeh F, Greenwood M, Baqai TJ, Cambridge S, Shaikh M, Rooney M, Donnelly S, Tahir H, Ryan S, Kamath S, Hassell A, McCuish WJ, Bearne L, Mackenzie-Green B, Price E, Williamson L, Collins D, Tang E, Hayes J, McLoughlin YM, Chamberlain V, Campbell S, Shah P, McKenna F, Cornell P, Westlake S, Thompson P, Richards S, Homer D, Gould E, Empson B, Kemp P, Richards AG, Walker J, Taylor S, Bari SF, Alachkar M, Rajak R, Lawson T, O'Sullivan M, Samant S, Butt S, Gadsby K, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Edwards KR, Rowe I, Sanders T, Dunn K, Konstantinou K, Hay E, Jones LE, Adams J, White P, Donovan-Hall M, Hislop K, Barbosa Boucas S, Nichols VP, Williamson EM, Toye F, Lamb SE, Rodham K, Gavin J, Watts L, Coulson N, Diver C, Avis M, Gupta A, Ryan SJ, Stangroom S, Pearce JM, Byrne J, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Taylor J, Morris M, Dures E, Hewlett S, Wilson A, Adams J, Larkin L, Kennedy N, Gallagher S, Fraser AD, Shrestha P, Batley M, Koduri G, Scott DL, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P, Ferguson AM, Ibrahim F, Scott DL, Lempp H, Tierney M, Fraser A, Kennedy N, Barbosa Boucas S, Hislop K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J, Nutland H, Dean A, Laxminarayan R, Gates L, Bowen C, Arden N, Hermsen L, Terwee CB, Leone SS, vd Zwaard B, Smalbrugge M, Dekker J, vd Horst H, Wilkie R, Ferguson AM, Nicky Thomas V, Lempp H, Cope A, Scott DL, Simpson C, Weinman J, Agarwal S, Kirkham B, Patel A, Ibrahim F, Barn R, Brandon M, Rafferty D, Sturrock R, Turner D, Woodburn J, Rafferty D, Paul L, Marshall R, Gill J, McInnes I, Roderick Porter D, Woodburn J, Hennessy K, Woodburn J, Steultjens M, Siddle HJ, Hodgson RJ, Hensor EM, Grainger AJ, Redmond A, Wakefield RJ, Helliwell PS, Hammond A, Rayner J, Law RJ, Breslin A, Kraus A, Maddison P, Thom JM, Newcombe LW, Woodburn J, Porter D, Saunders S, McCarey D, Gupta M, Turner D, McGavin L, Freeburn R, Crilly A, Lockhart JC, Ferrell WR, Goodyear C, Ledingham J, Waterman T, Berkin L, Nicolaou M, Watson P, Lillicrap M, Birrell F, Mooney J, Merkel PA, Poland F, Spalding N, Grayson P, Leduc R, Shereff D, Richesson R, Watts RA, Roussou E, Thapper M, Bateman J, Allen M, Kidd J, Parsons N, Davies D, Watt KA, Scally MD, Bosworth A, Wilkinson K, Collins S, Jacklin CB, Ball SK, Grosart R, Marks J, Litwic AE, Sriranganathan MK, Mukherjee S, Khurshid MA, Matthews SM, Hall A, Sheeran T, Baskar S, Muether M, Mackenzie-Green B, Hetherington A, Wickrematilake G, Williamson L, Daniels LE, Gwynne CE, Khan A, Lawson T, Clunie G, Stephenson S, Gaffney K, Belsey J, Harvey NC, Clarke-Harris R, Murray R, Costello P, Garrett E, Holbrook J, Teh AL, Wong J, Dogra S, Barton S, Davies L, Inskip H, Hanson M, Gluckman P, Cooper C, Godfrey K, Lillycrop K, Anderton T, Clarke S, Rao Chaganti S, Viner N, Seymour R, Edwards MH, Parsons C, Ward K, Thompson J, Prentice A, Dennison E, Cooper C, Clark E, Cumming M, Morrison L, Gould VC, Tobias J, Holroyd CR, Winder N, Osmond C, Fall C, Barker D, Ring S, Lawlor D, Tobias J, Davey Smith G, Cooper C, Harvey NC, Toms TE, Afreedi S, Salt K, Roskell S, Passey K, Price T, Venkatachalam S, Sheeran T, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kingsbury D, Quartier P, Patel G, Arora V, Kupper H, Mozaffarian N, Kearsley-Fleet L, Baildam E, Beresford MW, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Saunders