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El Jeni R, Villot C, Koyun OY, Osorio-Doblado A, Baloyi JJ, Lourenco JM, Steele M, Callaway TR. Invited review: "Probiotic" approaches to improving dairy production: Reassessing "magic foo-foo dust". J Dairy Sci 2024; 107:1832-1856. [PMID: 37949397 DOI: 10.3168/jds.2023-23831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
The gastrointestinal microbial consortium in dairy cattle is critical to determining the energetic status of the dairy cow from birth through her final lactation. The ruminant's microbial community can degrade a wide variety of feedstuffs, which can affect growth, as well as production rate and efficiency on the farm, but can also affect food safety, animal health, and environmental impacts of dairy production. Gut microbial diversity and density are powerful tools that can be harnessed to benefit both producers and consumers. The incentives in the United States to develop Alternatives to Antibiotics for use in food-animal production have been largely driven by the Veterinary Feed Directive and have led to an increased use of probiotic approaches to alter the gastrointestinal microbial community composition, resulting in improved heifer growth, milk production and efficiency, and animal health. However, the efficacy of direct-fed microbials or probiotics in dairy cattle has been highly variable due to specific microbial ecological factors within the host gut and its native microflora. Interactions (both synergistic and antagonistic) between the microbial ecosystem and the host animal physiology (including epithelial cells, immune system, hormones, enzyme activities, and epigenetics) are critical to understanding why some probiotics work but others do not. Increasing availability of next-generation sequencing approaches provides novel insights into how probiotic approaches change the microbial community composition in the gut that can potentially affect animal health (e.g., diarrhea or scours, gut integrity, foodborne pathogens), as well as animal performance (e.g., growth, reproduction, productivity) and fermentation parameters (e.g., pH, short-chain fatty acids, methane production, and microbial profiles) of cattle. However, it remains clear that all direct-fed microbials are not created equal and their efficacy remains highly variable and dependent on stage of production and farm environment. Collectively, data have demonstrated that probiotic effects are not limited to the simple mechanisms that have been traditionally hypothesized, but instead are part of a complex cascade of microbial ecological and host animal physiological effects that ultimately impact dairy production and profitability.
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Affiliation(s)
- R El Jeni
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602
| | - C Villot
- Lallemand SAS, Blagnac, France, 31069
| | - O Y Koyun
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602
| | - A Osorio-Doblado
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602
| | - J J Baloyi
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602
| | - J M Lourenco
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602
| | - M Steele
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1
| | - T R Callaway
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602.
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2
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Greenwell K, Becque T, Sivyer K, Steele M, Denison-Day J, Steele M, Howells LM, Ridd MJ, Roberts A, Lawton S, Langan SM, Hooper J, Wilczynska S, Griffiths G, Sach TH, Little P, Williams H, Thomas KS, Yardley L, Muller I, Santer M, Stuart B. Online behavioural interventions for children and young people with eczema: Quantitative evaluation. Br J Gen Pract 2024:BJGP.2023.0411. [PMID: 38316467 DOI: 10.3399/bjgp.2023.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Two online behavioural interventions (Eczema Care Online; one website for parents/carers of children with eczema; one for young people with eczema) have been shown in randomised controlled trials to facilitate a sustained improvement in eczema severity. AIM To describe intervention use and examine potential mediators of intervention outcomes and contextual factors that may influence intervention delivery and outcomes. DESIGN AND SETTING Quantitative process evaluation; UK primary care. METHOD Parents/carers and young people were recruited through primary care. Intervention use was recorded and summarised descriptively. Logistic regression explored socio-demographic and other factors associated with intervention engagement. Mediation analysis investigated whether patient enablement (ability to understand and cope with health issues), treatment use, and barriers to adherence were mediators of intervention effect. Subgroup analysis compared intervention effects among pre-specified participants subsets. RESULTS 340 parents/carers and 337 young people were recruited. 87% (148/171) parent/carers and 91% (153/168) young people in the intervention group completed the core introduction. At 24 weeks, users spent approximately 20 minutes on average on the interventions. Among parents/carers, greater intervention engagement was associated with higher education levels, uncertainty about carrying out treatments, and doubts about treatment efficacy at baseline. Among young people, higher intervention use was associated with higher baseline eczema severity. Patient enablement accounted for approximately 30% of the intervention effect among parents/carers and 50% among young people. CONCLUSION Findings demonstrated that positive intervention outcomes depended on a modest time commitment from users. They provide further support that the wider implementation of Eczema Care Online is justified.
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Affiliation(s)
- Kate Greenwell
- University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Taeko Becque
- University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Katy Sivyer
- University of Southampton, Psychology, Southampton, United Kingdom
| | - Mary Steele
- University of Southampton, Psychology, Southampton, United Kingdom
| | | | - Mary Steele
- University of Southampton, Psychology, Southampton, United Kingdom
| | - Laura M Howells
- University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Matthew J Ridd
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, United Kingdom
| | - Sandra Lawton
- Rotherham NHS Foundation Trust, Dermatology, Rotherham, United Kingdom
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Julie Hooper
- University of Southampton, Primary Care and Population Sciences, Southampton, United Kingdom
| | - Sylvia Wilczynska
- King's College London, King's Clinical Trials Unit, London, United Kingdom
| | - Gareth Griffiths
- University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Tracey H Sach
- University of Southampton, Psychology, Southampton, United Kingdom
| | - Paul Little
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Hywel Williams
- University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Kim S Thomas
- University of Nottingham Faculty of Medicine and Health Sciences, Centre for Evidence Based Medicine, Nottingham, United Kingdom
| | - Lucy Yardley
- University of Bristol, Population Health Sciences, Bristol, United Kingdom
| | - Ingrid Muller
- University of Southampton, Psychology, Southampton, United Kingdom
| | - Miriam Santer
- University of Southampton, Primary Care and Population Sciences, Southampton, United Kingdom
| | - Beth Stuart
- Queen Mary University of London, London, United Kingdom
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3
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Sach TH, Onoja M, Clarke H, Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, Wilczynska S, Ridd MJ, Roberts A, Ahmed A, Yardley L, Little P, Greenwell K, Sivyer K, Nuttall J, Griffiths G, Lawton S, Langan SM, Howells L, Leighton P, Williams HC, Thomas KS. Cost-effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people. Eur J Health Econ 2024:10.1007/s10198-023-01649-9. [PMID: 38194207 DOI: 10.1007/s10198-023-01649-9] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To estimate the cost-effectiveness of online behavioral interventions (EczemaCareOnline.org.uk) designed to support eczema self-care management for parents/carers and young people from an NHS perspective. METHODS Two within-trial economic evaluations, using regression-based approaches, adjusting for baseline and pre-specified confounder variables, were undertaken alongside two independent, pragmatic, parallel group, unmasked randomized controlled trials, recruiting through primary care. Trial 1 recruited 340 parents/carers of children aged 0-12 years and Trial 2 337 young people aged 13-25 years with eczema scored ≥ 5 on Patient-Oriented Eczema Measure (POEM). Participants were randomized (1:1) to online intervention plus usual care or usual care alone. Resource use, collected via medical notes review, was valued using published unit costs in UK £Sterling 2021. Quality-of-life was elicited using proxy CHU-9D in Trial 1 and self-report EQ-5D-5L in Trial 2. RESULTS The intervention was dominant (cost saving and more effective) with a high probability of cost-effectiveness (> 68%) in most analyses. The exception was the complete case cost-utility analysis for Trial 1 (omitting participants with children aged < 2), with adjusted incremental cost savings of -£34.15 (95% CI - 104.54 to 36.24) and incremental QALYs of - 0.003 (95% CI - 0.021 to 0.015) producing an incremental cost per QALY of £12,466. In the secondary combined (Trials 1 and 2) cost-effectiveness analysis, the adjusted incremental cost was -£20.35 (95% CI - 55.41 to 14.70) with incremental success (≥ 2-point change on POEM) of 10.3% (95% CI 2.3-18.1%). CONCLUSION The free at point of use online eczema self-management intervention was low cost to run and cost-effective. TRIAL REGISTRATION This trial was registered prospectively with the ISRCTN registry (ISRCTN79282252). URL www.EczemaCareOnline.org.uk .
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Affiliation(s)
- Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK.
| | - Mary Onoja
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Holly Clarke
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Miriam Santer
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Ingrid Muller
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Beth Stuart
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
- Pragmatic Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Julie Hooper
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Mary Steele
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Sylvia Wilczynska
- King's Clinical Trial Unit, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Matthew J Ridd
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Amanda Roberts
- Patient and Public Contributor, Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK
| | - Amina Ahmed
- Patient and Public Contributor, Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Kate Greenwell
- Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, 12A Priory Rd, Bristol, BS8 1TU, UK
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, 12A Priory Rd, Bristol, BS8 1TU, UK
| | - Jacqui Nuttall
- Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sandra Lawton
- Dermatology, The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK
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Little P, Bradbury K, Stuart B, Barnett J, Krusche A, Steele M, Heber E, Easton S, Smith KA, Slodkowska-Barabasz J, Payne L, Corbett T, Yao G, Pollet S, Smith J, Joseph J, Lawrence M, Bohning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Muller A, Neal R, Osborne R, Rathod S, Richardson A, Grimmett C, Sharman G, Bacon R, Turner L, Stephens R, Burford T, Wilde L, Middleton K, Liddiard M, Rogers K, Raftery J, Zhu S, Webley F, Griffiths G, Nutall J, Chalder T, Wilkinson CE, Watson E, Yardley L. A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors. Br J Gen Pract 2023:BJGP.2023.0262. [PMID: 38164562 DOI: 10.3399/bjgp.2023.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Many cancer survivors following primary treatment have prolonged poor quality of life. AIM To determine the effectiveness of a bespoke digital intervention to support cancer survivors. DESIGN Pragmatic parallel open randomised trial. SETTING UK general practices. METHODS People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed 'generic' digital NHS support ('LiveWell';n=906), 2) a bespoke complex digital intervention ('Renewed';n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) 'Renewed-with-support' (n=903): 'Renewed' with additional brief email and telephone support. RESULTS Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n's respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. CONCLUSION Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs.
