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Hu J, Wang X, Prince M, Wang F, Sun J, Yang X, Wang W, Ye J, Chen L, Luo X. Gd-EOB-DTPA enhanced MRI based radiomics combined with clinical variables in stratifying hepatic functional reserve in HBV infected patients. Abdom Radiol (NY) 2024; 49:1051-1062. [PMID: 38294541 DOI: 10.1007/s00261-023-04176-6] [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: 08/21/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
PURPOSES To evaluate radiomics from Gd-EOB-DTPA enhanced MR combined with clinical variables for stratifying hepatic functional reserve in hepatitis B virus (HBV) patients. METHODS Our study included 279 chronic HBV patients divided 8:2 for training and test cohorts. Radiomics features were extracted from the hepatobiliary phase (HBP) MR images. Radiomics features were selected to construct a Rad-score which was combined with clinical parameters in two models differentiating hepatitis vs. Child-Pugh A and Child-Pugh A vs. B/C. Performances of these stratifying models were compared using area under curve (AUC). RESULTS Rad-score alone discriminated hepatitis vs. Child-Pugh A with AUC = 0.890, 0.914 and Child-Pugh A vs. B/C with AUC = 0.862, 0.865 for the training and test cohorts, respectively. Model 1 [Rad-score + clinical parameters for hepatitis vs. Child-Pugh A] showed AUC = 0.978 for the test cohort, which was higher than ALBI [albumin-bilirubin] and MELD [model for end-stage liver disease], with AUCs of 0.716, 0.799, respectively (p < 0.001, < 0.001). Model 2 [Rad-score + clinical parameters for Child-Pugh A vs. B/C] showed AUC of 0.890 in the test cohort, which was similar to ALBI (AUC = 0.908, p = 0.760), and higher than MELD (AUC = 0.709, p = 0.018). CONCLUSION Rad-score combined with clinical variables stratifies hepatic functional reserve in HBV patients.
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Affiliation(s)
- Jinghui Hu
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Xiaoxiao Wang
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Martin Prince
- Department of Radiology, Weill Medical College of Cornell University, 407 E61st Street, New York, NY, 10065, USA
| | - Fang Wang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Yunjin Road 701, Xuhui District, Shanghai, 200232, China
| | - Jun Sun
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Xin Yang
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Wenjian Wang
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Lei Chen
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Yunjin Road 701, Xuhui District, Shanghai, 200232, China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, China.
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Jones DE, Beuers U, Bonder A, Carbone M, Culver E, Dyson J, Gish RG, Hansen BE, Hirschfield G, Jones R, Kowdley K, Kremer AE, Lindor K, Mayo M, Mells G, Neuberger J, Prince M, Swain M, Tanaka A, Thorburn D, Trauner M, Trivedi P, Weltman M, Yeoman A, Levy C. Primary biliary cholangitis drug evaluation and regulatory approval: Where do we go from here? Hepatology 2024:01515467-990000000-00814. [PMID: 38506926 DOI: 10.1097/hep.0000000000000864] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease. The management landscape was transformed 20 years ago with the advent of Ursodeoxycholic Acid (UDCA). Up to 40% of patients do not, however, respond adequately to UDCA and therefore still remain at risk of disease progression to cirrhosis. The introduction of Obeticholic acid (OCA) as second-line therapy for patients failing UDCA has improved outcomes for PBC patients. There remains, however, a need for better treatments for higher risk patients. The greatest threat facing our efforts to improve treatment in PBC is, paradoxically, the regulatory approval model providing conditional marketing authorisation for new drugs based on biochemical markers on the condition that long-term, randomized placebo-controlled outcomes trials are performed to confirm efficacy. As demonstrated by the COBALT confirmatory study with OCA, it is difficult to retain patients in the required follow-on confirmatory placebo-controlled PBC outcomes trials when a licensed drug is commercially available. New PBC therapies in development such as the PPAR agonists, face even greater challenges in demonstrating outcomes benefit through randomized placebo-controlled studies once following conditional marketing authorisation, as there will be even more treatment options available. A recently published EMA Reflection Paper provides some guidance on the regulatory pathway to full approval but fails to recognise the importance of Real-World Data in providing evidence of outcomes benefit in rare diseases. Here we explore the impact of the EMA reflection paper on PBC therapy and offer pragmatic solutions for generating evidence of long-term outcomes through Real World data collection.
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Affiliation(s)
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academisch Medisch Centrum Universiteit van Amsterdam, Netherlands
| | - Alan Bonder
- Division of Gastreonterology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Marco Carbone
- Division of Gastroenterology and Centre for Autoimmune Liver Disease, University of Milano-Bicocca, Milan, Italy and Liver Unit, ASST Grande Ospedale, Metropolitano Niguarda, Milan, Italy
| | - Emma Culver
- John Radcliffe Hospital, Oxford, UK and University of Oxford, UK
| | - Jessica Dyson
- Liver Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | - Robert G Gish
- Hepatitis B Foundation, San Diego, California, USA and Division of Gastroenterology and Hepatology, Stanford Medicine, Stanford, USA
| | - Bettina E Hansen
- Department of Epidemiology & Biostatistics, Erasmus MC, Rotterdam, Netherlands and University of Toronto, Toronto, Canada and Toronto Center for Liver Disease & Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Rebecca Jones
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | - Kris Kowdley
- Liver Institute Northwest, Elson S. Floyd College of Medicine, Washington State University, USA and Velocity Clinical Research, Seattle, USA
| | - Andreas E Kremer
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Keith Lindor
- College of Health Solutions, Arizona State University, USA
| | - Marlyn Mayo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Texas, USA
| | - George Mells
- The Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge, UK
| | - James Neuberger
- Liver and Hepato-Pancreato-Biliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Prince
- Central Manchester University Hospitals NHS Foundation Trust, Department of Gastroenterology (Manchester Royal Infirmary), Manchester, UK
| | - Mark Swain
- University of Calgary, Calgary, Alberta, Canada
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Japan
| | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna, Austria
| | - Palak Trivedi
- National Institute for Health and Care Research, Birmingham Biomedical Research Centre, Birmingham, UK and Liver Unit, University Hospitals Birmingham, UK
| | - Martin Weltman
- Gastroenterology and Hepatology, Nepean Hospital, New South Wales, Australia
| | - Andrew Yeoman
- Aneurin Bevan University Health Board, Gwent Liver unit, Newport, Wales, UK
| | - Cynthia Levy
- Division of Digestive Health and Liver Diseases and Schiff Center for Liver Diseases, Miami, USA
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Demissie M, Birhane R, Hanlon C, Eshetu T, Medhin G, Minaye A, Habtamu K, Cleare AJ, Milkias B, Prince M, Fekadu A. Developing interventions to improve detection of depression in primary healthcare settings in rural Ethiopia. BJPsych Open 2024; 10:e52. [PMID: 38404026 PMCID: PMC10897685 DOI: 10.1192/bjo.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The poor detection of depression in primary healthcare (PHC) in low- and middle-income countries continues to threaten the plan to scale up mental healthcare coverage. AIMS To describe the process followed to develop an intervention package to improve detection of depression in PHC settings in rural Ethiopia. METHOD The study was conducted in Sodo, a rural district in south Ethiopia. The Medical Research Council's framework for the development of complex interventions was followed. Qualitative interviews, observations of provider-patient communication, intervention development workshops and pre-testing of the screening component of the intervention were conducted to develop the intervention. RESULTS A multicomponent intervention package was developed, which included (a) manual-based training of PHC workers for 10 days, adapted from the World Health Organization's Mental Health Gap Action Programme Intervention Guide, with emphasis on depression, locally identified depressive symptoms, communication skills, training by people with lived experience and active learning methods; (b) screening for culturally salient manifestations of depression, using a four-item tool; (c) raising awareness among people attending out-patient clinics about depression, using information leaflets and health education; and (d) system-level interventions, such as supportive supervision, use of posters at health facilities and a decision support mobile app. CONCLUSIONS This contextualised, multicomponent intervention package may lead to meaningful impact on the detection of depression in PHC in rural Ethiopia and similar settings. The intervention will be pilot tested for feasibility, acceptability and effectiveness before its wider implementation.
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Affiliation(s)
- Mekdes Demissie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia; and School Of Nursing and Midwifery, College of Health Sciences and Medicine, Haramaya University, Ethiopia
| | - Rahel Birhane
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia; and Centre for Global Mental Health & Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Tigist Eshetu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Abebaw Minaye
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Ethiopia
| | - Anthony J Cleare
- Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Barkot Milkias
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Martin Prince
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and King's Global Health Institute, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia; Department of Psychiatry, College of Health Sciences, Addis Ababa University, Ethiopia; Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Department of Global Health & Infection, Brighton and Sussex Medical School, UK
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Negussie H, Getachew M, Deneke A, Tadesse A, Abdella A, Prince M, Leather A, Hanlon C, Willott C, Mayston R. "Problems you can live with" versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery. BMC Health Serv Res 2024; 24:214. [PMID: 38365723 PMCID: PMC10874059 DOI: 10.1186/s12913-024-10620-0] [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: 11/21/2022] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND 98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models. METHODS Our study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman's explanatory models framework and decided to use this to guide the final stages of analysis. RESULTS We found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care. CONCLUSIONS We found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.
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Affiliation(s)
- Hanna Negussie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Medhanit Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Andualem Deneke
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amezene Tadesse
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Charlotte Hanlon
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chris Willott
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Rosie Mayston
- Global Health & Social Medicine, King's College London, London, UK
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Wimo A, Seeher K, Cataldi R, Cyhlarova E, Dielemann JL, Frisell O, Guerchet M, Jönsson L, Malaha AK, Nichols E, Pedroza P, Prince M, Knapp M, Dua T. The worldwide costs of dementia in 2019. Alzheimers Dement 2023; 19:2865-2873. [PMID: 36617519 PMCID: PMC10842637 DOI: 10.1002/alz.12901] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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: 05/26/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Dementia is a leading cause of death and disability globally. Estimating total societal costs demonstrates the wide impact of dementia and its main direct and indirect economic components. METHODS We constructed a global cost model for dementia, presenting costs as cumulated global and regional costs. RESULTS In 2019, the annual global societal costs of dementia were estimated at US $1313.4 billion for 55.2 million people with dementia, corresponding to US $23,796 per person with dementia. Of the total, US $213.2 billion (16%) were direct medical costs, US $448.7 billion (34%) direct social sector costs (including long-term care), and US $651.4 billion (50%) costs of informal care. DISCUSSION The huge costs of dementia worldwide place enormous strains on care systems and families alike. Although most people with dementia live in low- and middle-income countries, highest total and per-person costs are seen in high-income countries. HIGHLIGHTS Global economic costs of dementia were estimated to reach US $1313.4 in 2019. Sixty-one percent of people with dementia live in low-and middle-income countries, whereas 74% of the costs occur in high-income countries. The impact of informal care accounts for about 50% of the global costs. The development of a long-term care infrastructure is a great challenge for low-and middle-income countries. There is a great need for more cost studies, particularly in low- and middle-income countries. Discussions of a framework for global cost comparisons are needed.
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Affiliation(s)
- Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | | | | | - Eva Cyhlarova
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Joseph L. Dielemann
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Maëlenn Guerchet
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Linus Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Angeladine Kenne Malaha
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Emma Nichols
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Paola Pedroza
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Tarun Dua
- World Health Organization, Geneva, Switzerland
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Behzadi AH, Latich I, Prince M, Mojibian H. Abstract No. 19 Catheter-Directed Thrombolysis versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome in Lower Extremity Deep Vein Thrombosis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.059] [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: 02/27/2023] Open
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Curran R, Murdoch J, van Rensburg AJ, Bachmann M, Awotiwon A, Ras CJ, Petersen I, Prince M, Moultrie H, Nzuza M, Fairall L. A health systems intervention to strengthen the integration of tuberculosis and COVID-19 detection: Outcomes of a quasi-experimental study in a high burden tuberculosis district in KwaZulu Natal, South Africa. Trop Med Int Health 2023; 28:324-334. [PMID: 36751975 DOI: 10.1111/tmi.13860] [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: 02/09/2023]
Abstract
OBJECTIVES The adverse effects of the COVID-19 pandemic on tuberculosis (TB) detection have been well documented. Despite shared symptoms, guidance for integrated screening for TBand COVID-19 are limited, and opportunities for health systems strengthening curtailed by lockdowns. We partnered with a high TB burden district in KwaZulu-Natal, South Africa, to co-develop an integrated approach to assessing COVID-19 and TB, delivered using online learning and quality improvement, and evaluated its performance on TB testing and detection. METHODS We conducted a mixed methods study incorporating a quasi-experimental design and process evaluation in 10 intervention and 18 control clinics. Nurses in all 28 clinics were all provided access to a four-session online course to integrate TB and COVID-19 screening and testing, which was augmented with some webinar and in-person support at the 10 intervention clinics. We estimated the effects of exposure to this additional support using interrupted time series Poisson regression mixed models. Process evaluation data comprised interviews before and after the intervention. Thematic coding was employed to provide explanations for effects of the intervention. RESULTS Clinic-level support at intervention clinics was associated with a markedly higher uptake (177 nurses from 10 intervention clinics vs. 19 from 18 control clinics). Lack of familiarity with online learning, and a preference for group learning hindered the transition from face-to-face to online learning. Even so, any exposure to training was initially associated with higher rates of GeneXpert testing (adjusted incidence ratio [IRR] 1.11, 95% confidence interval 1.07-1.15) and higher positive TB diagnosis (IRR 1.38, 1.11-1.71). CONCLUSIONS These results add to the knowledge base regarding the effectiveness of interventions to strengthen TB case detection during the COVID-19 pandemic. The findings support the feasibility of a shift to online learning approaches in low-resource settings with appropriate support and suggest that even low-intensity interventions are capable of activating nurses to integrate existing disease control priorities during pandemic conditions.