E, Baildam E, Chieng A, Davidson J, Foster H, Gardner-Medwin J, Wedderburn L, Thomson W, Hyrich K, McErlane F, Beresford M, Baildam E, Chieng SE, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Thomson W, Hyrich K, Rooney M, Finnegan S, Gibson DS, Borg FA, Bale PJ, Armon K, Cavelle A, Foster HE, McDonagh J, Bale PJ, Armon K, Wu Q, Pesenacker AM, Stansfield A, King D, Barge D, Abinun M, Foster HE, Wedderburn L, Stanley K, Morrissey D, Parsons S, Kuttikat A, Shenker N, Garrood T, Medley S, Ferguson AM, Keeling D, Duffort P, Irving K, Goulston L, Culliford D, Coakley P, Taylor P, Hart D, Spector T, Hakim A, Arden N, Mian A, Garrood T, Magan T, Chaudhary M, Lazic S, Sofat N, Thomas MJ, Moore A, Roddy E, Peat G, Rees F, Lanyon P, Jordan N, Chaib A, Sangle S, Tungekar F, Sabharwal T, Abbs I, Khamashta M, D'Cruz D, Dzifa Dey I, Isenberg DA, Chin CW, Cheung C, Ng M, Gao F, Qiong Huang F, Thao Le T, Yong Fong K, San Tan R, Yin Wong T, Julian T, Parker B, Al-Husain A, Yvonne Alexander M, Bruce I, Jordan N, Abbs I, D'cruz D, McDonald G, Miguel L, Hall C, Isenberg DA, Magee A, Butters T, Jury E, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Lazarus MN, Isenberg DA, Ehrenstein M, Carter LM, Isenberg DA, Ehrenstein MR, Chanchlani N, Gayed M, Yee CS, Gordon C, Ball E, Rooney M, Bell A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Sutton EJ, Watson KD, Isenberg D, Rahman A, Gordon C, Yee CS, Lanyon P, Jayne D, Akil M, D'Cruz D, Khamashta M, Lutalo P, Erb N, Prabu A, Edwards CJ, Youssef H, McHugh N, Vital E, Amft N, Griffiths B, Teh LS, Zoma A, Bruce I, Durrani M, Jordan N, Sangle S, D'Cruz D, Pericleous C, Ruiz-Limon P, Romay-Penabad Z, Carrera-Marin A, Garza-Garcia A, Murfitt L, Driscoll PC, Giles IP, Ioannou Y, Rahman A, Pierangeli SS, Ripoll VM, Lambrianides A, Heywood WE, Ioannou J, Giles IP, Rahman A, Stevens C, Dures E, Morris M, Knowles S, Hewlett S, Marshall R, Reddy V, Croca S, Gerona D, De La Torre Ortega I, Isenberg DA, Leandro M, Cambridge G, Reddy V, Cambridge G, Isenberg DA, Glennie M, Cragg M, Leandro M, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Artim Esen B, Pericleous C, MacKie I, Ioannou Y, Rahman A, Isenberg DA, Giles I, Skeoch S, Haque S, Pemberton P, Bruce I. BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket196] [Citation(s) in RCA: 1] [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: 11/12/2022] Open
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Halsby KD, Walsh AL, Smith R, Said B, Kirkbride H, Smyth B, Browning L, Larkin L, Morgan D. The Health Burden of Orphan Zoonotic Disease in the United Kingdom, 2005-2009. Zoonoses Public Health 2013; 61:39-47. [DOI: 10.1111/zph.12040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Indexed: 11/30/2022]
Affiliation(s)
- K. D. Halsby
- Gastrointestinal, Zoonotic and Emerging Infections Department; Health Protection Agency Colindale; London UK
| | - A. L. Walsh
- Gastrointestinal, Zoonotic and Emerging Infections Department; Health Protection Agency Colindale; London UK
| | - R. Smith
- Public Health Wales Communicable Disease Surveillance Centre; Cardiff UK
| | - B. Said
- Gastrointestinal, Zoonotic and Emerging Infections Department; Health Protection Agency Colindale; London UK
| | - H. Kirkbride
- Gastrointestinal, Zoonotic and Emerging Infections Department; Health Protection Agency Colindale; London UK