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Affiliation(s)
- Paul Little
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Katherine Bradbury
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Beth Stuart
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Jane Barnett
- University of Southampton, Southampton, United Kingdom
| | - Adele Krusche
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Mary Steele
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Elena Heber
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Steph Easton
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Kirsten Ailsa Smith
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | | | - Liz Payne
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | | | - Guiqing Yao
- University of Leicester, Department of Health Sciences, Leicester, United Kingdom
| | - Sebastien Pollet
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Jazzine Smith
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Judith Joseph
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Megan Lawrence
- University of Southampton, Clinical Trials Unit, Southampton, United Kingdom
| | - Dankmar Bohning
- University of Southampton School of Mathematical Sciences, Southampton, United Kingdom
| | - Tara Cheetham-Blake
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Diana Eccles
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Claire Foster
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Adam W A Geraghty
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | | | - Andre Muller
- National University of Singapore, Singapore, Singapore
| | | | | | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Alison Richardson
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Chloe Grimmett
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Geoff Sharman
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Roger Bacon
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Lesley Turner
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Richard Stephens
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Tamsin Burford
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Laura Wilde
- Coventry University, Coventry, United Kingdom
| | - Karen Middleton
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Megan Liddiard
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Kirsty Rogers
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - James Raftery
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Shihua Zhu
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Fran Webley
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Gareth Griffiths
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Jaqui Nutall
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Trudie Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | - Eila Watson
- Oxford Brookes University, Oxford, United Kingdom
| | - Lucy Yardley
- Oxford Brookes University, Oxford, United Kingdom
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5
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Bajus A, Renaud DL, Goetz HM, Steele M, Kelton D, Proudfoot KL, Creutzinger KC. Effects of transportation duration on lying behavior in young surplus dairy calves. J Dairy Sci 2023; 106:7932-7941. [PMID: 37268586 DOI: 10.3168/jds.2023-23229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023]
Abstract
Surplus dairy calves are commonly transported long distances from dairy farms to calf-raising facilities and livestock auctions. Current calf transportation research mainly describes physiological changes resulting from transportation. However, few studies have described the effects of transportation on calf behavior. The main objective of this study was to determine the effects of different durations of transportation (6, 12, and 16 h) on lying time and bouts in surplus dairy calves. A secondary objective of this study was to investigate whether calf age affected lying behavior around transportation. Surplus dairy calves (n = 175) were transported in 7 cohorts from 5 commercial dairy farms in Ontario to a single veal facility. On the day of transportation (d 0), calves were randomly assigned to 1 of 3 treatment groups: (1) 6 h (n = 60), (2) 12 h (n = 58), or (3) 16 h (n = 57) of continuous transportation by road. Calf lying and standing behaviors were recorded using HOBO data loggers (Hobo Pendant G Acceleration Data Logger, Onset Computer Corporation). Daily lying time (h/d) and bouts (no./d) were assessed from -1 to 3 d relative to transportation. The total time spent lying during transportation was assessed as the percentage of time lying (min lying/total min on the trailer × 100) from the time each calf was loaded onto the trailer until the time each calf was unloaded at the veal facility (n = 167). On the day of transportation (d 0), calves transported for 12 and 16 h spent less time lying (6 h: 17.1 h/d; 12 h: 15.9 h/d; 16 h: 15.0 h/d) and had more lying bouts (6 h: 21.9 bouts/d; 12 h: 25.8 bouts/d; 16 h: 29.8 bouts/d) compared with those transported for 6 h. On the day after transportation (d 1), calves transported for 16 h spent more time lying down than calves transported for 6 h (19.9 h/d vs. 18.8 h/d, respectively). In addition, during transportation, calves transported for 12 h and 16 h spent 5.8% and 7.6% more time lying down, respectively, than calves transported for 6 h. On each day relative to transportation (d -1 to 3), younger calves (2 to 5 d of age) spent a greater amount of time lying down than older calves (6 to 19 d of age) and, overall, had a greater number of lying bouts. The results of this study suggest that longer durations of transportation influence the lying behavior of surplus dairy calves, resulting in more fatigue during and after the journey and, therefore, potentially have negative implications for calf welfare. Additionally, longer durations of transportation may have greater influence on younger calves than older calves.
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Affiliation(s)
- A Bajus
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - D L Renaud
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - H M Goetz
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - M Steele
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - D Kelton
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - K L Proudfoot
- Department of Health Management and Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada C1A 4P3
| | - K C Creutzinger
- Department of Animal and Food Science, University of Wisconsin-River Falls, River Falls, WI 54022.
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6
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Calame DG, Guo T, Wang C, Garrett L, Jolly A, Dawood M, Kurolap A, Henig NZ, Fatih JM, Herman I, Du H, Mitani T, Becker L, Rathkolb B, Gerlini R, Seisenberger C, Marschall S, Hunter JV, Gerard A, Heidlebaugh A, Challman T, Spillmann RC, Jhangiani SN, Coban-Akdemir Z, Lalani S, Liu L, Revah-Politi A, Iglesias A, Guzman E, Baugh E, Boddaert N, Rondeau S, Ormieres C, Barcia G, Tan QKG, Thiffault I, Pastinen T, Sheikh K, Biliciler S, Mei D, Melani F, Shashi V, Yaron Y, Steele M, Wakeling E, Østergaard E, Nazaryan-Petersen L, Millan F, Santiago-Sim T, Thevenon J, Bruel AL, Thauvin-Robinet C, Popp D, Platzer K, Gawlinski P, Wiszniewski W, Marafi D, Pehlivan D, Posey JE, Gibbs RA, Gailus-Durner V, Guerrini R, Fuchs H, Hrabě de Angelis M, Hölter SM, Cheung HH, Gu S, Lupski JR. Monoallelic variation in DHX9, the gene encoding the DExH-box helicase DHX9, underlies neurodevelopment disorders and Charcot-Marie-Tooth disease. Am J Hum Genet 2023; 110:1394-1413. [PMID: 37467750 PMCID: PMC10432148 DOI: 10.1016/j.ajhg.2023.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/23/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
DExD/H-box RNA helicases (DDX/DHX) are encoded by a large paralogous gene family; in a subset of these human helicase genes, pathogenic variation causes neurodevelopmental disorder (NDD) traits and cancer. DHX9 encodes a BRCA1-interacting nuclear helicase regulating transcription, R-loops, and homologous recombination and exhibits the highest mutational constraint of all DDX/DHX paralogs but remains unassociated with disease traits in OMIM. Using exome sequencing and family-based rare-variant analyses, we identified 20 individuals with de novo, ultra-rare, heterozygous missense or loss-of-function (LoF) DHX9 variant alleles. Phenotypes ranged from NDDs to the distal symmetric polyneuropathy axonal Charcot-Marie-Tooth disease (CMT2). Quantitative Human Phenotype Ontology (HPO) analysis demonstrated genotype-phenotype correlations with LoF variants causing mild NDD phenotypes and nuclear localization signal (NLS) missense variants causing severe NDD. We investigated DHX9 variant-associated cellular phenotypes in human cell lines. Whereas wild-type DHX9 was restricted to the nucleus, NLS missense variants abnormally accumulated in the cytoplasm. Fibroblasts from an individual with an NLS variant also showed abnormal cytoplasmic DHX9 accumulation. CMT2-associated missense variants caused aberrant nucleolar DHX9 accumulation, a phenomenon previously associated with cellular stress. Two NDD-associated variants, p.Gly411Glu and p.Arg761Gln, altered DHX9 ATPase activity. The severe NDD-associated variant p.Arg141Gln did not affect DHX9 localization but instead increased R-loop levels and double-stranded DNA breaks. Dhx9-/- mice exhibited hypoactivity in novel environments, tremor, and sensorineural hearing loss. All together, these results establish DHX9 as a critical regulator of mammalian neurodevelopment and neuronal homeostasis.
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Affiliation(s)
- Daniel G Calame
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tianyu Guo
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chen Wang
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lillian Garrett
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Angad Jolly
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Moez Dawood
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Alina Kurolap
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noa Zunz Henig
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jawid M Fatih
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Isabella Herman
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Boys Town National Research Hospital, Boys Town, NE, USA
| | - Haowei Du
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tadahiro Mitani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lore Becker
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Birgit Rathkolb
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians University Munich, Munich, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Raffaele Gerlini
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Seisenberger
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Susan Marschall
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jill V Hunter
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA; E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Amanda Gerard
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Thomas Challman
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, USA
| | - Rebecca C Spillmann
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Zeynep Coban-Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Seema Lalani
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lingxiao Liu
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alejandro Iglesias
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Edwin Guzman
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Evan Baugh
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, 75015 Paris, France
| | - Sophie Rondeau
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Clothide Ormieres
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Giulia Barcia
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Queenie K G Tan
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Isabelle Thiffault
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tomi Pastinen
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Kazim Sheikh
- Department of Neurology, UT Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Suur Biliciler
- Department of Neurology, UT Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Davide Mei
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Federico Melani
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Vandana Shashi
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Yuval Yaron
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mary Steele
- Lifetime Neurodevelopmental Care, San Francisco, CA, USA
| | - Emma Wakeling
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elsebet Østergaard
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lusine Nazaryan-Petersen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Julien Thevenon
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Fédération Hospitalo-Universitaire Médecine TRANSLationnelle et Anomalies du Développement, Centre Hospitalier Universitaire Dijon, Equipe Genetics of Developmental Anomalies-INSERM UMR 1231, Dijon, France
| | - Ange-Line Bruel
- Functional Unit for Diagnostic Innovation in Rare Diseases, FHU-TRANSLAD, Dijon Bourgogne University Hospital, Dijon, France; INSERM UMR1231 GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - Christel Thauvin-Robinet
- INSERM UMR1231 GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France; Department of Genetics and Reference Center for Development Disorders and Intellectual Disabilities, Dijon Bourgogne University Hospital, Dijon, France
| | - Denny Popp
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Pawel Gawlinski
- Institute of Mother and Child, Kasprzaka 17a, 02-211 Warsaw, Poland
| | - Wojciech Wiszniewski
- Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road L103, Portland, OR, USA
| | - Dana Marafi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer E Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Valerie Gailus-Durner
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy; University of Florence, Florence, Italy
| | - Helmut Fuchs
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Chair of Experimental Genetics, TUM School of Life Sciences, Technische Universität München, Alte Akademie 8, 85354 Freising, Germany
| | - Sabine M Hölter
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Technische Universität München, Freising-Weihenstephan, Germany
| | - Hoi-Hung Cheung
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shen Gu
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China; Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China; Kunming Institute of Zoology Chinese Academy of Sciences, the Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Hong Kong SAR, China.
| | - James R Lupski
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Vennik J, Hughes S, Lyness E, McDermott C, Smith KA, Steele M, Bostock J, Howick J, Little P, Leydon G, Mallen C, Morrison L, Stuart B, Everitt H, Bishop FL. Patient perceptions of empathy in primary care telephone consultations: A mixed methods study. Patient Educ Couns 2023; 113:107748. [PMID: 37141693 DOI: 10.1016/j.pec.2023.107748] [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] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Clinical empathy can enhance patient outcomes. This study examined patients' perceptions of empathy in primary care consultations delivered by telephone. METHODS A mixed methods study was nested in a larger feasibility study conducted May-October 2020. Adults reporting a UK primary care consultation in the previous 2 weeks completed an online survey. A sample of survey respondents participated in a semi-structured qualitative interview. Interviews were analysed thematically. RESULTS Survey respondents (n = 359) rated practitioners as between 'good' and 'very good' at established patient-reported indicators of clinical empathy. Telephone consultations were rated slightly lower than face-to-face or other consultations. 30 survey respondents were interviewed. Three qualitative themes identified how telephone consultations can shape clinical empathy: setting for an empathic encounter; feeling connected; being acknowledged. CONCLUSION Primary care patients typically perceive good levels of clinical empathy in telephone consultations; specific features of telephone consultations may facilitate and/or hinder clinical empathy. PRACTICE IMPLICATIONS To ensure patients feel listened to, acknowledged and understood, practitioners may need to increase their empathic verbalisations in telephone consultations. By using verbal responses to demonstrate active listening and by clearly describing and/or implementing next steps in management, practitioners may be able to enhance clinical empathy in telephone consultations.