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Affiliation(s)
- Robyn Curran
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jamie Murdoch
- School of Life Course and Population Sciences, Department of Social Science and Health, King's College, London, UK
| | - André J van Rensburg
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Max Bachmann
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Ajibola Awotiwon
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christy-Joy Ras
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Martin Prince
- King's Global Health Institute, Department of Population Science, King's College, London, UK
| | - Harry Moultrie
- Centre for Tuberculosis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Sandringham, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercury Nzuza
- Department of Health, Amajuba Health District, Newcastle, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa.,King's Global Health Institute, Department of Population Science, King's College, London, UK
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Seward N, Hanlon C, Abdella A, Abrahams Z, Alem A, Araya R, Bachmann M, Bekele A, Bogale B, Brima N, Chibanda D, Curran R, Davies J, Beyene A, Fairall L, Farrant L, Frissa S, Gallagher J, Gao W, Gwyther L, Harding R, Kartha MR, Leather A, Lund C, Marx M, Nkhoma K, Murdoch J, Petersen I, Petrus R, van Rensburg A, Sandall J, Sevdalis N, Sheenan A, Tadesse A, Thornicroft G, Verhey R, Willott C, Prince M. HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies. Glob Health Action 2022; 15:1987044. [PMID: 35037844 PMCID: PMC8765245 DOI: 10.1080/16549716.2021.1987044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/25/2021] [Indexed: 12/03/2022] Open
Abstract
To achieve universal health coverage, health system strengthening (HSS) is required to support the of delivery of high-quality care. The aim of the National Institute for Health Research Global Research Unit on HeAlth System StrEngThening in Sub-Saharan Africa (ASSET) is to address this need in a four-year programme, with three healthcare platforms involving eight work-packages. Key to effective health system strengthening (HSS) is the pre-implementation phase of research where efforts focus on applying participatory methods to embed the research programme within the existing health system. To conceptualise the approach, we provide an overview of the key methods applied across work-package to address this important phase of research conducted between 2017 and 2021.Work-packages are being undertaken in publicly funded health systems in rural and urban areas in Ethiopia, Sierra Leone, South Africa, and Zimbabwe. Stakeholders including patients and their caregivers, community representatives, clinicians, managers, administrators, and policymakers are the main research participants.In each work-package, initial activities engage stakeholders and build relationships to ensure co-production and ownership of HSSIs. A mixed-methods approach is then applied to understand and address determinants of high-quality care delivery. Methods such as situation analysis, cross-sectional surveys, interviews and focus group discussions are adopted to each work-package aim and context. At the end of the pre-implementation phase, findings are disseminated using focus group discussions and participatory Theory of Change workshops where stakeholders from each work package use findings to select HSSIs and develop a programme theory.ASSET places a strong emphasis of the pre-implementation phase in order to provide an in-depth and systematic diagnosis of the existing heath system functioning, needs for strengthening and stakeholder engagement. This common approach will inform the design and evaluation of the HSSIs to increase effectiveness across work packages and contexts, to better understand what works, for whom, and how.
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zulfa Abrahams
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Atalay Alem
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ricardo Araya
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Max Bachmann
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alemayehu Bekele
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birke Bogale
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King’s College London, London, UK
- Department of Dentistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nataliya Brima
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Dixon Chibanda
- University of Zimbabwe, Harare, Zimbabwe
- Psychology Department, School of Applied Human Science College of Humanities, University of KwaZulu Natal, London, UK
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justine Davies
- Centre for Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Andualem Beyene
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
- King’s Global Health Institute, King’s College London, London, UK
| | - Lindsay Farrant
- Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Souci Frissa
- King’s Global Health Institute, King’s College London, London, UK
| | - Jennifer Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King’s College London, London, UK
| | - Wei Gao
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | - Liz Gwyther
- Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | | | - Andrew Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Maggie Marx
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | - Jamie Murdoch
- Department of Population Health Science, Kings College London, London, UK
| | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Berea, Durban, South Africa
| | - Ruwayda Petrus
- Psychology Department, School of Applied Human Science College of Humanities, University of KwaZulu Natal, Berea, Durban, South Africa
| | - André van Rensburg
- Centre for Rural Health, University of KwaZulu-Natal, Berea, Durban, South Africa
| | - Jane Sandall
- Department of Women and Children’s Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Andrew Sheenan
- Department of Women and Children’s Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Amezene Tadesse
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Chris Willott
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Martin Prince
- King’s Global Health Institute, King’s College London, London, UK
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9
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Phetsitong R, Vapattanawong P, Mayston R, Prince M, Chua KC. In Caring for Older People in Low- and Middle-Income Countries, Do Older Caregivers Have a High Level of Care Burden and Psychological Morbidity Compared to Younger Caregivers? Int J Environ Res Public Health 2022; 19:ijerph192416405. [PMID: 36554286 PMCID: PMC9778435 DOI: 10.3390/ijerph192416405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 06/02/2023]
Abstract
Caregivers have become older as longevity increases. Caregiving for older people can cause burdens and psychological morbidity, which are the chronic stresses perceived by informal caregivers. This study aimed to compare the levels of care burden and psychological morbidity between older and younger caregivers in low- and middle-income countries. A cross-sectional survey was conducted in Cuba, the Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, and China. Data were collected by the 10/66 Dementia Research Group. The Zarit Burden Inventory was used to measure the levels of burden on caregivers. Psychological morbidity was assessed through the Self-Reporting Questionnaire. Data from 1348 households in which informal caregivers provided home care for one older person were included in the analysis. Multivariable logistic regression was used to investigate the effects of caregiver age upon care burden and psychological morbidity. A fixed-effect meta-analysis model was used to obtain a pooled estimate of the overall odds ratios of each country. The unadjusted and the adjusted model for potential covariates revealed no significant difference in care burden and psychological morbidity between older caregivers and younger caregivers. The adjusted pooled estimates, however, indicated a lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41-0.93, I2 = 0.0%). The demographic implications of caregiver age may suggest different policy responses across low- and middle-income countries.
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Affiliation(s)
- Ruttana Phetsitong
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Patama Vapattanawong
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Rosie Mayston
- Department of Global Health and Social Medicine, Social Science and Public Policy, King’s College London, London WC2R 2LS, UK
| | - Martin Prince
- King’s Global Health Institute, King’s College London, London WC2R 2LS, UK
| | - Kia-Chong Chua
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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10
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Barmpas P, Tasoulis S, Vrahatis AG, Georgakopoulos SV, Anagnostou P, Prina M, Ayuso-Mateos JL, Bickenbach J, Bayes I, Bobak M, Caballero FF, Chatterji S, Egea-Cortés L, García-Esquinas E, Leonardi M, Koskinen S, Koupil I, Paja̧k A, Prince M, Sanderson W, Scherbov S, Tamosiunas A, Galas A, Haro JM, Sanchez-Niubo A, Plagianakos VP, Panagiotakos D. A divisive hierarchical clustering methodology for enhancing the ensemble prediction power in large scale population studies: the ATHLOS project. Health Inf Sci Syst 2022; 10:6. [PMID: 35529251 PMCID: PMC9013733 DOI: 10.1007/s13755-022-00171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/30/2022] [Indexed: 01/13/2023] Open
Abstract
The ATHLOS cohort is composed of several harmonized datasets of international groups related to health and aging. As a result, the Healthy Aging index has been constructed based on a selection of variables from 16 individual studies. In this paper, we consider additional variables found in ATHLOS and investigate their utilization for predicting the Healthy Aging index. For this purpose, motivated by the volume and diversity of the dataset, we focus our attention upon data clustering, where unsupervised learning is utilized to enhance prediction power. Thus we show the predictive utility of exploiting hidden data structures. In addition, we demonstrate that imposed computation bottlenecks can be surpassed when using appropriate hierarchical clustering, within a clustering for ensemble classification scheme, while retaining prediction benefits. We propose a complete methodology that is evaluated against baseline methods and the original concept. The results are very encouraging suggesting further developments in this direction along with applications in tasks with similar characteristics. A straightforward open source implementation for the R project is also provided (https://github.com/Petros-Barmpas/HCEP). Supplementary Information The online version contains supplementary material available at 10.1007/s13755-022-00171-1.
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Affiliation(s)
- Petros Barmpas
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Sotiris Tasoulis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Aristidis G. Vrahatis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | | | - Panagiotis Anagnostou
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Matthew Prina
- Social Epidemiology Research Group. Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Global Health Institute, King’s College London, London, UK
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Guido A. Zäch Institute (GZI), Nottwil, Switzerland
- Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Ivet Bayes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Research, Innovation and Teaching Unit. Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Francisco Félix Caballero
- Department Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Idipaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Laia Egea-Cortés
- Research, Innovation and Teaching Unit. Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Esther García-Esquinas
- Department Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Idipaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | | | - Seppo Koskinen
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ilona Koupil
- Centre for Health Equity Studies, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Andrzej Paja̧k
- Department of Epidemiology and Population Studies, Jagienllonian University, Krakow, Poland
| | - Martin Prince
- Global Health Institute, King’s College London, London, UK
- Centre for Global Mental Health. Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Warren Sanderson
- International Institute for Applied Systems Analysis, World Population Program, Wittgenstein Centre for Demography and Global Human Capital, Laxenburg, Austria
- Department of Economics, Stony Brook University, Stony Brook, NY USA
| | - Sergei Scherbov
- International Institute for Applied Systems Analysis, World Population Program, Wittgenstein Centre for Demography and Global Human Capital, Laxenburg, Austria
- Austrian Academy of Science, Vienna Institute of Demography, Vienna, Austria
- Russian Presidential Academy of National Economy and Public Administration (RANEPA), Moscow, Russian Federation
| | | | - Aleksander Galas
- Department of Epidemiology and Preventive Medicine, Jagiellonian University, Krakow, Poland
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Research, Innovation and Teaching Unit. Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Albert Sanchez-Niubo
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Research, Innovation and Teaching Unit. Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Vassilis P. Plagianakos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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11
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Jiang M, Llibre Rodriguez JJ, Sosa AL, Acosta D, Jimenez-Velasquez IZ, Guerra M, Salas A, Huang YQ, Prince M, Albanese E. Incidence and predictors of frailty in Latin America and China: evidence from 10/66 cohort studies. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.014] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Evidence on the incidence and risk factors of frailty in low- and middle-income countries is very limited. We aimed to compare the incidence of frailty and explore its determinants in rural and urban areas in six Latin American countries and China.
Methods
The 10/66 is a multi-site cohort study in older adults. We conducted baseline and follow-up surveys in 2003-2006, and 2007-2010. We assessed frailty using a modified Fried frailty phenotype criterion, and adjudicated frailty (yes/no) when two or more of the following indicators were present: exhaustion, low physical activity, slow gait speed, and weight loss. We excluded frail participants at baseline and calculated person-years as the time interval between baseline and follow-up for frailty-free people who were survived and reinterviewed or the midpoint of it for incident frailty cases. We used Poisson and Cox regressions to model the incidence of frailty and its risk factors.
Results
We included 9,747 participants (≥65 years) for the analysis of frailty risk factors. Of whom, 8,212 were reinterviewed with an average of 4.0 years of follow-up, the incidence of frailty was lowest in Venezuela (21.9 per 1000 person-years) and rural Peru (24.3 per 1000 person-years), highest in rural Mexico (110.5 per 1000 person-years) and urban Peru (84.0 per 1000 person-years). In the overall Cox regression, we found significant prospective associations of incident frailty with living in rural areas (HR: 1.97, 95% CI: 1.69, 2.29), dementia (HR: 1.76, 95% CI: 1.42, 2.18), depression (HR: 1.69, 95% CI: 1.49, 1.93), comorbidity, female gender, older age, disability, hearing, and vision problems. Higher arm circumference was associated with a lower frailty risk (HR: 0.97, 95% CI: 0.96, 0.98).
Conclusions
The incidence of frailty varied substantially in Latin America and China, and between urban and rural areas. The identified risk factors could be potential intervention targets to decrease the global burden of frailty.
Key messages
• In Latin America and China, the incidence of frailty varied from 21.9 to 110.5 cases per 1000 person-years.
• We identified 9 risk factors and 1 protective factor for developing frailty, and the most relevant risk factors were living in the rural area, dementia, and depression.