| | - B. Smyth
- Public Health Agency; Belfast UK
| | - L. Browning
- Health Protection Scotland; NHS National Services Scotland; Glasgow UK
| | - L. Larkin
- Disease Mitigation and Control (Zoonoses); Department for Environment Food, and Rural Affairs; London UK
| | - D. Morgan
- Gastrointestinal, Zoonotic and Emerging Infections Department; Health Protection Agency Colindale; London UK
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Larkin L. P-66: Implementation of a pilot program utilizing a nursing driven protocol for intravenous insulin infusion to achieve tight glycemic control in bariatric surgery patients on a general surgical unit. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.134] [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: 10/20/2022]
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Vasilaki A, Mansouri A, Van Remmen H, van der Meulen JH, Larkin L, Richardson AG, McArdle A, Faulkner JA, Jackson MJ. Free radical generation by skeletal muscle of adult and old mice: effect of contractile activity. Aging Cell 2006; 5:109-17. [PMID: 16626390 DOI: 10.1111/j.1474-9726.2006.00198.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [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] [Indexed: 11/26/2022] Open
Abstract
Oxidative modification of cellular components may contribute to tissue dysfunction during aging. In skeletal muscle, contractile activity increases the generation of reactive oxygen and nitrogen species (ROS). The question of whether contraction-induced ROS generation is further increased in skeletal muscle of the elderly is important since this influences recommendations on their exercise participation. Three different approaches were used to examine whether aging influences contraction-induced ROS generation. Hind limb muscles of adult and old mice underwent a 15-min period of isometric contractions and we examined ROS generation by isolated skeletal muscle mitochondria, ROS release into the muscle extracellular fluid using microdialysis techniques, and the muscle glutathione and protein thiol contents. Resting skeletal muscle of old mice compared with adult mice showed increased ROS release from isolated mitochondria, but no changes in the extracellular levels of superoxide, nitric oxide, hydrogen peroxide, hydroxyl radical activity or muscle glutathione and protein thiol contents. Skeletal muscle mitochondria isolated from both adult and old mice after contractile activity showed significant increases in hydrogen peroxide release compared with pre-contraction values. Contractions increased extracellular hydroxyl radical activity in adult and old mice, but had no significant effect on extracellular hydrogen peroxide or nitric oxide in either group. In adult mice only, contractile activity increased the skeletal muscle release of superoxide. A similar decrease in muscle glutathione and protein thiol contents was seen in adult and old mice following contractions. Thus, contractile activity increased skeletal muscle ROS generation in both adult and old mice with no evidence for an age-related exacerbation of ROS generation.
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Affiliation(s)
- A Vasilaki
- Division of Metabolic and Cellular Medicine, School of Clinical Sciences, University of Liverpool, Liverppol L69 3GA, UK.