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Affiliation(s)
- Jane Vennik
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Clare McDermott
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care Research Centre, University of Southampton, Southampton, UK; School of Computing, University of Portsmouth, Portsmouth, UK
| | - Mary Steele
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Evaluation and Methods Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hazel Everitt
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
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Calhoun K, Gray A, Steele M, Smith J. Amoebic Encephalitis: A Rare Cause of Encephalopathy in a Lung Transplant Patient. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.672] [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: 04/05/2023] Open
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Pryor J, Agarwal N, Randhawa S, Thomas N, Steele M, Gray A, Smith J. Treating 2 Birds with 1 Stone: Lobectomy for Diagnosis of Lung Cancer and Lung Volume Reduction Surgery Post-Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1428] [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: 04/05/2023] Open
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Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, Wilczynska S, Sach TH, Ridd MJ, Roberts A, Ahmed A, Yardley L, Little P, Greenwell K, Sivyer K, Nuttall J, Griffiths G, Lawton S, Langan SM, Howells LM, Leighton P, Williams HC, Thomas KS. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials. BMJ 2022; 379:e072007. [PMID: 36740888 DOI: 10.1136/bmj-2022-072007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the effectiveness of two online behavioural interventions, one for parents and carers and one for young people, to support eczema self-management. DESIGN Two independent, pragmatic, parallel group, unmasked, randomised controlled trials. SETTING 98 general practices in England. PARTICIPANTS Parents and carers of children (0-12 years) with eczema (trial 1) and young people (13-25 years) with eczema (trial 2), excluding people with inactive or very mild eczema (≤5 on POEM, the Patient-Oriented Eczema Measure). INTERVENTIONS Participants were randomised (1:1) using online software to receive usual eczema care or an online (www.EczemaCareOnline.org.uk) behavioural intervention for eczema plus usual care. MAIN OUTCOME MEASURES Primary outcome was eczema symptoms rated using POEM (range 0-28, with 28 being very severe) every four weeks over 24 weeks. Outcomes were reported by parents or carers for children and by self-report for young people. Secondary outcomes included POEM score every four weeks over 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, treatment use, perceived barriers to treatment use, and intervention use. Analyses were carried out separately for the two trials and according to intention-to-treat principles. RESULTS 340 parents or carers of children (169 usual care; 171 intervention) and 337 young people (169 usual care; 168 intervention) were randomised. The mean baseline POEM score was 12.8 (standard deviation 5.3) for parents and carers and 15.2 (5.4) for young people. Three young people withdrew from follow-up but did not withdraw their data. All randomised participants were included in the analyses. At 24 weeks, follow-up rates were 91.5% (311/340) for parents or carers and 90.2% (304/337) for young people. After controlling for baseline eczema severity and confounders, compared with usual care groups over 24 weeks, eczema severity improved in the intervention groups: mean difference in POEM score -1.5 (95% confidence interval -2.5 to -0.6; P=0.002) for parents or carers and -1.9 (-3.0 to -0.8; P<0.001) for young people. The number needed to treat to achieve a 2.5 difference in POEM score at 24 weeks was 6 in both trials. Improvements were sustained to 52 weeks in both trials. Enablement showed a statistically significant difference favouring the intervention group in both trials: adjusted mean difference at 24 weeks -0.7 (95% confidence interval -1.0 to -0.4) for parents or carers and -0.9 (-1.3 to -0.6) for young people. No harms were identified in either group. CONCLUSIONS Two online interventions for self-management of eczema aimed at parents or carers of children with eczema and at young people with eczema provide a useful, sustained benefit in managing eczema severity in children and young people when offered in addition to usual eczema care. TRIAL REGISTRATION ISRCTN registry ISRCTN79282252.
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Affiliation(s)
- Miriam Santer
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Ingrid Muller
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Beth Stuart
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Hooper
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Mary Steele
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Sylvia Wilczynska
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Kate Greenwell
- School of Psychology, University of Southampton, Southampton, UK
| | - Katy Sivyer
- School of Psychology, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Sinéad M Langan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura M Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Greenwell K, Sivyer K, Howells L, Steele M, Ridd MJ, Roberts A, Ahmed A, Lawton S, Langan SM, Hooper J, Wilczynska S, Leighton P, Griffiths G, Sach T, Little P, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. 'Eczema shouldn't control you; you should control eczema': qualitative process evaluation of online behavioural interventions to support young people and parents/carers of children with eczema. Br J Dermatol 2022; 188:506-513. [PMID: 36745562 DOI: 10.1093/bjd/ljac115] [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] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a lack of well-conducted randomized controlled trials evaluating the effectiveness of theory-based online interventions for eczema. To address these deficiencies, we previously developed and demonstrated the effectiveness of two online behavioural interventions: Eczema Care Online for parents/carers of children with eczema, and Eczema Care Online for young people with eczema. OBJECTIVES To explore the views and experiences of people who have used the Eczema Care Online interventions to provide insights into how the interventions worked and identify contextual factors that may impede users' engagement with the interventions. METHODS Qualitative semistructured interviews were conducted with 17 parents/carers of children with eczema and 17 young people with eczema. Participants were purposively sampled from two randomized controlled trials of the interventions and recruited from GP surgeries in England. Transcripts were analysed using inductive thematic analysis, and intervention modifications were identified using the person-based approach table of changes method. RESULTS Both young people and parents/carers found the interventions easy to use, relatable and trustworthy, and perceived that they helped them to manage their eczema, thus suggesting that Eczema Care Online may be acceptable to its target groups. Our analysis suggested that the interventions may reduce eczema severity by facilitating empowerment among its users, specifically through improved understanding of, and confidence in, eczema management, reduced treatment concerns, and improved treatment adherence and management of irritants/triggers. Reading about the experiences of others with eczema helped people to feel 'normal' and less alone. Some (mainly young people) expressed firmly held negative beliefs about topical corticosteroids, views that were not influenced by the intervention. Minor improvements to the design and navigation of the Eczema Care Online interventions and content changes were identified and made, ready for wider implementation. CONCLUSIONS People with eczema and their families can benefit from reliable information, specifically information on the best and safest ways to use their eczema treatments early in their eczema journey. Together, our findings from this study and the corresponding trials suggest wider implementation of Eczema Care Online (EczemaCareOnline.org.uk) is justified.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mary Steele
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Hooper
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sylvia Wilczynska
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Paul Little
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Miriam Santer
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Jussila A, Zhang B, Kirti S, Wyetzner R, Reynolds C, Steele M, Hamburg-Shields E, Horsley V, Atit R. 124 Wnt signaling activation causes ATGL-dependent lipolysis in skin fibrosis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.130] [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: 10/17/2022]
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King E, Cheyne H, Abhyankar P, Elders A, Grindle M, Hapca A, Jones C, O'Carroll R, Steele M, Williams B. Promoting smoking cessation during pregnancy: A feasibility and pilot trial of a digital storytelling intervention delivered via text-messaging. Patient Educ Couns 2022; 105:2562-2572. [PMID: 35063311 PMCID: PMC7612869 DOI: 10.1016/j.pec.2021.12.019] [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] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 11/12/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Smoking during pregnancy causes risks to mother and infant health. We investigated the feasibility and likely success of SKIP-IT, a narrative and picture-based smoking cessation intervention delivered via text messages. METHODS A feasibility and pilot trial. We aimed to recruit 70 pregnant women who smoked, randomised to usual care alone, or usual care and the SKIP-IT intervention, between 12 weeks of pregnancy and 6 weeks post due-date. Outcomes assessed were recruitment, retention, acceptability of, and engagement with the intervention, smoking behaviour, intentions, perceived risk, and self-efficacy. RESULTS Of 312 women initially approached by smoking cessation services only 54 (17%) agreed to be contacted by the research team. Twenty were then either ineligible or uncontactable and 28 (82%) participated. Most women reported texts to be entertaining and helpful. The proportion of women not smoking at follow-up was lower in the intervention group, but numbers were too small to draw conclusions about effectiveness. CONCLUSION The intervention was acceptable, but difficulty in making initial and follow-up contacts meant our methods were unfeasible for a larger trial. PRACTICE IMPLICATIONS Digital Storytelling interventions could help women quit smoking, but further research is required to identify alternative methods for studies with pregnant women who smoke.
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Affiliation(s)
- Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling FK9 4LA, UK.
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling FK9 4LA, UK.
| | - Purva Abhyankar
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road Glasgow, G4 0BA, UK.
| | - Mark Grindle
- University of Highlands and Islands, 12B Ness Walk Inverness Inverness-Shire, IV3 5SQ, UK.
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Nethergate, Dundee DD1 4HN, UK.
| | - Claire Jones
- University of Dundee Nethergate, Dundee DD1 4HN, UK.
| | - Ronan O'Carroll
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Mary Steele
- School of Psychology, University of Southampton, Building 44 Highfield Campus, Southampton, SO17 1BJ, UK; Primary Care and Population Sciences, University of Southampton, Primary Medical Care Aldermoor Health Centre, Southampton SO16 5ST, UK.
| | - Brian Williams
- School of Health, Social Care and Life Sciences, University of the Highlands and Islands, 12b Ness Walk, Inverness, Scotland, IV3 5SQ, UK; School of Health & Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK.
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14
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Sivyer K, Teasdale E, Greenwell K, Steele M, Ghio D, Ridd MJ, Roberts A, Chalmers JR, Lawton S, Langan SM, Cowdell F, Le Roux E, Wilczynska S, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. Supporting families managing childhood eczema: developing and optimising eczema care online using qualitative research. Br J Gen Pract 2022; 72:e378-e389. [PMID: 35577586 PMCID: PMC9119812 DOI: 10.3399/bjgp.2021.0503] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood eczema is often poorly controlled owing to underuse of emollients and topical corticosteroids (TCS). Parents/carers report practical and psychosocial barriers to managing their child's eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited. AIM To develop an online behavioural intervention to help parents/carers manage and co-manage their child's eczema. DESIGN AND SETTING Intervention development using a theory-, evidence-, and person-based approach (PBA) with qualitative research. METHOD A systematic review and qualitative synthesis of studies (n = 32) and interviews with parents/carers (n = 30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (n = 25) were then used to optimise the intervention to increase its acceptability and feasibility. RESULTS Qualitative research identified that parents/carers had concerns about using emollients and TCS, incomplete knowledge and skills around managing eczema, and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that, while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included providing a rationale explaining how emollients and TCS work, demonstrating how to use treatments, and highlighting that the intervention provided new, up-to-date information. CONCLUSION Parents/carers need support in effectively managing and co-managing their child's eczema. The key output of this research is Eczema Care Online for Families, an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial.