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Affiliation(s)
- M Jiang
- Institute of Public Health, Università della Svizzera Italiana , Lugano, Switzerland
| | - JJ Llibre Rodriguez
- Facultad de Medicina Finlay-Albarran, Medical University of Havana , Havana, Cuba
| | - AL Sosa
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery of Mexico , Mexico City, Mexico
| | - D Acosta
- Internal Medicine Department, Universidad Nacional Pedro Henríquez Ureña , Santo Domingo, Dominican Republic
| | - IZ Jimenez-Velasquez
- Internal Medicine Department, School of Medicine, University of Puerto Rico , San Juan, Puerto Rico
| | - M Guerra
- Instituto de la Memoria Depresion y Enfermedades de Riesgo IMEDER , Lima, Peru
| | - A Salas
- Medicine Department, Caracas University Hospital , Caracas, Venezuela
- Faculty of Medicine, Universidad Central de Venezuela , Caracas, Venezuela
| | - YQ Huang
- Institute of Mental Health, Peking University , Beijing, China
| | - M Prince
- King's Global Health Institute, King's College London , London, UK
| | - E Albanese
- Institute of Public Health, Università della Svizzera Italiana , Lugano, Switzerland
- Institute of Global Health, University of Geneva , Geneva, Switzerland
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12
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Lam A, Jankovic L, Aharonyan L, McGroarty K, Prince M, Morris L, Stang C, Berdahl C, Torbati S. 95 A Tender-Loving-Care Volunteer Program to Provide Non-Clinical, Supportive Interventions to Older Adults in the Emergency Department. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Doherty DT, Athwal V, Moinuddin Z, Augustine T, Prince M, van Dellen D, Khambalia HA. Kidney Transplantation From Hepatitis-C Viraemic Donors:Considerations for Practice in the United Kingdom. Transpl Int 2022; 35:10277. [PMID: 35592447 PMCID: PMC9110637 DOI: 10.3389/ti.2022.10277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/11/2022] [Indexed: 12/01/2022]
Abstract
Background: Donor hepatitis-C (HCV) infection has historically represented a barrier to kidney transplantation (KT). However, direct-acting antiviral (DAA) medications have revolutionised treatment of chronic HCV infection. Recent American studies have demonstrated that DAA regimes can be used safely peri-operatively in KT to mitigate HCV transmission risk. Methods: To formulate this narrative review, a comprehensive literature search was performed to analyse results of existing clinical trials examining KT from HCV-positive donors to HCV-negative recipients with peri-operative DAA regimes. Results: 13 studies were reviewed (11 single centre, four retrospective). Outcomes for 315 recipients were available across these studies. A sustained virological response at 12 weeks (SVR12) of 100% was achieved in 11 studies. One study employed an ultra-short DAA regime and achieved an SVR12 of 98%, while another achieved SVR12 of 96% due to treatment of a missed mixed genotype. Conclusion: HCV+ KT is safe and may allow increased utilisation of organs for transplantation from HCV+ donors, who often have other favourable characteristics for successful donation. Findings from US clinical trials can be applied to the United Kingdom transplant framework to improve organ utilisation as suggested by the NHSBT vision strategy "Organ Donation and Transplantation 2030: meeting the need".
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Affiliation(s)
- Daniel T. Doherty
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Varinder Athwal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Hepatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Zia Moinuddin
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Martin Prince
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Hepatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Hussein A. Khambalia
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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14
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Govindan P, Sundararaj S, Karthikeyan C, Prince M, Aadhishwaran S, George J. Exergy and SCAPS 1-D Analysis on Modified Thermophotovoltaic Cell with Fresnel Lens Concentrator and Absorber–Emitter Materials. Arab J Sci Eng 2022. [DOI: 10.1007/s13369-022-06712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Gordon V, Adhikary R, Appleby V, Das D, Day J, Delahooke T, Dixon S, Elphick D, Hardie C, Heneghan MA, Hoeroldt B, Hooper P, Hutchinson J, Jones R, Khan F, Aithal GP, Metcalf J, Nkhoma A, Pelitari S, Prince M, Prosser A, Sathyanarayana V, Saksena S, Vani D, Yeoman A, Abouda G, Nelson A, Gleeson D. Treatment and Outcome of Autoimmune Hepatitis (AIH): Audit of 28 UK centres. Liver Int 2022; 42:1571-1584. [PMID: 35286013 DOI: 10.1111/liv.15241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/27/2022] [Accepted: 03/10/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND With few data regarding treatment and outcome of patients with AIH outside of large centres we present such a study of patients with AIH in 28 UK hospitals of varying size and facilities. METHODS Patients with AIH were identified in 14 University and 14 District General hospitals; incident cases during 2007-2015 and prevalent cases, presenting 2000-2015. Treatment and outcomes were analysed. RESULTS In 1267 patients with AIH, followed-up for 3.8(0-15) years, 5- and 10-year death/transplant rates were 7.1+0.8% and 10.1+1.3% (all-cause) and 4.0+0.6% and 5.9+1% (liver-related) respectively. Baseline parameters independently associated with death/transplantation for all-causes were: older age, vascular/respiratory co-morbidity, cirrhosis, decompensation, platelet count, attending transplant centre and for liver-related: the last four of these and peak bilirubin All-cause and liver-related death/transplantation was independently associated with: non-treatment with corticosteroids, non-treatment with a steroid-sparing agent (SSA), non-treatment of asymptomatic or non-cirrhotic patients and initial dose of Prednisolone >35mg/0.5mg/kg/day (all-cause only), but not with type of steroid (Prednisolone versus Budesonide) or steroid duration beyond 12-months. Subsequent all-cause and liver-death/transplant rates showed independent associations with smaller percentage fall in serum ALT after 1 and 3-months, but not with failure to normalise levels over 12-months. CONCLUSIONS We observed higher death/transplant rates in patients with AIH who were untreated with steroids (including asymptomatic or non-cirrhotic sub-groups), those receiving higher Prednisolone doses and those who did not receive an SSA. Similar death/transplant rates were seen in those receiving Prednisolone or Budesonide, those continuing steroids after 12-months and patients attaining normal ALT within 12-months versus not.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guruprasad P Aithal
- Nottingham Digestive Diseases centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham
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16
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Flykt MS, Prince M, Vänskä M, Lindblom J, Minkkinen J, Tiitinen A, Poikkeus P, Biringen Z, Punamäki RL. Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception. Hum Reprod Open 2022; 2022:hoac012. [PMID: 35419495 PMCID: PMC8994490 DOI: 10.1093/hropen/hoac012] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)? SUMMARY ANSWER Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner. WHAT IS KNOWN ALREADY Most studies have not found differences between ART and NC singletons in parent–adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships. STUDY DESIGN, SIZE, DURATION This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers and fathers gave background information for this study during pregnancy, and during the child’s first year and early school age (7–8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships—Relationship Structures) at 17–19 years of age. MAIN RESULTS AND THE ROLE OF CHANCE Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055. LIMITATIONS, REASONS FOR CAUTION The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons. WIDER IMPLICATIONS OF THE FINDINGS The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother–child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father–adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M S Flykt
- University of Helsinki, Faculty of Medicine, Department of Psychology and Logopedics, 00014 University of Helsinki, Helsinki, Finland
- Tampere University, Faculty of Social Sciences, Department of Psychology, 33014 Tampere University, Tampere, Finland
| | - M Prince
- Colorado State University, Department of Psychology, Fort Collins, Colorado, 80523, USA
| | - M Vänskä
- Tampere University, Faculty of Social Sciences, Department of Psychology, 33014 Tampere University, Tampere, Finland
| | - J Lindblom
- Tampere University, Faculty of Social Sciences, Department of Psychology, 33014 Tampere University, Tampere, Finland
- University of Turku, Department of Clinical Medicine, 20014 University of Turku, Turku, Finland
| | - J Minkkinen
- Tampere University, Faculty of Social Sciences, Department of Psychology, 33014 Tampere University, Tampere, Finland
| | - A Tiitinen
- University of Helsinki, Faculty of Medicine, Department of Obstetrics and Gynecology, 00014 University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, 00029 Helsinki University Hospital, Helsinki, Finland
| | - P Poikkeus
- University of Helsinki, Faculty of Medicine, Department of Obstetrics and Gynecology, 00014 University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, 00029 Helsinki University Hospital, Helsinki, Finland
| | - Z Biringen
- Colorado State University, Department of Human Development and Family Studies, Fort Collins, Colorado, 80523, USA
| | - R-L Punamäki
- Tampere University, Faculty of Social Sciences, Department of Psychology, 33014 Tampere University, Tampere, Finland
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17
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Fekadu A, Demissie M, Birhane R, Medhin G, Bitew T, Hailemariam M, Minaye A, Habtamu K, Milkias B, Petersen I, Patel V, Cleare AJ, Mayston R, Thornicroft G, Alem A, Hanlon C, Prince M. Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis. Syst Rev 2022; 11:21. [PMID: 35123556 PMCID: PMC8818168 DOI: 10.1186/s13643-022-01893-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the commonest mental disorders in primary care but is poorly identified. The objective of this review was to determine the level of detection of depression by primary care clinicians and its determinants in studies from low- to middle-income countries (LMICs). METHODS A systematic review and meta-analysis was conducted using PubMed, PsycINFO, MEDLINE, EMBASE, LILAC, and AJOL with no restriction of year of publication. Risk of bias within studies was evaluated with the Effective Public Health Practice Project (EPHPP). "Gold standard" diagnosis for the purposes of this review was based on the 9-item Patient Health Questionnaire (PHQ-9; cutoff scores of 5 and 10), other standard questionnaires and interview scales or expert diagnosis. Meta-analysis was conducted excluding studies on special populations. Analyses of pooled data were stratified by diagnostic approaches. RESULTS A total of 3159 non-duplicate publications were screened. Nine publications, 2 multi-country studies, and 7 single-country studies, making 12 country-level reports, were included. Overall methodological quality of the studies was good. Depression detection was 0.0% in four of the twelve reports and < 12% in another five. PHQ-9 was the main tool used: the pooled detection in two reports that used PHQ-9 at a cutoff point of 5 (combined sample size = 1426) was 3.9% (95% CI = 2.3%, 5.5%); in four reports that used PHQ-9 cutoff score of 10 (combined sample size = 5481), the pooled detection was 7.0% (95% CI = 3.9%, 10.2%). Severity of depression and suicidality were significantly associated with detection. CONCLUSIONS While the use of screening tools is an important limitation, the extremely low detection of depression by primary care clinicians poses a serious threat to scaling up mental healthcare in LMICs. Interventions to improve detection should be prioritized. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016039704 .
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Affiliation(s)
- Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK. .,Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.
| | - Mekdes Demissie
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Birhane
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Debremarkos University, Debremarkos, Ethiopia
| | - Maji Hailemariam
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Abebaw Minaye
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barkot Milkias
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA, USA
| | - Anthony J Cleare
- Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Rosie Mayston
- King's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London, WC2B 4BJ, UK
| | - Graham Thornicroft
- Centre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Martin Prince
- King's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London, WC2B 4BJ, UK.,Centre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
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18
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Chowdhary N, Barbui C, Anstey KJ, Kivipelto M, Barbera M, Peters R, Zheng L, Kulmala J, Stephen R, Ferri CP, Joanette Y, Wang H, Comas-Herrera A, Alessi C, Suharya Dy K, Mwangi KJ, Petersen RC, Motala AA, Mendis S, Prabhakaran D, Bibi Mia Sorefan A, Dias A, Gouider R, Shahar S, Ashby-Mitchell K, Prince M, Dua T. Reducing the Risk of Cognitive Decline and Dementia: WHO Recommendations. Front Neurol 2022; 12:765584. [PMID: 35082745 PMCID: PMC8784726 DOI: 10.3389/fneur.2021.765584] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
With population ageing worldwide, dementia poses one of the greatest global challenges for health and social care in the 21st century. In 2019, around 55 million people were affected by dementia, with the majority living in low- and middle-income countries. Dementia leads to increased costs for governments, communities, families and individuals. Dementia is overwhelming for the family and caregivers of the person with dementia, who are the cornerstone of care and support systems throughout the world. To assist countries in addressing the global burden of dementia, the World Health Organisation (WHO) developed the Global Action Plan on the Public Health Response to Dementia 2017–2025. It proposes actions to be taken by governments, civil society, and other global and regional partners across seven action areas, one of which is dementia risk reduction. This paper is based on WHO Guidelines on risk reduction of cognitive decline and dementia and presents recommendations on evidence-based, multisectoral interventions for reducing dementia risks, considerations for their implementation and policy actions. These global evidence-informed recommendations were developed by WHO, following a rigorous guideline development methodology and involved a panel of academicians and clinicians with multidisciplinary expertise and representing geographical diversity. The recommendations are considered under three broad headings: lifestyle and behaviour interventions, interventions for physical health conditions and specific interventions. By supporting health and social care professionals, particularly by improving their capacity to provide gender and culturally appropriate interventions to the general population, the risk of developing dementia can be potentially reduced, or its progression delayed.