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Abstract
Apolipoprotein E (apo E), a 34 kDa component of lipoproteins produced by the liver and in circulating macrophages, plays a critical role in the reverse transport of cholesterol to the liver via the circulation. Cholesterol-rich macrophages (macrophage foam cells) are a major cell type in human atherosclerotic lesions. Apo E deficiency in mice leads to the formation of atherosclerotic lesions. Conversely, macrophage-specific expression of apo E in these deficient mice can reduce the extent of atherosclerosis. These observations, together with the anti-inflammatory and anti-proliferative properties of Apo E, demonstrate an atheroprotective role for the apolipoprotein. Agents that regulate macrophage metabolism are also able to modulate apo E expression. Sterol loading, for example, enhances apo E synthesis and secretion. Additionally, exposure of macrophage foam cells to cholesterol acceptors such as apo A-1, the protein component of high density lipoprotein, further enhance apo E secretion. Cytokines can have a negative regulatory effect on apo E production in macrophages. Apo E expression is controlled at the transcriptional, post-transcriptional and post-translational level. Here, we review the cellular and molecular mechanisms modulating apo E synthesis and secretion in macrophages.
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Affiliation(s)
- L Larkin
- Cell Biology Group, The Heart Research Institute, Camperdown, Sydney, Australia
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Abstract
Despite the dramatic growth of homelessness research, there have been no systematic assessments of consumer and provider preferences regarding the content of this research. Therefore, 87 clients and 28 staff of a homeless veterans program were administered a 15-item questionnaire requesting identification of the 5 "most" and 5 "least" important research topics. Staff and clients differed significantly on 6 items considered most important and 4 items considered least important. Clients wanted more research that focused on material needs, whereas staff preferences were more broadly distributed. The fact that appreciable data exist for many of the research topics that respondents identified as important raises concerns about the accessibility of homelessness research.
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Affiliation(s)
- C I Cohen
- Project Torch, Veterans Administration Medical Center, and SUNY Health Science Center at Brooklyn, NY 11203, USA
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Larkin L, Leiendecker ER, Supiano M, Halter J. Glucose transporter content and enzymes of metabolism in nerve-repair grafted muscle of aging Fischer 344 rats. J Appl Physiol (1985) 1997; 83:1623-9. [PMID: 9375330 DOI: 10.1152/jappl.1997.83.5.1623] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aging and grafting are associated with decreased ability of muscle to sustain power, likely reflecting diminished fuel availability. To assess mechanisms that may contribute to availability of glucose, we studied GLUT-1 and GLUT-4 protein as well as mRNA contents and enzymes of glucose metabolism in grafted and control medial gastrocnemius (MG) muscles of 6-, 12-, and 24-mo-old male Fischer 344 rats. There was no effect of age or grafting on MG GLUT-4 content. There was both an age- and graft-associated increase in GLUT-1 content (P = 0.0044 and 0.0063, respectively). There was no effect of aging or grafting on hexokinase and phosphofructokinase activity or on protein and glycogen content. Muscle mass and citrate synthase activity were significantly diminished with grafting. Citrate synthase activity was significantly greater in the 12-mo-old compared with the 6- and 24-mo-old animals. Grafting in combination with aging had no impact on any of the parameters measured. We conclude that diminished glucose transporter expression cannot explain the decreased ability of aged muscle to sustain power. In addition, we conclude that the diminished ability of the grafted MG muscle to sustain power may be explained, in part, by a decrease in energy available from oxidative metabolism.
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Affiliation(s)
- L Larkin
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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Brownhill R, Larkin L. Safety within the community: legislation, change and education. Accid Emerg Nurs 1996; 4:31-3. [PMID: 8696853 DOI: 10.1016/s0965-2302(96)90035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Accidents are commonplace within society and hence have been identified as one of the key areas of the Government's Health of the Nation document (Department of Health 1992). This places a significant emphasis upon the nature of work undertaken in the Accident and Emergency setting. It is intended that this paper addresses issues related to clinical practice and highlights ways in which this practice may serve to enhance safety within the community as a whole.
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