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Affiliation(s)
- Katy Sivyer
- Department of Psychology, University of Southampton, Southampton; lecturer, University of Portsmouth, Portsmouth
| | | | | | | | - Daniela Ghio
- University of Manchester, Manchester; research fellow, University of Southampton, Southampton
| | | | | | | | | | | | | | | | | | | | | | - Lucy Yardley
- University of Bristol, Bristol; professor of health psychology, University of Southampton, Southampton
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15
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Greenwell K, Ghio D, Sivyer K, Steele M, Teasdale E, Ridd MJ, Roberts A, Chalmers JR, Lawton S, Langan S, Cowdell F, Le Roux E, Wilczynska S, Jones H, Whittaker E, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. Eczema Care Online: development and qualitative optimisation of an online behavioural intervention to support self-management in young people with eczema. BMJ Open 2022; 12:e056867. [PMID: 35443955 PMCID: PMC9021764 DOI: 10.1136/bmjopen-2021-056867] [Citation(s) in RCA: 4] [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: 01/08/2023] Open
Abstract
OBJECTIVES To describe the development of Eczema Care Online (ECO), an online behaviour change intervention for young people with eczema (phase I); and explore and optimise the acceptability of ECO among this target group using think-aloud interviews (phase II). METHODS Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I, a qualitative systematic review and qualitative interviews developed an in-depth understanding of the needs and challenges of young people with eczema. Guiding principles highlighted key intervention design objectives and features to address the needs of this target group to maximise user engagement. Behavioural analysis and logic modelling developed ECO's hypothesised programme theory. In phase II, qualitative think-aloud interviews were carried out with 28 young people with eczema and the intervention was optimised based on their feedback. RESULTS The final intervention aimed to reduce eczema severity by supporting treatment use (emollients, topical corticosteroids/topical calcineurin inhibitors), management of irritants/triggers, emotional management and reducing scratching. Generally, young people expressed positive views of intervention content and design in think-aloud interviews. Quotes and stories from other young people with eczema and ECO's focus on living with eczema (not just topical treatments) were valuable for normalising eczema. Young people believed ECO addressed knowledge gaps they had from childhood and the safety information about topical corticosteroids was reassuring. Negative feedback was used to modify ECO. CONCLUSIONS A prototype of the ECO intervention was developed using rigorous and complementary intervention development approaches. Subsequent think-aloud interviews helped optimise the intervention, demonstrated ECO is likely to be acceptable to this target group, and provided support for our guiding principles including key design objectives and features to consider when developing interventions for this population. A randomised controlled trial and process evaluation of the intervention is underway to assess effectiveness and explore user engagement with the intervention's behavioural goals.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Daniela Ghio
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Psychology, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Mary Steele
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Sinead Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Emma Le Roux
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Sylvia Wilczynska
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Jones
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - H C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim Suzanne Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Centre for Academic Primary Care, School of Psychological Science, University of Bristol, Bristol, UK
| | - Miriam Santer
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ingrid Muller
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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16
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Steele M, Steele H, Murphy A. Bringing Reflective Functioning to the Community: Aspects of psychotherapy process in the Group Attachment Based Intervention. The Psychoanalytic Study of the Child 2022. [DOI: 10.1080/00797308.2021.2022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Steele
- Clinical Psychology and Center for Attachment Research, New School for Social Research
| | - H. Steele
- Clinical Pediatrics, Center for Babies, Toddlers and Families & the Early Childhood Center and Rose F Kennedy Children’s Evaluation and Rehabilitation Center, Albert Einstein College of Medicine
| | - A. Murphy
- Clinical Psychology and Center for Attachment Research, New School for Social Research
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17
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Steele M, Howells L, Santer M, Sivyer K, Lawton S, Roberts A, Teasdale E, Muller I, Greenwell K. How has the COVID-19 pandemic affected eczema self-management and help seeking? A qualitative interview study with young people and parents/carers of children with eczema. Skin Health Dis 2021; 1:e59. [PMID: 34514465 PMCID: PMC8420339 DOI: 10.1002/ski2.59] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 01/31/2023]
Abstract
Background Eczema can have a considerable impact on quality of life. Treatments can improve this, but management is complex. Barriers to eczema self‐management may be impacted upon by environmental context, such as the COVID‐19 pandemic. Objectives To explore experiences of eczema, self‐management, and accessing healthcare and advice during the COVID‐19 pandemic among young people with eczema and parents/carers of children with eczema. Methods Qualitative semi‐structured interviews were carried out with 36 participants recruited from general practices as part of randomised controlled trials of online eczema resources. Results Changes to everyday life—Periods of staying at home due to the pandemic alter the burden of eczema, with reports of an improved routine and application of topical treatments for many, but difficulties with handwashing for others. Parents/carers reported improved eczema control due to closures of educational settings. Young people reported higher stress that may have triggered eczema flare‐ups. Changes to access to advice and treatment—There was a reluctance to seek medical appointments in a non‐emergency situation. Participants reported a lack of trust in the outcome of telephone consultations because health professionals were unable to see or feel the skin. Delays or difficulties when obtaining appointments and treatments caused frustration. Access to an online eczema resource was reported to have extra value in the context of the pandemic. Conclusion Changes to lifestyle and access to healthcare during the pandemic have affected eczema and self‐management. Healthcare settings may want to consider providing extra reassurance around remote consultations.
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Affiliation(s)
- M Steele
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK.,Centre for Clinical and Community Applications of Health Psychology School of Psychology Faculty of Environmental and Life Sciences University of Southampton Southampton UK
| | - L Howells
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - M Santer
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - K Sivyer
- Department of Psychology Faculty of Science and Health University of Portsmouth Portsmouth UK
| | - S Lawton
- Rotherham NHS Foundation Trust Rotherham UK
| | - A Roberts
- Nottingham Support Group for Carers of Children with Eczema Nottingham UK
| | - E Teasdale
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - I Muller
- Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - K Greenwell
- Centre for Clinical and Community Applications of Health Psychology School of Psychology Faculty of Environmental and Life Sciences University of Southampton Southampton UK
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18
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Smith KA, Vennik J, Morrison L, Hughes S, Steele M, Tiwari R, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Misurya P, Leydon GM, Dambha-Miller H, Everitt HA, Bishop FL. Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations. Front Pain Res (Lausanne) 2021; 2:721222. [PMID: 35295512 PMCID: PMC8915751 DOI: 10.3389/fpain.2021.721222] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Empathic communication and positive messages are important components of "placebo" effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention-"Empathico"-to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations. Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization. Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities. Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.
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Affiliation(s)
- Kirsten A. Smith
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Jane Vennik
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Leanne Morrison
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Stephanie Hughes
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mary Steele
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Riya Tiwari
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Jennifer Bostock
- Policy Innovation & Evaluation Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mohana Ratnapalan
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Emily Lyness
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Pranati Misurya
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Geraldine M. Leydon
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hajira Dambha-Miller
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hazel A. Everitt
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
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19
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O'Connor SR, Flannagan C, Parahoo K, Steele M, Thompson S, Jain S, Kirby M, Brady N, Maguire R, Connaghan J, McCaughan EM. Efficacy, Use, and Acceptability of a Web-Based Self-management Intervention Designed to Maximize Sexual Well-being in Men Living With Prostate Cancer: Single-Arm Experimental Study. J Med Internet Res 2021; 23:e21502. [PMID: 34309580 PMCID: PMC8367143 DOI: 10.2196/21502] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sexual dysfunction is a frequent side effect associated with different prostate cancer treatment approaches. It can have a substantial impact on men and their partners and is associated with increased psychological morbidity. Despite this, sexual concerns are often not adequately addressed in routine practice. Evidence-based web-based interventions have the potential to provide ongoing information and sexual well-being support throughout all stages of care. OBJECTIVE The aim of this study is to examine the efficacy of a web-based self-management intervention designed to maximize sexual well-being in men living with prostate cancer and explore user perspectives on usability and acceptability. METHODS We used a single-arm study design, and participants were provided with access to the 5-step intervention for a period of 3 months. The intervention content was tailored based on responses to brief screening questions on treatment type, relationship status, and sexual orientation. Efficacy was assessed by using two-tailed, paired sample t tests for comparing the mean differences between pre- and postintervention measurements for exploring the participants' self-reported knowledge and understanding, sexual satisfaction, and comfort in discussing sexual issues. Usability and acceptability were determined based on the program use data and a postintervention survey for exploring perceived usefulness. RESULTS A total of 109 participants were recruited for this study. Significant postintervention improvements at follow-up were observed in the total scores (out of 20) from the survey (mean 12.23/20 points, SD 2.46 vs mean 13.62/20, SD 2.31; t88=9.570; P=.001) as well as in individual item scores on the extent to which the participants agreed that they had sufficient information to manage the impact that prostate cancer had on their sex life (mean 2.31/4 points, SD 0.86 vs mean 2.57/4, SD 0.85; t88=3.660; P=.001) and had the potential to have a satisfying sex life following treatment (mean 2.38/4 points, SD 0.79 vs mean 3.17/4, SD 0.78; t88=7.643; P=.001). The median number of intervention sessions was 3 (range 1-11), and intervention sessions had a median duration of 22 minutes (range 8-77). Acceptable usability scores were reported, with the highest result observed for the question on the extent to which the intervention provided relevant information. CONCLUSIONS This study provides evidence on the efficacy of a tailored web-based intervention for maximizing sexual well-being in men living with prostate cancer. The results indicate that the intervention may improve one's self-perceived knowledge and understanding of how to manage sexual issues and increase self-efficacy or the belief that a satisfactory sex life could be achieved following treatment. The findings will be used to refine the intervention content before testing as part of a larger longitudinal study for examining its effectiveness.
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Affiliation(s)
- Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Carrie Flannagan
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Kader Parahoo
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Mary Steele
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Suneil Jain
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Clinical Oncology, Northern Ireland Cancer Centre, Belfast, United Kingdom
| | - Michael Kirby
- Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, United Kingdom.,The Prostate Centre, London, United Kingdom
| | - Nuala Brady
- Northern Health and Social Care Trust, Antrim, United Kingdom
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - John Connaghan
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Eilis M McCaughan
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
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20
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Jussila A, Zhang B, Kirti S, Steele M, Hamburg E, Horsley V, Atit R. 612 Wnt signaling induces fibrotic fat loss via DPP4 in skin fibrosis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.641] [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]
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21
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Muller I, Stuart B, Sach T, Hooper J, Wilczynska S, Steele M, Greenwell K, Sivyer K, Yardley L, Williams HC, Chalmers JR, Leighton P, Howells LM, Ridd MJ, Lawton S, Griffiths G, Nuttall J, Langan SM, Roberts A, Ahmed A, Kirk H, Becque T, Little P, Thomas KS, Santer M. Supporting self-care for eczema: protocol for two randomised controlled trials of ECO (Eczema Care Online) interventions for young people and parents/carers. BMJ Open 2021; 11:e045583. [PMID: 33550268 PMCID: PMC7925854 DOI: 10.1136/bmjopen-2020-045583] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Eczema care requires management of triggers and various treatments. We developed two online behavioural interventions to support eczema care called ECO (Eczema Care Online) for young people and ECO for families. This protocol describes two randomised controlled trials (RCTs) aimed to evaluate clinical and cost-effectiveness of the two interventions. METHODS AND ANALYSIS: Design: Two independent, pragmatic, unmasked, parallel group RCTs with internal pilots and nested health economic and process evaluation studies. Setting: Participants will be recruited from general practitioner practices in England. Participants: Young people aged 13-25 years with eczema and parents and carers of children aged 0-12 years with eczema, excluding inactive or very mild eczema (five or less on Patient-Oriented Eczema Measure (POEM)). Interventions: Participants will be randomised to online intervention plus usual care or to usual eczema care alone. Outcome measures: Primary outcome is eczema severity over 24 weeks measured by POEM. Secondary outcomes include POEM 4-weekly for 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, health service and treatment use. Process measures include treatment adherence, barriers to adherence and intervention usage. Our sample sizes of 303 participants per trial are powered to detect a group difference of 2.5 (SD 6.5) in monthly POEM scores over 24 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up. Cost-effectiveness analysis will be from a National Health Service and personal social service perspective. Qualitative and quantitative process evaluation will help understand the mechanisms of action and participant experiences and inform implementation. ETHICS AND DISSEMINATION The study has been approved by South Central Oxford A Research Ethics Committee (19/SC/0351). Recruitment is ongoing, and follow-up will be completed by mid-2022. Findings will be disseminated to participants, the public, dermatology and primary care journals, and policy makers. TRIAL REGISTRATION NUMBER ISRCTN79282252.