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Affiliation(s)
- Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | | | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,The Ageing Epidemiology Research Unit, Imperial College London, School of Public Health, London, United Kingdom.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Mariagnese Barbera
- The Ageing Epidemiology Research Unit, Imperial College London, School of Public Health, London, United Kingdom.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ruth Peters
- University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Lidan Zheng
- University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
| | - Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Cleusa P Ferri
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Yves Joanette
- Canadian Institutes of Health Research, Government of Canada, Ottawa, ON, Canada
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health, Beijing, China.,Beijing Dementia Key Laboratory, Beijing, China
| | - Adelina Comas-Herrera
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | | | | | - Kibachio J Mwangi
- Division of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
| | | | | | | | | | | | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
| | - Riadh Gouider
- Faculty of Medicine, Clinical Investigation Centre Neurosciences and Mental Health Razi University Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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19
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Krishna M, Majgi S, DU B, Krishnaveni GV, Veena SR, Prince M, Kumaran K, Christaprasad Karat S, Kumar M, Padukundru M, Nagaraj S, Fall CH. A lifecourse approach to the relationship between lung function and cognition function in late life: findings from the Mysore studies of Natal effect on Ageing and Health (MYNAH) in South India. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.16981.1] [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: 11/20/2022] Open
Abstract
Background: Emerging evidence from high income settings indicates that lung function may be an independent determinant of cognitive abilities in late life. Despite a high burden of chronic lung disorders and neurocognitive disorders, there are limited data exploring the relationship between lung and cognitive function in later life in low- and middle-income (LMIC) settings. Methods: Between 2013 and 2016, 721 men and women from the Mysore Birth Records Cohort in South India, aged 55-80 years, were retraced and underwent standardised assessments for sociodemographic characteristics, cardiometabolic risk factors, lung function, cognitive function and mental health. Approximately 20 years earlier, a subset of them had assessments for cardiometabolic risk factors (n=522) and lung function (n=143). Results: Forced Expiratory Volume at one second (FEV1) and six seconds (FEV6) were higher among men than women. Women had higher immediate and delayed recall scores compared to men. Multivariate models indicated that those with lower FEV1 (lts) and FEV1/FEV6 ratio in late life had lower composite cognitive score (SD, standard deviation), independent of growth and environment in early life and childhood, attained education, socioeconomic position, cardiometabolic disorders in mid-and late life and lifestyle factors (0.29 SD per litre 95% confidence interval [CI] (0.10, 0.50) p=0.006 for FEV1 and 1.32 SD (0.20, 2.50) p=0.02 for FEV1/FEV6 ratio). Lung function in midlife was unrelated to cognitive outcomes in late life. Conclusions: Causality cannot be inferred from cross sectional associations. Therefore, causality is best explored in longitudinal studies with serial, but contemporaneous measurements of both lung and cognitive function. Mechanistic studies that examine the role of shared risk factors like environmental pollutants and biomass exposure on this relationship are urgently required in LMICs.
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20
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Alexandra Dunn J, Medhin G, Dewey M, Alem A, Worku B, Paksarian D, Newton CR, Tomlinson M, Prince M, Hanlon C. Common perinatal mental disorders and post‐infancy child development in rural Ethiopia: a population‐based cohort study. Trop Med Int Health 2022; 27:251-261. [PMID: 35080279 PMCID: PMC9305759 DOI: 10.1111/tmi.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To investigate whether maternal common mental disorders (CMD) in the postnatal period are prospectively associated with child development at 2.5 and 3.5 years in a rural low‐income African setting. Methods This study was nested within the C‐MaMiE (Child outcomes in relation to Maternal Mental health in Ethiopia) population‐based cohort in Butajira, Ethiopia, and conducted from 2005 to 2006. The sample comprised of 496 women who had recently given birth to living, singleton babies with recorded birth weight measurements, who were 15 to 44 years of age, and residing in six rural sub‐districts. Postnatal CMD measurements were ascertained 2 months after delivery. Language, cognitive, and motor development were obtained from the child 2.5 and 3.5 years after birth using a locally adapted version of the Bayley Scales of Infant Development (3rd Ed). Maternal CMD symptoms were measured using a locally validated WHO Self‐Reporting Questionnaire. A linear mixed‐effects regression model was used to analyze the relationship between postnatal CMD and child development. Results After adjusting for confounders, there was no evidence for an association between postnatal CMD and overall child development or the cognitive sub‐domain in the preschool period. There was no evidence of effect modification by levels of social support, socioeconomic status, stunting, or sex of the child. Conclusions Previous studies from predominantly urban and peri‐urban settings in middle‐income countries have established a relationship between maternal CMD and child development, which contrasts with the findings from this study. The risk and protective factors for child development may differ in areas characterized by high social adversity and food insecurity. More studies are needed to investigate maternal CMD’s impact on child development in low‐resource and rural areas.
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Affiliation(s)
- Julia Alexandra Dunn
- King’s College London Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience London UK
- National Institute of Mental Health Genetic Epidemiology Research Branch Intramural Research Program Bethesda USA
| | - Girmay Medhin
- Aklilu‐Lemma Institute of Pathobiology Addis Ababa University Addis Ababa Ethiopia
| | - Michael Dewey
- King’s College London Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Atalay Alem
- Addis Ababa University Department of Psychiatry WHO Collaborating Centre for Mental Health Research and Capacity‐Building School of Medicine College of Health Sciences Addis Ababa Ethiopia
| | - Bogale Worku
- Department of Paediatrics and Community Health Addis Ababa University Addis Ababa Ethiopia
| | - Diana Paksarian
- National Institute of Mental Health Genetic Epidemiology Research Branch Intramural Research Program Bethesda USA
| | | | - Mark Tomlinson
- Institute for Life Course Health Research Department of Global Health Stellenbosch University Cape Town South Africa
- School of Nursing and Midwifery Queens University Belfast UK
| | - Martin Prince
- King’s College London King’s Global Health Institute London UK
| | - Charlotte Hanlon
- King’s College London Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience London UK
- Addis Ababa University Department of Psychiatry WHO Collaborating Centre for Mental Health Research and Capacity‐Building School of Medicine College of Health Sciences Addis Ababa Ethiopia
- Addis Ababa University Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT‐Africa) College of Health Sciences Addis Ababa Ethiopia
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21
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Hanlon C, Medhin G, Dewey ME, Prince M, Assefa E, Shibre T, Ejigu DA, Negussie H, Timothewos S, Schneider M, Thornicroft G, Wissow L, Susser E, Lund C, Fekadu A, Alem A. Efficacy and cost-effectiveness of task-shared care for people with severe mental disorders in Ethiopia (TaSCS): a single-blind, randomised, controlled, phase 3 non-inferiority trial. Lancet Psychiatry 2022; 9:59-71. [PMID: 34921796 PMCID: PMC8872807 DOI: 10.1016/s2215-0366(21)00384-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FINDINGS We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING US National Institute of Mental Health.
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Affiliation(s)
- Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Girmay Medhin
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael E Dewey
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Prince
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Economics, College of Business and Economics, Jimma University, Jimma, Ethiopia
| | | | - Dawit A Ejigu
- Department of Pharmacology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hanna Negussie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sewit Timothewos
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lawrence Wissow
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- Department of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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22
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Abrahams Z, Boisits S, Schneider M, Prince M, Lund C. The relationship between common mental disorders (CMDs), food insecurity and domestic violence in pregnant women during the COVID-19 lockdown in Cape Town, South Africa. Soc Psychiatry Psychiatr Epidemiol 2022; 57:37-46. [PMID: 34282488 PMCID: PMC8288830 DOI: 10.1007/s00127-021-02140-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/09/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE We aimed to explore the relationship between common mental disorders (CMDs), food insecurity and experiences of domestic violence among pregnant women attending public sector midwife obstetric units and basic antenatal care clinics in Cape Town during the COVID-19 lockdown. METHODS Perinatal women, attending 14 healthcare facilities in Cape Town, were enrolled in the study during baseline data collection before the COVID-19 lockdown. During the lockdown period, fieldworkers telephonically contacted the perinatal women who were enrolled in the study and had provided contact details. The following data were collected from those who consented to the study: socio-demographic information, mental health assessment, food insecurity status and experiences of domestic violence. Poisson regression was used to model the associations of a number of risk factors with the occurrence of CMDs. RESULTS Of the 2149 women enrolled in the ASSET study, 885 consented to telephonic interviews. We found that 12.5% of women had probable CMDs and 43% were severely food insecure. Psychological distress increased significantly during the lockdown period, compared to before the COVID-19 outbreak. Using multivariate Poisson regression modelling, we showed that the risk of CMDs was increased in women who were severely food insecure or who experienced psychological or sexual abuse. CONCLUSIONS This study provides evidence of the effect of the COVID-19 lockdown on the mental health status of perinatal women living in low-resource settings in Cape Town and highlights how a crisis such as the COVID-19 lockdown amplifies the psycho-social risk factors associated with CMDs in perinatal women.
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Affiliation(s)
- Zulfa Abrahams
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.
| | - Sonet Boisits
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, South Africa
| | - Marguerite Schneider
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, South Africa
| | - Martin Prince
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s Global Health Institute, King’s College London, London, UK
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, South Africa ,Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s Global Health Institute, King’s College London, London, UK
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23
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Zhang Z, Bai H, Blumenfeld J, Ramnauth AB, Barash I, Prince M, Tan AY, Michaeel A, Liu G, Chicos I, Rennert L, Giannakopoulos S, Larbi K, Hughes S, Salvatore SP, Robinson BD, Kapur S, Rennert H. Detection of PKD1 and PKD2 Somatic Variants in Autosomal Dominant Polycystic Kidney Cyst Epithelial Cells by Whole-Genome Sequencing. J Am Soc Nephrol 2021; 32:3114-3129. [PMID: 34716216 PMCID: PMC8638386 DOI: 10.1681/asn.2021050690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/03/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by the development of multiple cysts in the kidneys. It is often caused by pathogenic mutations in PKD1 and PKD2 genes that encode polycystin proteins. Although the molecular mechanisms for cystogenesis are not established, concurrent inactivating germline and somatic mutations in PKD1 and PKD2 have been previously observed in renal tubular epithelium (RTE). METHODS To further investigate the cellular recessive mechanism of cystogenesis in RTE, we conducted whole-genome DNA sequencing analysis to identify germline variants and somatic alterations in RTE of 90 unique kidney cysts obtained during nephrectomy from 24 unrelated participants. RESULTS Kidney cysts were overall genomically stable, with low burdens of somatic short mutations or large-scale structural alterations. Pathogenic somatic "second hit" alterations disrupting PKD1 or PKD2 were identified in 93% of the cysts. Of these, 77% of cysts acquired short mutations in PKD1 or PKD2 ; specifically, 60% resulted in protein truncations (nonsense, frameshift, or splice site) and 17% caused non-truncating mutations (missense, in-frame insertions, or deletions). Another 18% of cysts acquired somatic chromosomal loss of heterozygosity (LOH) events encompassing PKD1 or PKD2 ranging from 2.6 to 81.3 Mb. 14% of these cysts harbored copy number neutral LOH events, while the other 3% had hemizygous chromosomal deletions. LOH events frequently occurred at chromosomal fragile sites, or in regions comprising chromosome microdeletion diseases/syndromes. Almost all somatic "second hit" alterations occurred at the same germline mutated PKD1/2 gene. CONCLUSIONS These findings further support a cellular recessive mechanism for cystogenesis in ADPKD primarily caused by inactivating germline and somatic variants of PKD1 or PKD2 genes in kidney cyst epithelium.
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Affiliation(s)
- Zhengmao Zhang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Hanwen Bai
- Vertex Pharmaceuticals Inc., Boston, Massachusetts
| | - Jon Blumenfeld
- Department of Medicine, Weill Cornell Medicine, New York, New York,The Rogosin Institute, New York, New York
| | - Andrew B. Ramnauth
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Irina Barash
- Department of Medicine, Weill Cornell Medicine, New York, New York,The Rogosin Institute, New York, New York
| | - Martin Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Adrian Y. Tan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Alber Michaeel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Genyan Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | | | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | | | - Karen Larbi
- Vertex Pharmaceuticals Inc., Oxford, United Kingdom
| | | | - Steven P. Salvatore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Brian D. Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Sandip Kapur
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Hanna Rennert
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Gao Q, Prina AM, Prince M, Acosta D, Luisa Sosa A, Guerra M, Huang Y, Jimenez-Velazquez IZ, Llibre Rodriguez JJ, Salas A, Williams JD, Liu Z, Acosta Castillo I, Mayston R. Loneliness Among Older Adults in Latin America, China, and India: Prevalence, Correlates and Association With Mortality. Int J Public Health 2021; 66:604449. [PMID: 34744572 PMCID: PMC8565277 DOI: 10.3389/ijph.2021.604449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: This study was designed to explore prevalence and correlates of self-reported loneliness and to investigate whether loneliness predicts mortality among older adults (aged 65 or above) in Latin America, China and India. Methods: The study investigated population-based cross-sectional (2003–2007) and longitudinal surveys (follow-up 2007–2010) from the 10/66 Dementia Research Group project. Poisson regression and Cox regression analyses were conducted to analyse correlates of loneliness and its association with mortality. Results: The standardised prevalence of loneliness varied between 25.3 and 32.4% in Latin America and was 18.3% in India. China showed a low prevalence of loneliness (3.8%). In pooled meta-analyses, there was robust evidence to support an association between loneliness and mortality across Latin American countries (HR = 1.13, 95% CI 1.01–1.26, I2 = 10.1%) and China (HR = 1.58, 95% CI 1.03–2.41), but there were no associations in India. Conclusion: Our findings suggest potential cultural variances may exist in the concept of loneliness in older age. The effect of loneliness upon mortality is consistent across different cultural settings excluding India. Loneliness should therefore be considered as a potential dimension of public health among older populations.
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Affiliation(s)
- Qian Gao
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - A Matthew Prina
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Martin Prince
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daisy Acosta
- Geriatric Section, Internal Medicine Department, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mariella Guerra
- Instituto de la Memoria Depresion y Enfermedades de Riesgo, Lima, Peru
| | - Yueqin Huang
- Social Psychiatry and Behavioral Medicine, Institute of Mental Health, Peking University, Beijing, China
| | - Ivonne Z Jimenez-Velazquez
- Geriatrics Program, Internal Medicine Department, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Joseph D Williams
- Department of Community Health, Voluntary Health Services, Chennai, India
| | - Zhaorui Liu
- Social Psychiatry and Behavioral Medicine, Institute of Mental Health, Peking University, Beijing, China
| | - Isaac Acosta Castillo
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosie Mayston
- Global Health and Social Medicine, King's Global Health Institute, Social Science and Public Policy, King's College London, London, United Kingdom
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25
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Queler SC, Tan ET, Geannette C, Prince M, Sneag DB. Ferumoxytol-enhanced vascular suppression in magnetic resonance neurography. Skeletal Radiol 2021; 50:2255-2266. [PMID: 33961070 DOI: 10.1007/s00256-021-03804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ferumoxytol-enhanced vascular suppression for visualizing branch nerves of the brachial plexus in magnetic resonance (MR) neurography. MATERIALS AND METHODS Signal simulations were performed to determine ferumoxytol's effect on nerve-, fat-, and blood-to-muscle contrast and to optimize pulse sequence parameters. Prospective, in vivo assessment included 10 subjects with chronic anemia who underwent a total of 19 (9 bilateral) pre- and post-infusion brachial plexus exams using three-dimensional (3D), T2-weighted short-tau inversion recovery (T2-STIR) sequences at 3.0 T. Two musculoskeletal radiologists qualitatively rated sequences for the degree of vascular suppression and brachial plexus branch nerve conspicuity. Nerve-to-muscle, -fat, and -vessel contrast ratios were measured. RESULTS Quantitative nerve/muscle and nerve/small vessel contrast ratios (CRs) increased with ferumoxytol (p < 0.05). Qualitative vascular suppression and suprascapular nerve visualization improved following ferumoxytol administration for both raters (p < .05). Pre- and post-ferumoxytol exams demonstrated moderate to near-perfect inter-rater agreement for nerve visualization and diagnostic confidence for the suprascapular and axillary nerves but poor to no agreement for the long thoracic nerve. CONCLUSION Ferumoxytol in T2-weighted brachial plexus MR neurography provides robust vascular suppression and aids visualization of the suprascapular nerve in volunteers without neuropathy.
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Affiliation(s)
- Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Martin Prince
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, 535 E. 70th St., New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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26
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Krishna M, Krishnaveni GV, Sargur V, Kumaran K, Kumar M, Nagaraj K, Coakley P, Karat SC, Chandak GR, Varghese M, Prince M, Osmond C, Fall CHD. Size at birth, lifecourse factors, and cognitive function in late life: findings from the MYsore study of Natal effects on Ageing and Health (MYNAH) cohort in South India. Int Psychogeriatr 2021; 34:1-14. [PMID: 34666849 DOI: 10.1017/s1041610221001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine if smaller size at birth, an indicator of growth restriction in utero, is associated with lower cognition in late life, and whether this may be mediated by impaired early life brain development and/or adverse cardiometabolic programming. DESIGN Longitudinal follow-up of a birth cohort. SETTING CSI Holdsworth Memorial Hospital (HMH), Mysore South India. PARTICIPANTS 721 men and women (55-80 years) whose size at birth was recorded at HMH. Approximately 20 years earlier, a subset (n = 522) of them had assessments for cardiometabolic disorders in mid-life. MEASUREMENTS Standardized measurement of cognitive function, depression, sociodemographic, and lifestyle factors; blood tests and assessments for cardiometabolic disorders. RESULTS Participants who were heavier at birth had higher composite cognitive scores (0.12 SD per SD birth weight [95% CI 0.05, 0.19] p = 0.001) in late life. Other lifecourse factors independently positively related to cognition were maternal educational level and participants' own educational level, adult leg length, body mass index, and socioeconomic position, and negatively were diabetes in mid-life and current depression and stroke. The association of birth weight with cognition was independent cardiometabolic risk factors and was attenuated after adjustment for all lifecourse factors (0.08 SD per SD birth weight [95% CI -0.01, 0.18] p = 0.07). CONCLUSIONS The findings are consistent with positive effects of early life environmental factors (better fetal growth, education, and childhood socioeconomic status) on brain development resulting in greater long-term cognitive function. The results do not support a pathway linking poorer fetal development with reduced late life cognitive function through cardiometabolic programming.
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Affiliation(s)
- Murali Krishna
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
- Foundation for Research and Advocacy in Mental Health Mysore, Mysore, India
| | | | - Veena Sargur
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Kalyanaraman Kumaran
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mohan Kumar
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Kiran Nagaraj
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Patsy Coakley
- Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | - Mathew Varghese
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Martin Prince
- Institute of Psychiatry, Kings College London, London, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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27
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Ademosu T, Ebuenyi I, Hoekstra RA, Prince M, Salisbury T. Burden, impact, and needs of caregivers of children living with mental health or neurodevelopmental conditions in low-income and middle-income countries: a scoping review. Lancet Psychiatry 2021; 8:919-928. [PMID: 34537102 DOI: 10.1016/s2215-0366(21)00207-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 02/04/2023]
Abstract
This scoping review synthesises previous research on caregivers' experiences and perspectives of caring for a child with a mental health or neurodevelopmental condition while living in low-income and middle-income countries (LMICs). 35 studies done across 15 LMICs were included in this Series paper. Most studies were done in the Africa region. Child and adolescent mental health and neurodevelopmental conditions were perceived by caregivers to have both biomedical and traditional or spiritual causes and help-seeking was aligned to these explanatory beliefs. Caregivers commonly described reduced quality of life, which they attributed to their children's mental or neurodevelopmental condition, and additional reports of family disruption, caregiver psychological distress, and financial hardship. To strengthen mental health outcomes of young people, better mental health promotion information for caregivers is required along with improved engagement with communities and increased sensitivity to caregiver wellbeing and needs when developing interventions for children and adolescents.
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Affiliation(s)
- Temitope Ademosu
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Children and Families Service, London Borough of Hackney, London, UK.
| | - Ikenna Ebuenyi
- Assisting Living & Learning Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Rosa A Hoekstra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Prince
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tatiana Salisbury
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Sanchez-Niubo A, Forero CG, Wu YT, Giné-Vázquez I, Prina M, De La Fuente J, Daskalopoulou C, Critselis E, De La Torre-Luque A, Panagiotakos D, Arndt H, Ayuso-Mateos JL, Bayes-Marin I, Bickenbach J, Bobak M, Caballero FF, Chatterji S, Egea-Cortés L, García-Esquinas E, Leonardi M, Koskinen S, Koupil I, Mellor-Marsá B, Olaya B, Pająk A, Prince M, Raggi A, Rodríguez-Artalejo F, Sanderson W, Scherbov S, Tamosiunas A, Tobias-Adamczyk B, Tyrovolas S, Haro JM. Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. Int J Epidemiol 2021; 50:880-892. [PMID: 33274372 PMCID: PMC8271194 DOI: 10.1093/ije/dyaa236] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Accepted: 10/23/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts. METHODS In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10. RESULTS A common scale was created for 343 915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality. CONCLUSIONS The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.
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Affiliation(s)
- Albert Sanchez-Niubo
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Carlos G Forero
- Department of Medicine, International University of Catalunya, Barcelona, Spain
| | - Yu-Tzu Wu
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Iago Giné-Vázquez
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Global Health Institute, King's College London, London, UK
| | - Javier De La Fuente
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS Princesa), Hospital Universitario de La Princesa, Madrid, Spain
| | - Christina Daskalopoulou
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elena Critselis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Alejandro De La Torre-Luque
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS Princesa), Hospital Universitario de La Princesa, Madrid, Spain
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | | | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS Princesa), Hospital Universitario de La Princesa, Madrid, Spain
| | - Ivet Bayes-Marin
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Guido A. Zäch Institute (GZI), Nottwil, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Laia Egea-Cortés
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ilona Koupil
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Blanca Mellor-Marsá
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Sanitary Research Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Martin Prince
- Global Health Institute, King's College London, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alberto Raggi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Warren Sanderson
- Wittgenstein Centre for Demography and Global Human Capital, International Institute for Applied Systems Analysis, Laxenburg, Austria.,Department of Economics, Stony Brook University, Stony Brook, NY, USA
| | - Sergei Scherbov
- Wittgenstein Centre for Demography and Global Human Capital, International Institute for Applied Systems Analysis, Laxenburg, Austria.,Austrian Academy of Science, Vienna Institute of Demography, Vienna, Austria.,International Laboratory of Demography and Human Capital, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation
| | - Abdonas Tamosiunas
- Department of Population Studies Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Beata Tobias-Adamczyk
- Department of Medical Sociology, Jagiellonian University Medical College, Krakow, Poland.,Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stefanos Tyrovolas
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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29
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Seward N, Murdoch J, Hanlon C, Araya R, Gao W, Harding R, Lund C, Hinrichs-Krapels S, Mayston R, Kartha M, Prince M, Sandall J, Thornicroft G, Verhey R, Sevdalis N. Implementation science protocol for a participatory, theory-informed implementation research programme in the context of health system strengthening in sub-Saharan Africa (ASSET-ImplementER). BMJ Open 2021; 11:e048742. [PMID: 34244274 PMCID: PMC8268893 DOI: 10.1136/bmjopen-2021-048742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/25/2023] Open
Abstract
OBJECTIVES ASSET (Health System Strengthening in sub-Saharan Africa) is a health system strengthening (HSS) programme involving eight work-packages (ie, a research study that addresses a specific need for HSS) that aims to develop solutions that support high-quality care. Here we present the protocol for the implementation science (IS) theme within ASSET (ASSET-ImplmentER) that aims to understand what HSS interventions work, for whom and how, and how IS methodologies can be adapted to improve the HSS interventions within resource-poor contexts. SETTINGS Publicly funded health facilities in rural and urban areas in in Ethiopia, South Africa, Sierra Leone, and Zimbabwe. PARTICIPANTS Research staff including principal investigators, coinvestigators, field staff, PhD students, and research assistants. INTERVENTIONS Work-packages use a mixed-methods effectiveness-effectiveness hybrid designs. At the end of the pre-implementation phase, a workshop is held whereby the IS theme, jointly with ASSET work-packages apply IS determinant frameworks to research findings to identify factors that influence the effectiveness of delivering evidence-informed care. Determinants are used to select a set of HSS interventions for further evaluation, where work-packages also theorise selective mechanisms.In the piloting and rolling implementation phase, work-packages pilot the HSS interventions. An iterative process then begins involving evaluation, reflection and adaptation. Throughout this phase, IS determinant frameworks are applied to monitor and identify barriers/enablers to implementation. Selective mechanisms of action are also investigated. Implementation outcomes are evaluated using qualitative and quantitative methods. The psychometric properties of outcome measures including acceptability, appropriateness and feasibility are also evaluated. In a final workshop, work-packages come together, to reflect and explore the utility of the selected IS methods and provide suggestions for future use.Structured templates are used to organise and analyse common and heterogeneous patterns across work-packages. Qualitative data are analysed using thematic analysis and quantitative data are analysed using means and proportions. CONCLUSIONS We use a novel combination of IS methods at a programmatic level to facilitate comparisons of determinants and mechanisms that influence the effectiveness of HSS interventions in achieving implementation outcomes across different contexts. The study also contributes conceptual development and clarification at the underdeveloped interface of IS, HSS and global health.The ASSET-ImplementER theme is considered minimal risk as we only interview researchers involved in the different work-packages. To this effect we have received approval from King's College London Ethics Committee for research that is considered minimal risk (Reference number: MRA-20/21-21772).