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Affiliation(s)
- Ingrid Muller
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julie Hooper
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Sylvia Wilczynska
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Mary Steele
- Department of Psychology, University of Southampton, Southampton, UK
| | - Kate Greenwell
- Department of Psychology, University of Southampton, Southampton, UK
| | - Katy Sivyer
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Laura M Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sinead M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hayden Kirk
- Neurological Rehabilitation, Solent NHS Trust, Southampton, UK
| | - Taeko Becque
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Miriam Santer
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
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22
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Raman S, English A, O'Keefe M, Harley A, Steele M, Minogue J, Weller K, Long D, Irwin A, Lister P. Designing Support Structures Post Sepsis in Children: Perspectives of the Queensland Paediatric Sepsis Program. Front Pediatr 2021; 9:759234. [PMID: 34869116 PMCID: PMC8636900 DOI: 10.3389/fped.2021.759234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Paediatric post sepsis syndrome is poorly defined and causes physical, neurocognitive, psychosocial morbidity, and family dysfunction. Families of sepsis survivors report unmet needs during care. Worldwide, the provision of post sepsis care is in its infancy with limited evidence to design clinical support pathways. Perspective: The Queensland Paediatric Sepsis Program (QPSP) developed a family support structure (FSS) to improve care during all stages of childhood sepsis. It was designed in partnership with consumers guided by information from consumers and it is partly delivered by consumers. Key areas include online, multimodal education for families and the ability to connect with other families affected by sepsis. The FSS is delivered by a multidisciplinary team (MDT) acting with clinicians local to the child. Families can join the FSS registry at any stage of their sepsis journey which connects them to our MDT team and opens opportunities to participate in future research and other initiatives. Improving public awareness is a critical outcome for our consumers and they have co-designed media and digital campaigns. Discussion: The ideal FSS for post sepsis syndrome management is a clinical pathway designed in partnership with consumers of interventions proven to improve outcomes from sepsis that meets their requirements. The QPSP FSS is novel as it is co-designed with, and partly delivered by, consumers with interventions aimed to improve the entire spectrum of morbidities suffered by survivors and their families, not just physical sequelae. Evaluation is embedded in the program and outcomes will guide evolution of the FSS.
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Affiliation(s)
- Sainath Raman
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, QLD, Australia.,The Faculty of Medicine, Centre for Children's Health Research, The University of Queensland, Brisbane, QLD, Australia
| | - Alana English
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Meagan O'Keefe
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Amanda Harley
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,The Faculty of Medicine, Centre for Children's Health Research, The University of Queensland, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.,Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Mary Steele
- Independent Researcher, Brisbane, QLD, Australia
| | - Jess Minogue
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kate Weller
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,Centre for Clinical Research, The University of Queensland (UQ), Brisbane, QLD, Australia
| | - Debbie Long
- Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, QLD, Australia.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Adam Irwin
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,Centre for Clinical Research, The University of Queensland (UQ), Brisbane, QLD, Australia.,Infectious Diseases, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Paula Lister
- Queensland Paediatric Sepsis Program, Brisbane, QLD, Australia.,The Faculty of Medicine, Centre for Children's Health Research, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Intensive Care, Sunshine Coast University Hospital, Birtinya, QLD, Australia
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23
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McCaughan E, Flannagan C, Parahoo K, Connaghan J, Maguire R, Steele M, Thompson S, Jain S, Kirby M, Brady N, O'Connor SR. The Tablet-Based, Engagement, Assessment, Support, and Sign-Posting (EASSi) Tool for Facilitating and Structuring Sexual Well-Being Conversations in Routine Prostate Cancer Care: Mixed-Methods Study. JMIR Cancer 2020; 6:e20137. [PMID: 33275109 PMCID: PMC7748949 DOI: 10.2196/20137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Long-term side-effects associated with different prostate cancer treatment approaches are common. Sexual challenges are the most frequently occurring issues and can result in increased psychological morbidity. It is recognized that barriers to communication can make initiating discussions around sexual concerns in routine practice difficult. Health care professionals need to routinely initiate conversations, effectively engage with patients, and assess needs in order to provide essential support. One proposed method that could support health care professionals to do this involves the use of prompts or structured frameworks to guide conversations. Objective This study aimed to assess feasibility, acceptability, and satisfaction with the tablet-based Engagement, Assessment, Support, and Sign-posting (EASSi) tool designed to facilitate and structure sexual well-being discussions in routine prostate cancer care. Methods Health care professionals (n=8) used the EASSi tool during 89 posttreatment appointments. Quantitative data were recorded based on program usage and surveys completed by health care professionals and patients. Qualitative data exploring perceptions on use of the tool were gathered using semistructured interviews with all health care professionals (n=8) and a sample of patients (n=10). Results Surveys were completed by health care professionals immediately following each appointment (n=89, 100%). Postal surveys were returned by 59 patients (66%). Health care professionals and patients reported that the tool helped facilitate discussions (81/89, 91% and 50/59, 85%, respectively) and that information provided was relevant (82/89, 92% and 50/59, 85%, respectively). The mean conversation duration was 6.01 minutes (SD 2.91). Qualitative synthesis identified the tool’s ability to initiate and structure discussions, improve the “depth” of conversations, and normalize sexual concerns. Conclusions The EASSi tool was appropriate and acceptable for use in practice and provided a flexible approach to facilitate routine brief conversations and deliver essential sexual well-being support. Further work will be conducted to evaluate the effectiveness of using the tablet-based tool in prostate cancer care settings.
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Affiliation(s)
- Eilís McCaughan
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Carrie Flannagan
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Kader Parahoo
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - John Connaghan
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Mary Steele
- Faculty of Social and Human Sciences, Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | | | - Suneil Jain
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.,Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdom
| | - Michael Kirby
- Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, United Kingdom.,The Prostate Centre, London, United Kingdom
| | - Nuala Brady
- Northern Heath and Social Care Trust, Antrim, United Kingdom
| | - Seán R O'Connor
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, United Kingdom
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24
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Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean S, Jolly K, Mutrie N, Lambert J, Yardley L, Greaves C, King J, McAdam C, Steele M, Price L, Streeter A, Charles N, Terry R, Webb D, Campbell J, Hughes L, Ainsworth B, Jones B, Jane B, Erwin J, Little P, Woolf A, Cavanagh C. Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT. Health Technol Assess 2020; 24:1-106. [PMID: 33243368 DOI: 10.3310/hta24630] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. OBJECTIVES To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. DESIGN A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). SETTING Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. PARTICIPANTS There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. INTERVENTION e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. PRIMARY OUTCOME MEASURE Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. SECONDARY OUTCOMES Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. RESULTS Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. LIMITATIONS A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. FUTURE WORK The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. CONCLUSIONS Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. TRIAL REGISTRATION Current Controlled Trials ISRCTN15644451. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adrian H Taylor
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Rod S Taylor
- University of Exeter Medical School, University of Exeter, Exeter, UK.,Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Wendy M Ingram
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Nana Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Sarah Dean
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jeffrey Lambert
- University of Exeter Medical School, University of Exeter, Exeter, UK.,Department for Health, University of Bath, Bath, UK
| | - Lucy Yardley
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Colin Greaves
- University of Exeter Medical School, University of Exeter, Exeter, UK.,School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Jennie King
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mary Steele
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Lisa Price
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Streeter
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | | | - Rohini Terry
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Douglas Webb
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lucy Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ben Ainsworth
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK.,Department of Psychology, University of Bath, Bath, UK
| | - Ben Jones
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ben Jane
- School of Sport, Health and Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Jo Erwin
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Paul Little
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
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25
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Hare KS, Pletts S, Pyo J, Haines D, Guan LL, Steele M. Feeding colostrum or a 1:1 colostrum:whole milk mixture for 3 days after birth increases serum immunoglobulin G and apparent immunoglobulin G persistency in Holstein bulls. J Dairy Sci 2020; 103:11833-11843. [PMID: 33069413 DOI: 10.3168/jds.2020-18558] [Citation(s) in RCA: 9] [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] [Received: 03/19/2020] [Accepted: 06/28/2020] [Indexed: 01/27/2023]
Abstract
Conflicting reports exist on whether prolonged IgG consumption can further increase serum IgG in neonatal calves. Given that higher serum IgG in neonates has lifelong benefits, our objective was to determine whether serum IgG can be increased by providing multiple meals containing IgG to neonatal calves. Twenty-seven Holstein bulls were all fed 1 colostrum meal (7.5% body weight; 62 g of IgG/L) at 2 h after birth and randomly assigned to be fed (5% body weight) colostrum (COL; n = 9), whole milk (WM; n = 9), or a 1:1 colostrum:whole milk mixture (MX; n = 9) every 12 h from 12 to 72 h. Serum IgG was measured at 1, 2, 3, 6, 9, 11, and 12 h after birth. After the 12-h meal, IgG was determined at 0.5-h intervals until 16 h and then at 1-h intervals from 16 to 24 h. Serum IgG was then measured at 27 h, then every 6 h from 30 to 60 h. From 60 to 64 h, IgG was measured every 0.5 h, then at 65 and 66 h, and then every 2 h until 72 h. Serum IgG increased rapidly between 2 and 12 h for all calves. A treatment × time interaction occurred as serum IgG began to diverge between treatments after they were fed at 12 h; the interaction was greatest over the entire period for COL compared with both MX and WM and was greater for MX than for WM. Maximum IgG concentrations (Cmax) were 30.4 ± 0.8, 27.2 ± 0.8, and 23.9 ± 0.8 g/L for COL, MX, and WM, respectively. Although MX Cmax was equivalent to both COL and WM Cmax, COL Cmax was greater than WM Cmax. Feeding COL and MX also prolonged the time to reach Cmax. Respectively, these calves achieved Cmax at 29.5 and 27.0 ± 3.4 h, whereas WM IgG peaked at 13.4 ± 3.4 h. No differences were observed for apparent efficiency of absorption between treatments from 0 to 12 h and 0 to 24 h. Immunoglobulin G area under the curve (AUC) was the same for COL and MX calves over the entire experimental period and from when treatments were fed. The IgG AUC for 0 to 72 h for WM calves was 27.4% lesser than that for COL calves but not different from MX calves. However, the IgG AUC for 12 to 72 h for WM calves differed relative to that for both COL (30.8% less) and MX (19.6% less) calves. Serum IgG concentrations were more persistent when COL (88.2 ± 2.4%) and MX (91.2 ± 2.4%) were fed rather than WM (75.3 ± 2.4%). Prolonged IgG consumption increased serum IgG concentrations, corresponding to the mass of IgG fed, and improved apparent IgG persistency in Holstein bulls. Neonatal calves should be fed at least 62 g of IgG at 12 h after birth to further increase serum IgG concentrations.