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Department of Health Services and Population Research, King's College London, London, UK
| | - Jamie Murdoch
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
| | - Wei Gao
- Department of Palliative Care and Policy, King's College London, London, UK
| | - Richard Harding
- Department of Palliative Care and Policy, King's College London, London, UK
| | - Crick Lund
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Saba Hinrichs-Krapels
- The Policy Institute, King's College London, London, UK
- King's Global Health Institute, King's College London, London, UK
| | - Rosie Mayston
- King's Global Health Institute, King's College London, London, UK
- Global Health and Social Medicine, King's College London, London, UK
| | | | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Jane Sandall
- Dept of Women and Children's Health, School of Life Course Sciences, FoLSM, King's College London, London, UK
| | - Graham Thornicroft
- Centre for Implementation Science, Department of Health Services and Population Research, King's College London, London, UK
| | - Ruth Verhey
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nick Sevdalis
- Centre for Implementation Science, Department of Health Services and Population Research, King's College London, London, UK
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30
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Gordon VM, Adhikary R, Aithal GP, Appleby V, Das D, Day J, Delahooke T, Dixon S, Elphick D, Hardie C, Heneghan M, Hoeroldt B, Hooper P, Hutchinson J, Jones RL, Khan F, Metcalf J, Nkhoma A, Pelitari S, Prince M, Prosser A, Saksena S, Sathyanarayana V, Vani D, Yeoman A, Gleeson D. Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH). Frontline Gastroenterol 2021; 13:126-132. [PMID: 35295749 PMCID: PMC8862490 DOI: 10.1136/flgastro-2020-101661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals. METHODS Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool. RESULTS Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3-23) gastroenterologists; including 3 (0-10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18-100) of all consultants managing AIH: in DGH's 92% (20-100) vs 46% (17-100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital. CONCLUSION Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.
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Affiliation(s)
- Victoria Mary Gordon
- Hepatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Guruprasad P Aithal
- Nottingham Digestive Disease Centre, NIHR Biomedical Research Unit, Nottingham University, Nottingham, UK
| | - Victoria Appleby
- Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | | | - James Day
- Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | - Michael Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - John Hutchinson
- Hepatology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Rebecca L Jones
- Department of Hepatology, St James's University Hospital, Leeds, UK
| | | | | | - Alick Nkhoma
- Gastroenterology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Stavroula Pelitari
- Hepatology, University Hospitals Coventry and Warwickshire NHS Trust Gastroenterology, Coventry, UK
| | | | | | | | | | - Deven Vani
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Andrew Yeoman
- Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, UK
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Peng Y, Ye J, Liu C, Jia H, Sun J, Ling J, Prince M, Li C, Luo X. Simultaneous hepatic iron and fat quantification with dual-energy CT in a rabbit model of coexisting iron and fat. Quant Imaging Med Surg 2021; 11:2001-2012. [PMID: 33936981 DOI: 10.21037/qims-20-902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Liver iron and fat are often co-deposited, synergistically aggravating the progression of chronic liver disease. Accurate determination of liver iron and fat content is helpful for patient management. To assess the accuracy of hepatic iron/fat decomposition using dual-energy computed tomography (DECT) for simultaneously quantifying hepatic iron and fat when both are present. Methods Sixty-eight New Zealand rabbits on a high-fat/cholesterol diet plus iron injections were used to establish a model of coexisting hepatic iron/fat. Abdominal imaging was performed using dual-source DECT. The iron and fat fractions (Iron-CT and Fat-CT, respectively) were calculated using a 3-material decomposition algorithm. The spectroscopic liver iron concentration (LIC) grading (normal, mild, moderate, severe, and massive iron overload) and the histopathological fat fraction (Fat-ref) grading (normal, mild, moderate, severe steatosis) were used as references. Correlations between the DECT parameters and the references were analyzed. Hepatic iron/fat quantification equations were established and validated. Analysis of covariance was used to assess the influence of fat on iron measurements and vice versa. Results Iron-CT highly correlated with LIC (r=0.94, P<0.001), and Fat-CT highly correlated with Fat-ref (r=0.88, P<0.001). Both the Iron-CT- and Fat-CT-derived LIC and fat fraction showed good agreement with spectroscopy/histology. The linear relationship between Iron-CT and spectroscopic LIC was not affected by the grade of hepatic fat (F=1.93, P=0.16). The linear relationship between Fat-CT and Fat-ref was unaffected by hepatic iron grades from normal to severe (F=0.18, P=0.91). However, with massive iron overload [>15.0 mg Fe/g (270 µmol/g)] the regression began to deviate, causing fat underestimation (F=5.50, P=0.04). Conclusions Our DECT-based iron/fat decomposition algorithm accurately measured hepatic iron and fat when both were present in a rabbit model. Hepatic fat may be underestimated when there is massive iron overload.
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Affiliation(s)
- Yun Peng
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chang Liu
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongru Jia
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jun Sun
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jun Ling
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Martin Prince
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Chang Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
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Heshmatzadeh Behzadi A, Velasco N, Prince M. Abstract No. 549 Trimetazidine in the prevention of contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography: a systematic review and meta-analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.359] [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: 10/21/2022] Open
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Smartt C, Ketema K, Frissa S, Tekola B, Birhane R, Eshetu T, Selamu M, Prince M, Fekadu A, Hanlon C. Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study. BMC Public Health 2021; 21:568. [PMID: 33752638 PMCID: PMC7986271 DOI: 10.1186/s12889-021-10629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the pathways followed into and out of homelessness among people with experience of severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia. Methods In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through their participation in the PRIME project, which implemented a multi-component district level plan to improve access to mental health care in primary care in Sodo district, Ethiopia. People enrolled in PRIME who were diagnosed with SMI (schizophrenia, schizoaffective disorder or bipolar disorder) and who had reported experiencing homelessness at recruitment formed the sampling frame for this qualitative study. We used OpenCode 4.0 and Microsoft Excel for data management. Thematic analysis was conducted using an inductive approach. Results Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return. Conclusions Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Our study findings indicate that interventions to prevent and tackle homelessness in this and similar settings ought to focus on increasing family support, and ensuring access to acceptable and suitable housing, mental health care and social support. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10629-8.
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Affiliation(s)
- Caroline Smartt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | | | - Souci Frissa
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Bethlehem Tekola
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Rahel Birhane
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia
| | - Medhin Selamu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Martin Prince
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK. .,King's College London, King's Global Health Institute, London, UK. .,Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia. .,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.
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Wu YT, Niubo AS, Daskalopoulou C, Moreno-Agostino D, Stefler D, Bobak M, Oram S, Prince M, Prina M. Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts. CMAJ 2021; 193:E361-E370. [PMID: 33722827 PMCID: PMC8096404 DOI: 10.1503/cmaj.200484] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Women generally have longer life expectancy than men but have higher levels of disability and morbidity. Few studies have identified factors that explain higher mortality in men. The aim of this study was to identify potential factors contributing to sex differences in mortality at older age and to investigate variation across countries. METHODS This study included participants age ≥ 50 yr from 28 countries in 12 cohort studies of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. Using a 2-step individual participant data meta-analysis framework, we applied Cox proportional hazards modelling to investigate the association between sex and mortality across different countries. We included socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), social (marital status, living alone) and health factors (cardiovascular disease, diabetes, mental disorders) as covariates or interaction terms with sex to test whether these factors contributed to the mortality gap between men and women. RESULTS The study included 179 044 individuals. Men had 60% higher mortality risk than women after adjustment for age (pooled hazard ratio [HR] 1.6; 95% confidence interval 1.5-1.7), yet the effect sizes varied across countries (I 2 = 71.5%, HR range 1.1-2.4). Only smoking and cardiovascular diseases substantially attenuated the effect size (by about 22%). INTERPRETATION Lifestyle and health factors may partially account for excess mortality in men compared with women, but residual variation remains unaccounted for. Variation in the effect sizes across countries may indicate contextual factors contributing to gender inequality in specific settings.
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Affiliation(s)
- Yu-Tzu Wu
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Albert Sanchez Niubo
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Christina Daskalopoulou
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Dario Moreno-Agostino
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Denes Stefler
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Martin Bobak
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Sian Oram
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Martin Prince
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
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Hanlon C, Alem A, Medhin G, Shibre T, Ejigu DA, Negussie H, Dewey M, Wissow L, Prince M, Susser E, Lund C, Fekadu A. Correction to: Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial. Trials 2020; 21:829. [PMID: 33023647 PMCID: PMC7539443 DOI: 10.1186/s13063-020-04776-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Daskalopoulou C, Wu YT, Pan W, Giné Vázquez I, Prince M, Prina M, Tyrovolas S. Factors related with sarcopenia and sarcopenic obesity among low- and middle-income settings: the 10/66 DRG study. Sci Rep 2020; 10:20453. [PMID: 33235211 PMCID: PMC7686337 DOI: 10.1038/s41598-020-76575-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia and sarcopenic obesity research in low- and middle- income countries (LMICs) is limited. We investigated sarcopenia and sarcopenic obesity prevalence and sociodemographic, bio-clinical and lifestyle factors in LMICs settings. For the purposes of this study, the 10/66 Dementia Research Group follow-up wave information from individuals aged 65 and over in Cuba, Dominican Republic, Peru, Mexico, Puerto Rico, China, was employed and analysed (n = 8.694). Based on indirect population formulas, we calculated body fat percentage (%BF) and skeletal muscle mass index (SMI). Sarcopenia prevalence ranged from 12.4% (Dominican Republic) to 24.6% (rural Peru); sarcopenic obesity prevalence ranged from 3.0% (rural China) to 10.2% (rural Peru). Odds ratios (OR) with 95% confidence intervals (CI) for sarcopenia were higher for men 2.82 (2.22-3.57) and those with higher %BF 1.08 (1.07-1.09), whereas higher number of assets was associated with a decreased likelihood 0.93 (0.87-1.00). OR of sarcopenic obesity were higher for men 2.17 (1.70-2.76), those reporting moderate alcohol drinking 1.76 (1.21-2.57), and those with increased number of limiting impairments 1.54 (1.11-2.14). We observed heterogeneity in the prevalence of sarcopenia and sarcopenic obesity in the 10/66 settings. We also found a variety of factors to be associated with those. Our results reveal the need for more research among the older population of LMICs.
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Affiliation(s)
- Christina Daskalopoulou
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - Yu-Tzu Wu
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - William Pan
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
- Global Health Institute, Duke University, Durham, NC, 27708, USA
| | - Iago Giné Vázquez
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Monforte de Lemos 3-5. Pabellón 11, 28029, Madrid, Spain
| | - Martin Prince
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - Matthew Prina
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Monforte de Lemos 3-5. Pabellón 11, 28029, Madrid, Spain.
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Baron EC, Rathod SD, Hanlon C, Prince M, Fedaku A, Kigozi F, Jordans M, Luitel NP, Medhin G, Murhar V, Nakku J, Patel V, Petersen I, Selohilwe O, Shidhaye R, Ssebunnya J, Tomlinson M, Lund C, De Silva M. Correction to: Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol. BMC Psychiatry 2020; 20:467. [PMID: 32993595 PMCID: PMC7523048 DOI: 10.1186/s12888-020-02890-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Emily C. Baron
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road 7700 Rondebosch, Cape Town, South Africa
| | - Sujit D. Rathod
- grid.8991.90000 0004 0425 469XDepartment of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Hanlon
- grid.7123.70000 0001 1250 5688College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia ,grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Services and Population Research Department, King’s College London, London, UK
| | - Martin Prince
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Services and Population Research Department, King’s College London, London, UK
| | - Abebaw Fedaku
- grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.12082.390000 0004 1936 7590Global Health and Infection Department, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Fred Kigozi
- grid.11194.3c0000 0004 0620 0548Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
| | - Mark Jordans
- grid.429145.f0000 0004 0369 5004Research and Development Department, HealthNet TPO, Amsterdam, the Netherlands ,grid.13097.3c0000 0001 2322 6764Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Girmay Medhin
- grid.7123.70000 0001 1250 5688Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Juliet Nakku
- grid.11194.3c0000 0004 0620 0548Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
| | - Vikram Patel
- grid.471010.3Sangath, Goa, India ,grid.38142.3c000000041936754XHarvard Medical School, Boston, USA ,grid.415361.40000 0004 1761 0198Public Health Foundation of India, New Delhi, India
| | - Inge Petersen
- grid.16463.360000 0001 0723 4123Centre for Rural Health, School of Nursing and Public Health and School of Applied Human Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - One Selohilwe
- grid.16463.360000 0001 0723 4123Centre for Rural Health, School of Nursing and Public Health and School of Applied Human Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Rahul Shidhaye
- grid.415361.40000 0004 1761 0198Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,grid.5012.60000 0001 0481 6099CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Joshua Ssebunnya
- grid.11194.3c0000 0004 0620 0548Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
| | - Mark Tomlinson
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road 7700 Rondebosch, Cape Town, South Africa ,grid.11956.3a0000 0001 2214 904XAlan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Crick Lund
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road 7700 Rondebosch, Cape Town, South Africa ,grid.13097.3c0000 0001 2322 6764Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mary De Silva
- grid.52788.300000 0004 0427 7672Department of Population Health, Wellcome Trust, London, UK
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Johansson L, Guerra M, Prince M, Hörder H, Falk H, Stubbs B, Prina AM. Associations between Depression, Depressive Symptoms, and Incidence of Dementia in Latin America: A 10/66 Dementia Research Group Study. J Alzheimers Dis 2020; 69:433-441. [PMID: 30958381 PMCID: PMC6598112 DOI: 10.3233/jad-190148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A growing body of evidence suggests that depression is related to dementia in older adults. Previous research has been done in high-income countries and there is a lack of studies in low- and middle income countries (LMICs). OBJECTIVE To examine the relationship between depressive symptoms and incidence of dementia in a population-based study of older adults in Latin America. METHODS The study is a part of the 10/66 Dementia Research Group's population survey and includes 11,472 older adults (baseline mean age 74 years) from Cuba, Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela. The baseline examinations were done in 2003-2007 and the follow-up examinations 4 years later. Semi-structured psychiatric interviews gave information about ICD-10 depression and sub-syndromal depression (i.e., ≥4 depressive symptoms) at baseline. Information on dementia were collected at the follow-up examination. Competing risk models analyzed the associations between depression and incidence of dementia and the final model were adjusted for age, sex, education, stroke, and diabetes. Separate analyses were conducted for each site and then meta-analyzed by means of fixed effect models. RESULTS At baseline, the prevalence of depression was 26.0% (n = 2,980): 5.4% had ICD-10 depression and 20.6% sub-syndromal depression. During the follow-up period, 9.3% (n = 862) developed dementia and 14.3% (n = 1,329) deceased. In the pooled analyses, both ICD-10 depression (adjusted sub-hazard ratio (sHR) 1.63, 95% confidence interval (CI) 1.26-2.11) and sub-syndromal depression (adjusted sHR 1.28, 95% CI: 1.09-1.51) were associated with increased incidence of dementia. The Higging I2 tests showed a moderate heterogeneity across the study sites. CONCLUSION Our findings suggest that late-life depression is associated with the incidence of dementia in LMICs in Latin America, which support results from earlier studies conducted in high-income countries.
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Affiliation(s)
- Lena Johansson
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Mariella Guerra
- Institute of Memory, Depression and Disease Risk, Lima, Peru
| | - Martin Prince
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Helena Hörder
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Hanna Falk
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Brendon Stubbs
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Physiotherapy, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - A Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Hiura G, Zhang X, Sun Y, Prince M, Dashnaw S, Wild J, Hughes E, Shen W, Oelsner E. Reproducibility of 3He-MRI acquisition assessed by a deep learning approach: ventilation defects in the VaPE-Tox pilot study. Imaging 2020. [DOI: 10.1183/13993003.congress-2020.2092] [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: 11/05/2022] Open
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Zhang X, Angelini E, Laine A, Sun Y, Hiura G, Dashnaw S, Prince M, Hoffman E, Ambale-Venkatesh B, Lima J, Wild J, Hughes E, Barr RG, Shen W. Ventilation defect quantification on 3He MRI through deep learning: the MESA COPD Study. Imaging 2020. [DOI: 10.1183/13993003.congress-2020.4332] [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: 11/05/2022] Open
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Wu YT, Daskalopoulou C, Muniz Terrera G, Sanchez Niubo A, Rodríguez-Artalejo F, Ayuso-Mateos JL, Bobak M, Caballero FF, de la Fuente J, de la Torre-Luque A, García-Esquinas E, Haro JM, Koskinen S, Koupil I, Leonardi M, Pajak A, Panagiotakos D, Stefler D, Tobias-Adamczyk B, Prince M, Prina AM. Education and wealth inequalities in healthy ageing in eight harmonised cohorts in the ATHLOS consortium: a population-based study. Lancet Public Health 2020; 5:e386-e394. [PMID: 32619540 DOI: 10.1016/s2468-2667(20)30077-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The rapid growth of the size of the older population is having a substantial effect on health and social care services in many societies across the world. Maintaining health and functioning in older age is a key public health issue but few studies have examined factors associated with inequalities in trajectories of health and functioning across countries. The aim of this study was to investigate trajectories of healthy ageing in older men and women (aged ≥45 years) and the effect of education and wealth on these trajectories. METHODS This population-based study is based on eight longitudinal cohorts from Australia, the USA, Japan, South Korea, Mexico, and Europe harmonised by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. We selected these studies from the repository of 17 ageing studies in the ATHLOS consortium because they reported at least three waves of collected data. We used multilevel modelling to investigate the effect of education and wealth on trajectories of healthy ageing scores, which incorporated 41 items of physical and cognitive functioning with a range between 0 (poor) and 100 (good), after adjustment for age, sex, and cohort study. FINDINGS We used data from 141 214 participants, with a mean age of 62·9 years (SD 10·1) and an age range of 45-106 years, of whom 76 484 (54·2%) were women. The earliest year of baseline data was 1992 and the most recent last follow-up year was 2015. Education and wealth affected baseline scores of healthy ageing but had little effect on the rate of decrease in healthy ageing score thereafter. Compared with those with primary education or less, participants with tertiary education had higher baseline scores (adjusted difference in score of 10·54 points, 95% CI 10·31-10·77). The adjusted difference in healthy ageing score between lowest and highest quintiles of wealth was 8·98 points (95% CI 8·74-9·22). Among the eight cohorts, the strongest inequality gradient for both education and wealth was found in the Health Retirement Study from the USA. INTERPRETATION The apparent difference in baseline healthy ageing scores between those with high versus low education levels and wealth suggests that cumulative disadvantage due to low education and wealth might have largely deteriorated health conditions in early life stages, leading to persistent differences throughout older age, but no further increase in ageing disparity after age 70 years. Future research should adopt a lifecourse approach to investigate mechanisms of health inequalities across education and wealth in different societies. FUNDING European Union Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- Yu-Tzu Wu
- Social Epidemiology Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina Daskalopoulou
- Social Epidemiology Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Albert Sanchez Niubo
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain; IMDEA-Food Institute, Campus of International Excellence, Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Javier de la Fuente
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - Alejandro de la Torre-Luque
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Jose Maria Haro
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Seppo Koskinen
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ilona Koupil
- Centre for Health Equity Studies, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Faculty of Health Sciences Jagienllonian University Medical College, Krakow, Poland
| | | | - Denes Stefler
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Beata Tobias-Adamczyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Martin Prince
- Global Health Institute, King's College London, London, UK
| | - A Matthew Prina
- Social Epidemiology Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Global Health Institute, King's College London, London, UK.
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Moreno-Agostino D, Daskalopoulou C, Wu YT, Koukounari A, Haro JM, Tyrovolas S, Panagiotakos DB, Prince M, Prina AM. The impact of physical activity on healthy ageing trajectories: evidence from eight cohort studies. Int J Behav Nutr Phys Act 2020; 17:92. [PMID: 32677960 PMCID: PMC7364650 DOI: 10.1186/s12966-020-00995-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Research has suggested the positive impact of physical activity on health and wellbeing in older age, yet few studies have investigated the associations between physical activity and heterogeneous trajectories of healthy ageing. We aimed to identify how physical activity can influence healthy ageing trajectories using a harmonised dataset of eight ageing cohorts across the world. METHODS Based on a harmonised dataset of eight ageing cohorts in Australia, USA, Mexico, Japan, South Korea, and Europe, comprising 130,521 older adults (Mage = 62.81, SDage = 10.06) followed-up up to 10 years (Mfollow-up = 5.47, SDfollow-up = 3.22), we employed growth mixture modelling to identify latent classes of people with different trajectories of healthy ageing scores, which incorporated 41 items of health and functioning. Multinomial logistic regression modelling was used to investigate the associations between physical activity and different types of trajectories adjusting for sociodemographic characteristics and other lifestyle behaviours. RESULTS Three latent classes of healthy ageing trajectories were identified: two with stable trajectories with high (71.4%) or low (25.2%) starting points and one with a high starting point but a fast decline over time (3.4%). Engagement in any level of physical activity was associated with decreased odds of being in the low stable (OR: 0.18; 95% CI: 0.17, 0.19) and fast decline trajectories groups (OR: 0.44; 95% CI: 0.39, 0.50) compared to the high stable trajectory group. These results were replicated with alternative physical activity operationalisations, as well as in sensitivity analyses using reduced samples. CONCLUSIONS Our findings suggest a positive impact of physical activity on healthy ageing, attenuating declines in health and functioning. Physical activity promotion should be a key focus of healthy ageing policies to prevent disability and fast deterioration in health.
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Affiliation(s)
- Darío Moreno-Agostino
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Christina Daskalopoulou
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Yu-Tzu Wu
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Martin Prince
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - A Matthew Prina
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
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Lund C, Schneider M, Garman EC, Davies T, Munodawafa M, Honikman S, Bhana A, Bass J, Bolton P, Dewey M, Joska J, Kagee A, Myer L, Petersen I, Prince M, Stein DJ, Tabana H, Thornicroft G, Tomlinson M, Hanlon C, Alem A, Susser E. Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial. Behav Res Ther 2020; 130:103466. [PMID: 31733813 PMCID: PMC7190434 DOI: 10.1016/j.brat.2019.103466] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 11/28/2018] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022]
Abstract
The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.
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Affiliation(s)
- Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Emily C Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Thandi Davies
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Memory Munodawafa
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Arvin Bhana
- Medical Research Council, Durban, South Africa; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Center for Humanitarian Health, Departments of International Health and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Paul Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Center for Humanitarian Health, Departments of International Health and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Michael Dewey
- King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - John Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ashraf Kagee
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Martin Prince
- King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Unit on Risk & Resilience in Mental Disorders, Medical Research Council, Cape Town, South Africa
| | - Hanani Tabana
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Graham Thornicroft
- King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa, And School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Charlotte Hanlon
- King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, USA; New York State Psychiatric Institute, New York, USA
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Li C, Ye J, Prince M, Peng Y, Dou W, Shang S, Wu J, Luo X. Comparing mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted MR imaging for stratifying non-alcoholic fatty liver disease in a rabbit model. Eur Radiol 2020; 30:6022-6032. [PMID: 32591883 DOI: 10.1007/s00330-020-07005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/17/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare diffusion parameters obtained from mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) in stratifying non-alcoholic fatty liver disease (NAFLD). METHODS Thirty-two New Zealand rabbits were fed a high-fat/cholesterol or standard diet to obtain different stages of NAFLD before 12 b-values (0-800 s/mm2) DWI. The apparent diffusion coefficient (ADC) from the mono-exponential model; pure water diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) from bi-exponential DWI; and distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from stretched-exponential DWI were calculated for hepatic parenchyma. The goodness of fit of the three models was compared. NAFLD severity was pathologically graded as normal, simple steatosis, borderline, and non-alcoholic steatohepatitis (NASH). Spearman rank correlation analysis and receiver operating characteristic curves were used to assess NAFLD severity. RESULTS Upon comparison, the goodness of fit chi-square from stretched-exponential fitting (0.077 ± 0.012) was significantly lower than that for the bi-exponential (0.110 ± 0.090) and mono-exponential (0.181 ± 0.131) models (p < 0.05). Seven normal, 8 simple steatosis, 6 borderline, and 11 NASH livers were pathologically confirmed from 32 rabbits. Both α and D increased with increasing NAFLD severity (r = 0.811 and 0.373, respectively; p < 0.05). ADC, f, and DDC decreased as NAFLD severity increased (r = - 0.529, - 0.717, and - 0.541, respectively; p < 0.05). Both α (area under the curve [AUC] = 0.952) and f (AUC = 0.931) had significantly greater AUCs than ADC (AUC = 0.727) in the differentiation of NASH from borderline or less severe groups (p < 0.05). CONCLUSIONS Stretched-exponential DWI with higher fitting efficiency performed, as well as bi-exponential DWI, better than mono-exponential DWI in the stratification of NAFLD severity. KEY POINTS • Stretched-exponential diffusion model fitting was more reliable than the bi-exponential and mono-exponential diffusion models (p = 0.039 and p < 0.001, respectively). • As NAFLD severity increased, the diffusion heterogeneity index (α) increased, while the perfusion fraction (f) decreased (r = 0.811, - 0.717, p < 0.05). • Both α and f showed superior NASH diagnostic performance (AUC = 0.952, 0.931) compared with ADC (AUC = 0.727, p < 0.05).
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Affiliation(s)
- Chang Li
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.,Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Martin Prince
- Department of Radiology, Weill Medical College of Cornell University, 407 E 61st Street, New York, NY, 10065, USA
| | - Yun Peng
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Bejing, 100176, China
| | - Songan Shang
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Jingtao Wu
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.
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Tyrovolas S, Panaretos D, Daskalopoulou C, Gine-Vazquez I, Niubo AS, Olaya B, Bobak M, Prince M, Prina M, Ayuso-Mateos JL, Caballero FF, Garcia-Esquinas E, Holger A, Scherbov S, Sanderson W, Gheno I, Koupil I, Bickenbach J, Chatterji S, Koskinen S, Raggi A, Pajak A, Tobiasz-Adamczyk B, Haro JM, Panagiotakos D. Alcohol Drinking and Health in Ageing: A Global Scale Analysis of Older Individual Data through the Harmonised Dataset of ATHLOS. Nutrients 2020; 12:E1746. [PMID: 32545243 PMCID: PMC7353331 DOI: 10.3390/nu12061746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022] Open
Abstract
We investigated the relation between alcohol drinking and healthy ageing by means of a validated health status metric, using individual data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. For the purposes of this study, the ATHLOS harmonised dataset, which includes information from individuals aged 65+ in 38 countries, was analysed (n = 135,440). Alcohol drinking was reflected by means of three harmonised variables: alcohol drinking frequency, current and past alcohol drinker. A set of 41 self-reported health items and measured tests were used to generate a specific health metric. In the harmonised dataset, the prevalence of current drinking was 47.5% while of past drinking was 26.5%. In the pooled sample, current alcohol drinking was positively associated with better health status among older adults ((b-coef (95% CI): 1.32(0.45 to 2.19)) and past alcohol drinking was inversely related (b-coef (95% CI): -0.83 (-1.51 to -0.16)) with health status. Often alcohol consumption appeared to be beneficial only for females in all super-regions except Africa, both age group categories (65-80 years old and 80+), both age group categories, as well as among all the financial status categories (all p < 0.05). Regional analysis pictured diverse patterns in the association for current and past alcohol drinkers. Our results report the need for specific alcohol intake recommendations among older adults that will help them maintain a better health status throughout the ageing process.