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Affiliation(s)
- K S Hare
- Department of Animal Biosciences, Animal Science and Nutrition, University of Guelph, Guelph, ON, Canada N1G 1Y2
| | - S Pletts
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Alberta, AB, Canada T6G 2P5
| | - J Pyo
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Alberta, AB, Canada T6G 2P5
| | - D Haines
- Saskatoon Colostrum Company Ltd., Saskatoon, SK, Canada S7K 6A2
| | - L L Guan
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Alberta, AB, Canada T6G 2P5
| | - M Steele
- Department of Animal Biosciences, Animal Science and Nutrition, University of Guelph, Guelph, ON, Canada N1G 1Y2.
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26
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McCaughan E, Parahoo K, Flannagan C, Maguire R, Connaghan J, Steele M, Thompson S, Jain S, Kirby M, Brady N, O'Connor SR. Development of a conceptual framework to improve sexual wellbeing communication in routine prostate cancer care. Patient Educ Couns 2020; 103:1150-1160. [PMID: 32029296 DOI: 10.1016/j.pec.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/31/2019] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To systematically develop a framework to improve sexual wellbeing communication in routine prostate cancer care. METHODS The Theoretical Domains Framework was used to guide a multi-phase process used to identify components of the framework based on evidence reviews, semi-structured interviews and stakeholder workshops. 'Think-aloud' testing was used to explore usability, potential barriers and other factors relevant to implementation. RESULTS A conceptual communication framework consisting of 'Engagement' (E), 'Assessment' (A), information and 'Support' (S) and 'Sign-posting' (Si) sections was developed. The framework emphasises routine engagement to normalise sexual concerns, brief, non-sensitive assessment, personalised advice based on treatment type and relationship status, and a mechanism for referral to additional support or self-management resources in the form of a patient and partner handout. Usability testing identified strategies to promote implementation. CONCLUSIONS The proposed framework is appropriate for use in routine practice and appears to be acceptable to patients, partners and healthcare professionals. Its use may help address gaps in sexual wellbeing support for men and partners living with prostate cancer. Further work will be conducted evaluating an online engagement tool, modelled on the framework. PRACTICE IMPLICATIONS The EASSi framework can facilitate and structure sexual wellbeing conversations and ensure fundamental but individualised support is provided routinely in prostate cancer care.
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Affiliation(s)
- Eilís McCaughan
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK.
| | - Kader Parahoo
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - John Connaghan
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Mary Steele
- Centre for Clinical and Community Applications of Health Psychology, Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Samantha Thompson
- Urology Department, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK; Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Mike Kirby
- Faculty of Health and Human Sciences, University of Hertfordshire and The Prostate Centre, London, UK
| | - Nuala Brady
- Northern Health and Social Care Trust, Northern Ireland, UK
| | - Seán R O'Connor
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
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27
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Pyo J, Hare K, Pletts S, Inabu Y, Haines D, Sugino T, Guan LL, Steele M. Feeding colostrum or a 1:1 colostrum:milk mixture for 3 days postnatal increases small intestinal development and minimally influences plasma glucagon-like peptide-2 and serum insulin-like growth factor-1 concentrations in Holstein bull calves. J Dairy Sci 2020; 103:4236-4251. [PMID: 32171512 DOI: 10.3168/jds.2019-17219] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 07/05/2019] [Accepted: 01/05/2020] [Indexed: 11/19/2022]
Abstract
This study evaluated how feeding colostrum- or a colostrum-milk mixture for 3 d postnatal affects plasma glucagon-like peptide-2 (GLP-2), serum insulin-like growth factor-1 (IGF-1), and small intestinal histomorphology in calves. Holstein bulls (n = 24) were fed colostrum at 2 h postnatal and randomly assigned to receive either colostrum (COL), whole milk (WM), or a 1:1 COL:WM mixture (MIX) every 12 h from 12 to 72 h. A jugular venous catheter was placed at 1 h postnatal to sample blood frequently for the duration of the experiment. Samples were collected at 1, 2, 3, 6, 9, 11, and 12 h. Following the 12-h meal, blood was collected at half-hour intervals until 16 h and then at 1-h intervals from 16 to 24 h. A 27-h sample was taken, then blood was sampled every 6 h from 30 to 60 h. Again, blood was taken at half-intervals from 60 to 64 h, then at 65 and 66 h, following which, a 2-h sampling interval was used until 72 h. Plasma GLP-2 (all time points) and serum IGF-1 (at time points: 1, 6, 12, 18, 24, 36, 48, and 72 h) were both analyzed. Duodenal, jejunal, and ileal tissues were collected at 75 h of age to assess histomorphology and cellular proliferation. Feeding COL, rather than WM, increased plasma GLP-2 by 60% for 2 h and tended to increase GLP-2 by 49.4% for 4 h after the 60-h meal. Insulin-like growth factor-1 area under the curve (from 12 to 72 h) tended to be 27% greater for COL than WM calves but was otherwise unaffected by treatment. Ileal crypts tended to proliferate more with MIX than WM, whereas ileal crypt proliferation did not differ for COL compared with MIX or WM and was not different between treatments in the proximal jejunum. Villi height was increased 1.8 and 1.5× (COL and MIX vs. WM) in the proximal and distal jejunum, respectively, whereas MIX duodenal and ileal villi height tended to be 1.5 and 1.4× that of WM. Crypt depth did not differ in any region. Surface area of the gastrointestinal tract was reduced for WM by 60 and 58% (proximal jejunum) and 38 and 52% (ileum) relative to COL and MIX and was 54% less than MIX in the distal jejunum. Overall, extended COL feeding minimally increased plasma GLP-2 and serum IGF-1 compared with WM feeding. As COL and MIX similarly promoted small intestinal maturation, feeding calves transition milk to promote intestinal development could be a strategy for producers.
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Affiliation(s)
- J Pyo
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB, Canada T6G 2P5
| | - K Hare
- Department of Animal Biosciences, Animal Science and Nutrition, University of Guelph, Guelph, ON, Canada N1G 1Y2
| | - S Pletts
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB, Canada T6G 2P5
| | - Y Inabu
- The Research Center for Animal Science, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Japan 739-8528
| | - D Haines
- The Saskatoon Colostrum Company Ltd., Saskatoon, SK, Canada S7K 6A2
| | - T Sugino
- The Research Center for Animal Science, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Japan 739-8528
| | - L L Guan
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB, Canada T6G 2P5
| | - M Steele
- Department of Animal Biosciences, Animal Science and Nutrition, University of Guelph, Guelph, ON, Canada N1G 1Y2.
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28
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Affiliation(s)
- M. Steele
- CAPD Unit South West Thames Renal Unit St. Helier Hospital
| | - J.T.C. Kwan
- CAPD Unit South West Thames Renal Unit St. Helier Hospital
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29
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Tombácz K, Peters LM, Chang YM, Steele M, Werling D, Gibson AJ. Short communication: Pegbovigrastim treatment in vivo does not affect granulocyte ability to migrate to endometrial cells and kill bacteria in vitro in healthy cows. J Dairy Sci 2019; 102:9389-9395. [PMID: 31326166 DOI: 10.3168/jds.2019-16563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022]
Abstract
In periparturient dairy cows, immune suppression, resulting in decreased neutrophil numbers and function, leads to increased susceptibility to postpartum conditions such as mastitis, retained placenta, and metritis. Administration of polyethylene glycol-conjugated bovine granulocyte colony stimulating factor (pegbovigrastim, Imrestor; Elanco Animal Health, Greenfield, IN) 7 d before and within 24 h of calving, effectively improves granulocyte production and function in vivo as well as in milk. A recently developed coculture assay was adapted for use with endometrial epithelial cells to assess the effects of pegbovigrastim application on directed granulocyte migration and bactericidal activity in vitro on a per-cell basis in endometrial cell cultures. Granulocytes from treated and untreated periparturient cows (6 and 5 per group, respectively) were evaluated for their ability to migrate to and kill bacteria after treatment, in context of the infected endometrium. We hypothesized that in addition to increasing the absolute concentration of circulating neutrophil granulocytes, pegbovigrastim treatment in vivo alters the ability of granulocytes to migrate to endometrial cells in vitro. The results clearly show a marked increase in the total concentration of granulocytes and monocytes between the 2 treatment groups as early as 2 d after the first injection, and this increased between the samples taken 2 d after calving. No migratory or killing differences were identified between granulocytes of both groups, suggesting that pegbovigrastim-induced granulocytes were as effective as non-induced cells. This may also be due to the absence of negative energy balance in the study animals and leads us to conclude that the positive effects seen in vivo are most likely based on the larger number of granulocytes present rather than a direct effect of pegbovigrastim treatment on the functionality of cells for the parameters tested in this study.
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Affiliation(s)
- K Tombácz
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, AL9 7TA, United Kingdom
| | - L M Peters
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, AL9 7TA, United Kingdom
| | - Y-M Chang
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, AL9 7TA, United Kingdom
| | - M Steele
- Elanco Animal Health, Eli Lilly and Company Ltd., Basingstoke, RG24 9NL, United Kingdom
| | - D Werling
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, AL9 7TA, United Kingdom.