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Affiliation(s)
- Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, 42, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (A.S.N.); (B.O.); (J.M.H.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5, Pabellón 11, 28029 Madrid, Spain;
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 Eleftheriou Venizelou Ave, Attica, 176 61 Athens, Greece; (D.P.); (D.P.)
| | - Dimitris Panaretos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 Eleftheriou Venizelou Ave, Attica, 176 61 Athens, Greece; (D.P.); (D.P.)
| | - Christina Daskalopoulou
- Psychology and Neuroscience, Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London WC1E 6BT, UK; (C.D.); (M.P.); (M.P.)
| | - Iago Gine-Vazquez
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, 42, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (A.S.N.); (B.O.); (J.M.H.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5, Pabellón 11, 28029 Madrid, Spain;
| | - Albert Sanchez Niubo
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, 42, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (A.S.N.); (B.O.); (J.M.H.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5, Pabellón 11, 28029 Madrid, Spain;
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, 42, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (A.S.N.); (B.O.); (J.M.H.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5, Pabellón 11, 28029 Madrid, Spain;
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 7HB, UK;
| | - Martin Prince
- Psychology and Neuroscience, Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London WC1E 6BT, UK; (C.D.); (M.P.); (M.P.)
| | - Matthew Prina
- Psychology and Neuroscience, Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London WC1E 6BT, UK; (C.D.); (M.P.); (M.P.)
| | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5, Pabellón 11, 28029 Madrid, Spain;
- Department of Psychiatry, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), 28006 Madrid, Spain
| | - Francisco Felix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.F.C.); (E.G.-E.)
- CIBER of Epidemiology and Public Health-CIBERESP, 28029 Madrid, Spain
| | - Esther Garcia-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.F.C.); (E.G.-E.)
- CIBER of Epidemiology and Public Health-CIBERESP, 28029 Madrid, Spain
| | - Arndt Holger
- SPRING TECHNO GMBH & Co. KG, 28199 Bremen, Germany;
| | - Sergei Scherbov
- World Population Program, International Institute for Applied Systems Analysis, Wittgenstein Centre for Demography and Global Human Capital, 2361 Laxenburg, Austria; (S.S.); (W.S.)
- Vienna Institute of Demography, Austrian Academy of Science, 1030 Vienna, Austria
- International Laboratory for Demography and Human Capital, Russian Presidential Academy of National Economy and Public Administration (RANEPA), 119571 Moscow, Russia
| | - Warren Sanderson
- World Population Program, International Institute for Applied Systems Analysis, Wittgenstein Centre for Demography and Global Human Capital, 2361 Laxenburg, Austria; (S.S.); (W.S.)
- Department of Economics, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Ilona Koupil
- Department of Public Health Sciences, Centre for Health Equity Studies, Stockholm University, 114 19 Stockholm, Sweden;
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne, 6002 Lucerne, Switzerland;
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, 1202 Geneva, Switzerland;
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland;
| | - Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, 42, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (A.S.N.); (B.O.); (J.M.H.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5, Pabellón 11, 28029 Madrid, Spain;
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 Eleftheriou Venizelou Ave, Attica, 176 61 Athens, Greece; (D.P.); (D.P.)
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Cetty L, Peh CX, Abdin E, Vaingankar JA, Shahwan S, Picco L, Prince M, Chong SA, Subramaniam M. Normative data for the 10/66 dementia research group neuropsychological test battery from Singapore's older adult population. Asian J Psychiatr 2020; 51:102019. [PMID: 32251896 DOI: 10.1016/j.ajp.2020.102019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 12/01/2022]
Abstract
Cognitive impairment in older adults is a major public concern for Singapore's aging population. The study aimed to (1) examine the effects of age, gender, and education on neuropsychological test performance, and (2) establish regression-based norms in the Singapore older adult (≥ 60 years) population. Data on neuropsychological test performance was extracted from the Well-being of the Singapore Elderly (WiSE) study (n = 2033). Participants who met criteria for dementia were excluded. The data included scores from the 10/66 Dementia Research Group neuropsychological test battery measuring verbal fluency, immediate memory recall, delayed memory recall, and global cognitive function. The General Linear Model (GLM) was used to examine the effects of age, gender, and education on neuropsychological test performance. Stratified weighted means and standard deviations by age, gender and education were reported to establish regression-based normative data. Results from GLM showed that older age and having lower education were associated with poorer performance on all four neuropsychological test measures, and females showed better performance on the tests for immediate memory recall and delayed memory recall. The current study provides useful information on cognitive functioning based on the 10/66 neuropsychological test battery in the older adult population in Singapore. This may help to improve neuropsychological assessments for older adults.
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Affiliation(s)
- Laxman Cetty
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
| | - Chao Xu Peh
- Clinical and Forensic Psychology Service, Ministry of Social and Family Development, Singapore 512 Thompson Road, MSF Building #12-00, 298136, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Martin Prince
- Health Services and Population Research Department, King's College London, London, UK M116, 1st Floor, Inst. of Psychiatry, Denmark Hill, United Kingdom
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore; Lee Kong Chian School of Medicine, Singapore Novena Campus, 11 Mandalay Road, 308232 Singapore
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Mekonnen H, Medhin G, Tomlinson M, Alem A, Prince M, Hanlon C. Impact of child emotional and behavioural difficulties on educational outcomes of primary school children in Ethiopia: a population-based cohort study. Child Adolesc Psychiatry Ment Health 2020; 14:22. [PMID: 32467725 PMCID: PMC7231403 DOI: 10.1186/s13034-020-00326-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 05/05/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The relationship between child emotional and behavioural difficulties (EBD) and educational outcomes has not been investigated in prospective, community studies from low-income countries. METHODS The association between child EBD symptoms and educational outcomes was examined in an ongoing cohort of 2090 mother-child dyads. Child EBD was measured when the mean age of children was 6.5 years, SD 0.04 (T0) and 8.4, SD 0.5 years (T1) using the Strength and Difficulties Questionnaire (SDQ). Educational outcomes were obtained from maternal report (drop-out) at T1 and from school records at when the mean age of the children was 9.3 (SD 0.5) years (T2). RESULT After adjusting for potential confounders, child EBD symptoms at T1 were associated significantly with school absenteeism at T2: SDQ total score: Risk Ratio (RR) 1.01; 95% confidence interval (CI) 1.01, 1.02; SDQ high score (≥ 14) RR 1.36; 95% CI 1.24, 1.48; emotional subscale RR 1.03; 95% CI 1.01, 1.04; hyperactivity subscale RR 1.03; 95% CI 1.02, 1.04 and peer problems subscale (RR 1.02; 95% CI 1.00, 1.04). High SDQ (β = - 2.89; 95% CI - 5.73, - 0.06) and the conduct problems sub-scale (β = - 0.57; 95% CI - 1.02, - 0.12) had a significant negative association with academic achievement. There was no significant association between child EBD and school drop-out. CONCLUSION Prospective associations were found between child EBD symptoms and increased school absenteeism and lower academic achievement, suggesting the need for child mental health to be considered in interventions targeting improvement of school attendance and academic achievement in low-income countries.
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Affiliation(s)
- Habtamu Mekonnen
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.411903.e0000 0001 2034 9160Department of Psychology, College of Education and Behavioural Sciences, Jimma University, Jimma, Ethiopia
| | - Girmay Medhin
- grid.7123.70000 0001 1250 5688Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mark Tomlinson
- grid.11956.3a0000 0001 2214 904XDepartment of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Atalay Alem
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Molenaar J, Hanlon C, Alem A, Wondimagegn D, Medhin G, Prince M, Stevenson EGJ. Perinatal mental distress in a rural Ethiopian community: a critical examination of psychiatric labels. BMC Psychiatry 2020; 20:223. [PMID: 32398030 PMCID: PMC7216512 DOI: 10.1186/s12888-020-02646-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/03/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Perinatal mental distress poses a heavy burden in low- and middle-income countries (LMICs). This study investigated perceptions and experiences of perinatal mental distress among women in a rural Ethiopian community, in an effort to advance understanding of cross-cultural experiences of perinatal mental distress. METHODS We employed a sequential explanatory study design. From a population-based cohort study of 1065 perinatal women in the Butajira Health and Demographic Surveillance Site, we purposively selected 22 women according to their scores on a culturally validated assessment of perinatal mental distress (the Self-Reporting Questionnaire). We examined concordance and discordance between qualitative semi-structured interview data ('emic' perspective) and the layperson-administered fully-structured questionnaire data ('etic' perspective) of perinatal mental distress. We analysed the questionnaire data using summary statistics and we carried out a thematic analysis of the qualitative data. RESULTS Most women in this setting recognised the existence of perinatal mental distress states, but did not typically label such distress as a discrete illness. Instead, perinatal mental distress states were mostly seen as non-pathological reactions to difficult circumstances. The dominant explanatory model of perinatal mental distress was as a response to poverty, associated with inadequate food, isolation, and hopelessness. Support from family and friends, both emotional and instrumental support, was regarded as vital in protecting against mental distress. Although some women considered their distress amenable to biomedical solution, many thought medical help-seeking was inappropriate. Integration of perspectives from the questionnaire and semi-structured interviews highlighted the important role of somatic symptoms and nutritional status. It also demonstrated the differential likelihood of endorsement of symptoms when screening tools versus in-depth interviews are used. CONCLUSIONS This study highlights the importance of the wider social context within which mental health problems are situated, specificially the inseparability of mental health from gender disadvantage, physical health and poverty. This implies that public health prevention strategies, assessments and interventions for perinatal distress should be developed from the bottom-up, taking account of local contexts and explanatory frameworks.
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Affiliation(s)
- Jil Molenaar
- School of Global Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen, Denmark
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
| | - Dawit Wondimagegn
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Sifra Selam, Addis Ababa, Ethiopia
| | - Martin Prince
- King’s College London, King’s Global Health Institute, Room 1.49, Franklin Wilkins Building, 127, Stamford Street, London, UK
| | - Edward G. J. Stevenson
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE UK
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Skapinakis P, Lewis G, Davies S, Brugha T, Prince M, Singleton N. Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. Eur Psychiatry 2020; 26:354-62. [DOI: 10.1016/j.eurpsy.2010.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/14/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022] Open
Abstract
AbstractObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.
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Li M, Huang Y, Liu Z, Shen R, Chen H, Ma C, Zhang T, Li S, Prince M. The association between frailty and incidence of dementia in Beijing: findings from 10/66 dementia research group population-based cohort study. BMC Geriatr 2020; 20:138. [PMID: 32293307 PMCID: PMC7158148 DOI: 10.1186/s12877-020-01539-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/29/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The relationship between frailty and dementia is unclear and there are very few population-based studies regarding this issue in China. The purpose of this study is to estimate the association between frailty and incident dementia in China, and to explore different effects of frailty established by three definitions of frailty on dementia incidence. METHODS A five-year prospective cohort study was carried out in 2022 participants aged 65 years and over in urban and rural sites in Beijing, China. The participants were interviewed by trained community primary health care workers from 2004 to 2009. Frailty was defined using modified Fried frailty phenotype, physical frailty definition, and multidimensional frailty definition. Dementia was diagnosed using the 10/66 dementia criterion for calculating cumulative incidence. Both competing risk regression models and Cox proportional hazards models were applied to examine the associations between frailty at baseline and five-year cumulative incidence of dementia. RESULTS At the end of follow-up the five-year cumulative incidence rates of dementia with frailty and without frailty defined by the modified Fried frailty were 21.0% and 9.6%, those defined by the physical frailty were 19.9% and 9.0%, and those defined by the multidimensional frailty were 22.8% and 8.9%, respectively. Compared with non-frail participants, frail people had a higher risk of incident dementia using multidimensional frailty definition after adjusting covariates based on competing risk regression model (HR = 1.47, 95% CI 1.01~2.17) and Cox proportional hazards model (HR = 1.56, 95% CI 1.07~2.26). The association between frailty and incident dementia was statistically significant in participants in the upper three quartiles of age (aged 68 years and over) using the multidimensional frailty definition based on the competing risk regression model (HR = 1.61, 95% CI 1.06~2.43) and Cox proportional hazard model (HR = 1.76, 95% CI 1.19~2.61). CONCLUSIONS Multidimensional frailty may play an inherent role in incident dementia, especially in the people aged over 68, which is significant for distinguishing high risk people and determining secondary prevention strategies for dementia patients.
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Affiliation(s)
- Minghui Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yueqin Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Zhaorui Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Rui Shen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chao Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tingting Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shuran Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Martin Prince
- Global Health Institute, King's College London, London, UK
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