| | - A J Gibson
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, AL9 7TA, United Kingdom
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Jussila A, Steele M, DiNuoscio G, Hamburg E, Yoon J, Atit R. 439 Mechanism for loss of intradermal fat accompanying skin fibrosis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.515] [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: 10/27/2022]
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McCaughan E, O'Connor S, Flannagan C, Maguire R, Connaghan J, Bamidele O, Ellis S, Steele M, Wittmann D, Thompson S, Jain S, Kirby M, Brady N, Parahoo K. 050 Maximising Sexual Wellbeing after diagnosis of Prostate Cancer. Developing and Testing Support Resources: A Global Approach. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.061] [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: 10/27/2022]
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Reiners J, Carlin K, Vonnahme K, Steele M, Swanson K. 96 Late-Breaking: Effects of graded amounts of Leucine in milk replacer on neonatal calf growth and nutrient digestibility. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Reiners
- North Dakota State University,Fargo, ND, United States
| | - K Carlin
- North Dakota State University,Fargo, ND, United States
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
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Villot C, Renaud D, Skidmore A, Aguilar A, Chevaux E, Steele M. 239 Effect of Saccharomyces cerevisiae boulardii supplementation on the health and performance of male Holstein calves. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Villot
- University of Alberta - Lallemand,Edmonton, AB, Canada
| | - D Renaud
- University of Guelph,Guelph, ON, Canada
| | - A Skidmore
- Lallemand Animal Nutrition,Montreal, QC, Canada
| | - A Aguilar
- Lallemand Animal Nutrition,Montreal, QC, Canada
| | - E Chevaux
- Lallemand Animal Nutrition,Martinsville, IN, United States
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Paddick K, DeVries T, Schwartzkopf-Genswein K, Steele M, Mutsvangwa T, Penner G. 337 Effect of the quantity of concentrate offered in an automated milking system on dry matter intake, milking frequency, milk and milk component yield, and ruminal fermentation when provided isocaloric diets. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Paddick
- University of Saskatchewan,Saskatoon, SK, Canada
| | - T DeVries
- University of Guelph,Guelph, ON, Canada
| | | | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - T Mutsvangwa
- University of Saskatchewan,Saskatoon, SK, Canada
| | - G Penner
- Department of Animal and Poultry Science, University of Saskatchewan,Saskatoon, SK, Canada
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Watanabe D, Steele M, Doelman J, Penner G. PSXIV-10 Effect of rumen protected Ca-gluconate on the performance, gastrointestinal tract development, digesta composition, and total tract digestibility of lambs. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Watanabe
- University of Saskatchewan,Saskatoon, SK, Canada
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - J Doelman
- Trouw Nutrition,Edmonton, AB, Canada
| | - G Penner
- Department of Animal and Poultry Science, University of Saskatchewan,Saskatoon, SK, Canada
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Van Niekerk J, Romao J, Middeldorp M, Steele M. 358 The short and long term effects of weaning on structural and transcriptomic adaptations of the colon in Holstein bull calves fed elevated plane of milk nutrition pre-weaning. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - J Romao
- University of Alberta,Edmonton, AB, Canada
| | - M Middeldorp
- Animal Nutrition Group, Wageningen UR, The Netherlands, Wageningen, The Nethrlands
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Welboren A, Hatew-Chuko B, Berends H, Leal L, Martín-Tereso J, Steele M. 345 Energy source of milk replacer affects glucose homeostasis in neonatal calves. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Welboren
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - B Hatew-Chuko
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - H Berends
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - L Leal
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - J Martín-Tereso
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Pyo J, Fischer A, He Z, Haines D, Guan L, Steele M. PSI-37 The effects of delaying initial colostrum feeding on gastrointestinal tract growth of neonatal bull dairy calves. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Pyo
- University of Alberta,Edmonton, AB, Canada
| | - A Fischer
- University of Alberta,Edmonton, AB, Canada
| | - Z He
- Institute of Subtropical Agriculture,Changsha, China (People’s Republic)
| | - D Haines
- Saskatoon Colostrum Co. Ltd.,Saskatoon, SK, Canada
| | - L Guan
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Ma T, Renaud D, Skidmore A, Aguilar A, Chevaux E, Guan L, Steele M. 94 Alteration of fecal bacterial composition in pre-weaned veal calves by supplementation of Saccharomyces cerevisiae boulardii in milk replacer. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Ma
- University of Alberta,Edmonton, AB, Canada
| | - D Renaud
- University of Guelph,Guelph, ON, Canada
| | - A Skidmore
- Lallemand Animal Nutrition,Montreal, QC, Canada
| | - A Aguilar
- Lallemand Animal Nutrition,Martinsville, IN, United States
| | - E Chevaux
- Lallemand Animal Nutrition,Blagnac, France
| | - L Guan
- Department of Agricultural, Food, and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - M Steele
- Department of Agricultural, Food, and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Pyo J, Pletts S, Romao J, Inabu Y, He Z, Haines D, Sugino T, Guan L, Steele M. 342 The effects of extended colostrum feeding on gastrointestinal tract growth of the neonatal dairy calf. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Pyo
- University of Alberta,Edmonton, AB, Canada
| | - S Pletts
- University of Alberta,Edmonton, AB, Canada
| | - J Romao
- University of Alberta,Edmonton, AB, Canada
| | - Y Inabu
- The Research Center for Animal Science, Graduate School of Biosphere Science, Hiroshima University,Higashihroshima, Japan
| | - Z He
- Institute of Subtropical Agriculture,Changsha, China
| | - D Haines
- Saskatoon Colostrum Co. Ltd.,Saskatoon, SK, Canada
| | - T Sugino
- The Research Center for Animal Science, Graduate School of Biosphere Science, Hiroshima University,Higashihroshima, Japan
| | - L Guan
- Department of Agricultural, Food, and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - M Steele
- Department of Agricultural, Food, and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Hare K, Romao J, Leal L, Hooiveld G, Soberon F, Berends H, Boekschoten M, Van Amburgh M, Martín-Tereso J, Steele M. 136 Increased pre-weaning metabolizable energy supply affects the expression of genes related to adipogenesis and lipid metabolism in the skeletal muscle of prepubertal Holstein heifers. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Hare
- Department of Agricultural, Food and Nutritional Science, Faculty of Agriculture Life and Environmental Sciences, University of Alberta,Saskatoon, SK, Canada
| | - J Romao
- University of Alberta,Edmonton, AB, Canada
| | - L Leal
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - G Hooiveld
- Wageningen University,Wageningen, Netherlands
| | - F Soberon
- Trouw Nutrition,Canandaigua, NY, United States
| | - H Berends
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | | | | | - J Martín-Tereso
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Welboren A, Leal L, Steele M, Khan A, Martín-Tereso J. PSXVII-32 Late-Breaking: Weaning of ad libitum fed dairy calves with automated feeders using fixed and individual methods. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Welboren
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - L Leal
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - A Khan
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
| | - J Martín-Tereso
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
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Romao J, Leal L, Hooiveld G, Soberon F, Berends H, Boekschoten M, Van Amburgh M, Martín-Tereso J, Steele M. PSXI-13 Nutrient supply alters adipose tissue physiology in pre-weaned calves. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Romao
- University of Alberta,Edmonton, AB, Canada
| | - L Leal
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - G Hooiveld
- Wageningen University,Wageningen, Netherlands
| | - F Soberon
- Trouw Nutrition,Amersfoort, Utrecht, Netherlands
| | - H Berends
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | | | | | - J Martín-Tereso
- Trouw Nutrition Research and Development,Amersfoort, Utrecht, Netherlands
| | - M Steele
- Department of Agricultural, Food and Nutritional Science, University of Alberta,Edmonton, AB, Canada
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Stuart B, Rumsby K, Santer M, Ridd MJ, Francis NA, Chorozoglou M, Spreadbury C, Steele M, Nollett C, Liddiard L, Prude M, Hooper J, Thomas-Jones E, Roberts A, Thomas KS, Williams HC, Little P. Feasibility of weekly participant-reported data collection in a pragmatic randomised controlled trial in primary care: experiences from the BATHE trial (Bath Additives for the Treatment of cHildhood Eczema). Trials 2018; 19:582. [PMID: 30355360 PMCID: PMC6201535 DOI: 10.1186/s13063-018-2962-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background Patient-reported outcomes measures in clinical trials ensure that evaluations of effectiveness focus on outcomes that are important to patients. In relapsing-remitting conditions, such as eczema, repeated measurements may allow a more accurate reflection of disease burden and treatment effect than less frequent measurements. We asked parents/carers of children with eczema taking part in a trial of bath emollients to complete weekly questionnaires for 16 weeks. Methods The objective of this study was to determine the acceptability and practicality of collecting weekly measures of eczema severity online for 16 weeks in children aged 1 to 11 years as part of the BATHE study. BATHE randomised patients to bath emollients plus standard eczema care or standard eczema care only. The primary outcome was eczema severity, measured by the seven-item Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Acceptability was explored through qualitative interviews with 10 participants. Interviews were audio-recorded, transcribed and analysed thematically. Practicality was assessed by exploring the completeness of the data and keeping a log of any problems. Results Four hundred and eighty-two participants were recruited to the trial and 429 opted to complete measures online (89.0%). Data were collected online for 83% of time points over the 16-week period and there was no association between socio-demographic characteristics and data completeness. Two hundred and six (48%) completed their weekly data every week for 16 weeks and 341 (79%) completed it at least 80% of the time. The mean number of weeks completed was 13.3 out of 16 (SD 4.2). Interviewees said that they understood the rationale behind weekly collection and some welcomed this as it helped them realise how their child’s eczema changed weekly. Whilst some interviewees spoke of weekly questionnaires as onerous, others said that they found them quick and easy. Reminders were welcomed. Parents/carers seemed happy to receive telephone reminders and it was sometimes useful for eliciting problems relating to obtaining trial medication or password problems for online data collection. Conclusions Amongst this population, high levels of data completeness suggests that weekly completion of the online questionnaire appears to be acceptable and feasible over a 16-week period. Trial registration ISRCTN84102309. Registered on 9 December 2013.
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Affiliation(s)
- Beth Stuart
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK.
| | - Kate Rumsby
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Miriam Santer
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Matthew J Ridd
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nick A Francis
- Wales School of Primary Care Research, Cardiff University, Cardiff, UK
| | - Maria Chorozoglou
- Southampton Health Technology Assessment Centre (SHTAC), University of Southampton, Southampton, UK
| | - Carla Spreadbury
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Mary Steele
- Centre for Clinical and Community Applications of Health Psychology, Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Claire Nollett
- Wales School of Primary Care Research, Cardiff University, Cardiff, UK
| | - Lyn Liddiard
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Martina Prude
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Julie Hooper
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Emma Thomas-Jones
- Wales School of Primary Care Research, Cardiff University, Cardiff, UK
| | - Amanda Roberts
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Little
- Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
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Ingram W, Webb D, Taylor RS, Anokye N, Yardley L, Jolly K, Mutrie N, Campbell JL, Dean SG, Greaves C, Steele M, Lambert JD, McAdam C, Jane B, King J, Jones RB, Little P, Woolf A, Erwin J, Charles N, Terry RH, Taylor AH. Multicentred randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculoskeletal and mental health conditions: protocol for the e-coachER trial. BMJ Open 2018; 8:e022382. [PMID: 30244214 PMCID: PMC6157530 DOI: 10.1136/bmjopen-2018-022382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Physical activity is recommended for improving health among people with common chronic conditions such as obesity, diabetes, hypertension, osteoarthritis and low mood. One approach to promote physical activity is via primary care exercise referral schemes (ERS). However, there is limited support for the effectiveness of ERS for increasing long-term physical activity and additional interventions are needed to help patients overcome barriers to ERS uptake and adherence.This study aims to determine whether augmenting usual ERS with web-based behavioural support, based on the LifeGuide platform, will increase long-term physical activity for patients with chronic physical and mental health conditions, and is cost-effective. METHODS AND ANALYSIS A multicentre parallel two-group randomised controlled trial with 1:1 individual allocation to usual ERS alone (control) or usual ERS plus web-based behavioural support (intervention) with parallel economic and mixed methods process evaluations. Participants are low active adults with obesity, diabetes, hypertension, osteoarthritis or a history of depression, referred to an ERS from primary care in the UK.The primary outcome measure is the number of minutes of moderate-to-vigorous physical activity (MVPA) in ≥10 min bouts measured by accelerometer over 1 week at 12 months.We plan to recruit 413 participants, with 88% power at a two-sided alpha of 5%, assuming 20% attrition, to demonstrate a between-group difference of 36-39 min of MVPA per week at 12 months. An improvement of this magnitude represents an important change in physical activity, particularly for inactive participants with chronic conditions. ETHICS AND DISSEMINATION Approved by North West Preston NHS Research Ethics Committee (15/NW/0347). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals.Results will be disseminated to ERS services, primary healthcare providers and trial participants. TRIAL REGISTRATION NUMBER ISRCTN15644451; Pre-results.
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Affiliation(s)
- Wendy Ingram
- Faculty of Medicine and Dentistry, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Douglas Webb
- Faculty of Medicine and Dentistry, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | - Nana Anokye
- Department of Clinical Sciences, Brunel University, London, UK
| | - Lucy Yardley
- Faculty of Medicine, Southampton University, Southampton, UK
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Kate Jolly
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | | | | | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Mary Steele
- Faculty of Medicine, Southampton University, Southampton, UK
| | | | - Chloe McAdam
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Ben Jane
- Faculty of Sport and Health, University of St Mark and St John, Plymouth, UK
| | | | - Ray B Jones
- Faculty of Medicine and Dentistry, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Paul Little
- Faculty of Medicine, Southampton University, Southampton, UK
| | - Anthony Woolf
- Department of Rheumatology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Jo Erwin
- Department of Rheumatology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | | | - Adrian H Taylor
- Faculty of Medicine and Dentistry, Peninsula Medical School, University of Plymouth, Plymouth, UK
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Roberts T, Steele M, Nunley D. HLA Donor Specific Antibody and HLA Antigen Bias are Independent Risk Factors for Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1150] [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: 11/15/2022] Open
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Steels E, Steele M, Harold M, Adams L, Coulson S. A double-blind, randomized, placebo-controlled trial evaluating safety and efficacy of an ayurvedic botanical formulation in reducing menopausal symptoms in otherwise healthy women. J Herb Med 2018. [DOI: 10.1016/j.hermed.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hayes SC, Steele M, Spence R, Gordon L, Battistutta D, Bashford J, Pyke C, Saunders C, Eakin E. Abstract P6-12-01: Can exercise influence survival following breast cancer? Evidence from randomised, controlled trials. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The Exercise for Health (EfH) trials were randomized, controlled trials designed to evaluate an 8-month pragmatic, exercise intervention, commencing 6 weeks post-surgery for women with newly diagnosed breast cancer residing in urban- or rural/regional areas. Outcomes for these exploratory analyses were overall survival (OS), breast cancer-specific survival (BCS) and disease-free survival (DFS). Methods: Consenting urban-residing women (EfH 1, n=194) and rural/regional-residing women (EfH 2, n=143) were randomized to exercise or usual care. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for OS, BCS and DFS (exercise group, n=207, 65% urban women; usual care group, n=130, 46% urban women), with and without adjustment for prognostic factors including trial (urban/rural), age, body mass index, disease stage and presence of comorbidities. Further exploratory subgroup analyses were also conducted to assess whether effect on OS, BCS and DFS differed according to prognostic variables. Results: After a median follow-up of 8.3 years (IQR: 8.0-8.7 years) there were 11 (5.3%) deaths in the exercise group compared with 15 (11.5%) deaths in the usual care group (Table 1).
Table 1 Overall, breast cancer-specific and disease-free survival events by group allocation. All patientsUsual careExercise n=337n = 130n = 207 n (%)n (%)n (%)Breast cancer-related deaths20 (5.9)10 (7.7)10 (4.8)Non-breast cancer-related deaths6 (1.8)5 (3.8)1 (0.5)Overall survival events26 (7.7)15 (11.5)11 (5.3)Recurrence of breast cancer20 (5.9)8 (6.2)12 (5.8)Alive at follow-up9 (2.7)3 (2.3)6 (4.6)Deceased by follow-up11 (3.3)5 (3.1)6 (4.6)New primary breast cancer13 (3.9)5 (3.8)8 (3.9)Alive at follow-up13 (3.9)5 (3.8)8 (6.2)Deceased by follow-up0 (0.0)0 (0.0)0 (0.0)Disease-free survival events*48 (14.2)23 (17.7)25 (12.1)* Disease-free survival events include recurrence of breast cancer, new primary breast cancers, and all-cause deaths. Note that women who had recurrence and died before follow-up only count once towards disease-free survival events.
HRs for the exercise group were: OS: 0.45, 95% CI=0.20-0.96; p=0.04; BCS: 0.61, 95% CI=0.25-1.46, p=0.26; and DFS: 0.66, 95% CI=0.38-1.17; p=0.16 (adjusted analyses yielded similar results). With the exception of BCS for those with a body mass index >30, all HRs for subgroup analyses favored exercise, with effect on OS for women of younger age (<55), those with stage II+ disease, and those with 1+ comorbidity at baseline significant (p<0.05). Effect of exercise on DFS was also significant (p<0.05) for urban women. Conclusion: Findings suggest that an individually-prescribed and monitored exercise program integrated during and beyond treatment for breast cancer, and that was designed to cater for all women, irrespective of place of residence and access to health services, has clear potential to influence survival.
Citation Format: Hayes SC, Steele M, Spence R, Gordon L, Battistutta D, Bashford J, Pyke C, Saunders C, Eakin E. Can exercise influence survival following breast cancer? Evidence from randomised, controlled trials [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-01.
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Affiliation(s)
- SC Hayes
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - M Steele
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - R Spence
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - L Gordon
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - D Battistutta
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - J Bashford
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - C Pyke
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - C Saunders
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
| | - E Eakin
- Queensland University of Technology, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Mater Public and Private Hospitals, Brisbane, Queensland, Australia; University of Western Australia, Perth, Western Australia, Australia; University of Queensland, Herston, Queensland, Australia
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Arbiv OA, Cuvelier G, Klaassen RJ, Fernandez CV, Robitaille N, Steele M, Breakey V, Abish S, Wu J, Sinha R, Silva M, Goodyear L, Jardine L, Lipton JH, Corriveau-Bourque C, Brossard J, Michon B, Ghemlas I, Waespe N, Zlateska B, Sung L, Cada M, Dror Y. Molecular analysis and genotype-phenotype correlation of Diamond-Blackfan anemia. Clin Genet 2017; 93:320-328. [PMID: 29044489 DOI: 10.1111/cge.13158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 02/03/2023]
Abstract
Diamond-Blackfan anemia (DBA) features hypoplastic anemia and congenital malformations, largely caused by mutations in various ribosomal proteins. The aim of this study was to characterize the spectrum of genetic lesions causing DBA and identify genotypes that correlate with phenotypes of clinical significance. Seventy-four patients with DBA from across Canada were included. Nucleotide-level mutations or large deletions were identified in 10 ribosomal genes in 45 cases. The RPS19 mutation group was associated with higher requirement for chronic treatment for anemia than other DBA groups. Patients with RPS19 mutations, however, were more likely to maintain long-term corticosteroid response without requirement for further chronic transfusions. Conversely, patients with RPL11 mutations were less likely to need chronic treatment. Birth defects, including cardiac, skeletal, hand, cleft lip or palate and genitourinary malformations, also varied among the various genetic groups. Patients with RPS19 mutations had the fewest number of defects, while patients with RPL5 had the greatest number of birth defects. This is the first study to show differences between DBA genetic groups with regards to treatment. Previously unreported differences in the rate and types of birth defects were also identified. These data allow better patient counseling, a more personalized monitoring plan, and may also suggest differential functions of DBA genes on ribosome and extra-ribosomal functions.
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Affiliation(s)
- O A Arbiv
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - G Cuvelier
- Division of Haematology/Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - R J Klaassen
- Division of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - C V Fernandez
- Division of Haematology/Oncology, IWK Health Centre, Halifax, Canada
| | - N Robitaille
- Division of Haematology/Oncology, CHU Sainte Justine, Montreal, Canada
| | - M Steele
- Division of Haematology/Oncology, Alberta Children's Hospital, Calgary, Canada
| | - V Breakey
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - S Abish
- Division of Haematology/Oncology, Montreal Children's Hospital, Montreal, Canada
| | - J Wu
- Division of Haematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - R Sinha
- Division of Haematology/Oncology, University of Saskatchewan, Saskatoon, Canada
| | - M Silva
- Division of Haematology/Oncology, Queen's University, Kingston, Canada
| | - L Goodyear
- Division of Haematology/Oncology, Janeway Child Health Centre, St. John's, Canada
| | - L Jardine
- Division of Haematology/Oncology, Children's Hospital of Western Ontario, London, Canada
| | - J H Lipton
- Department of Haematology and Internal Medicine, Princess Margaret Hospital, Toronto, Canada
| | - C Corriveau-Bourque
- Division of Haematology/Oncology, University of Alberta Health Sciences Centre, Edmonton, Canada
| | - J Brossard
- Division of Haematology/Oncology, Centre Y Sante L'Estrie-Fleur, Sherbrooke, Canada
| | - B Michon
- Division of Haematology/Oncology, Centre Hospitalier de l'Université Laval, Quebec City, Canada
| | - I Ghemlas
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Division of Haematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - N Waespe
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - B Zlateska
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - L Sung
- Program in Child Health and Evaluative Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Lymphoma Leukemia Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - M Cada
- The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Y Dror
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
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Ferrari M, Dal Cin M, Steele M. Self-compassion is associated with optimum self-care behaviour, medical outcomes and psychological well-being in a cross-sectional sample of adults with diabetes. Diabet Med 2017; 34:1546-1553. [PMID: 28799282 DOI: 10.1111/dme.13451] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
AIM To investigate the role of self-compassion in diabetes outcomes. Self-compassion is a construct which may be relevant to chronic conditions, given its focus on compassion toward oneself, especially in times of difficulty. METHODS In this cross-sectional study we collected data online from 310 adults diagnosed with diabetes. The questionnaire measured three primary outcomes: self-management behaviours; HbA1c levels and psychological well-being. Potential predictors were also assessed, including self-compassion, locus of control, social support and demographics. RESULTS Multiple regression analyses showed that self-compassion had the most consistent association with better outcomes, including all forms of self-management behaviour, HbA1c levels and psychological well-being. Self-compassion was independently associated with 55.1% of the variance in well-being. Internal locus of control was also significantly associated with better well-being and HbA1c outcomes. Chance and external locus of control and social support were generally associated with poorer outcomes. CONCLUSIONS Higher levels of self-compassion are typically associated with improved self-management behaviour, medical outcomes and psychological well-being in adults with diabetes mellitus. The present findings suggest that self-compassion may be a parsimonious and suitable intervention target. Future interventions and consultations with medical professionals may benefit from fostering self-compassion in adults with diabetes mellitus.
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Affiliation(s)
- M Ferrari
- School of Psychology, Australian Catholic University, Strathfield, New South Wales, Australia
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - M Dal Cin
- School of Psychology, Australian Catholic University, Strathfield, New South Wales, Australia
| | - M Steele
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
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