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McFarlane R, Peelo C, Galvin M, Heverin M, Hardiman O. Epidemiologic Trends of Amyotrophic Lateral Sclerosis in Ireland, 1996-2021. Neurology 2023; 101:e1905-e1912. [PMID: 37748881 PMCID: PMC10663006 DOI: 10.1212/wnl.0000000000207797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/28/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to examine changes to the incidence, prevalence, age at onset, and survival of patients diagnosed with amyotrophic lateral sclerosis (ALS) in the Republic of Ireland over 25 years. METHODS Incident and prevalent cases of ALS were estimated using the Irish population-based ALS Register, which has been in continuous operation since 1994. Incident cases were age standardized using the direct method and applied to 3 standard populations (Irish, European, and American). Survival was determined using Kaplan-Meier curves and Cox regression models. Non-normally distributed groups were compared using the Kruskal-Wallis test with a Bonferroni correction. RESULTS A total of 2,771 patients with ALS were identified in the Republic of Ireland over 25 years. Incidence per 100,000 was determined for the population older than 15 years. Crude incidence increased from 2.64 to 5.46 per 100,000. Standardized incidence increased from 2.64 to 3.1 per 100,000. Prevalence increased from 5.83 to 8.10 per 100,000. The median age at onset increased from 64 to 67 years. The peak age of incidence increased from those between 70 and 74 years to those between 75 and 79 years. Overall, women had a consistently later median age at onset of 67 years compared with men at 65 years (p < 0.001). No significant difference in survival was noted between those captured across 3 different epochs (1996-2003, 2004-2012, 2013-2021). Older age at onset (hazard ratio [HR] 1.03, CI 1.02-1.04, p < 0.001) was a negative predictive factor of survival in multivariate Cox regression analysis. Riluzole use (HR 0.67, CI 0.50-0.90, p = 0.033) and diagnostic delay (HR 0.98, CI 0.98-0.99, p < 0.001) were positive predictive factors. DISCUSSION Within the Republic of Ireland, the age-standardized overall incidence, peak incidence, prevalence, and age at onset of ALS have all increased over 25 years. Despite the widespread use of noninvasive ventilation, aggressive secretion management, and changes in ALS care, the mean survival within the Irish population has not changed.
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Affiliation(s)
- Robert McFarlane
- From the Academic Unit of Neurology, Trinity College Dublin, Ireland.
| | - Colm Peelo
- From the Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Miriam Galvin
- From the Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Mark Heverin
- From the Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Orla Hardiman
- From the Academic Unit of Neurology, Trinity College Dublin, Ireland
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Conroy E, Vélez-Gómez B, O'Brien D, Heverin M, Hardiman O, Mcdermott C, Galvin M. IMPACT-ALS: summary of results from a European survey of people living with ALS. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-10. [PMID: 37661426 DOI: 10.1080/21678421.2023.2249515] [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: 12/13/2022] [Revised: 06/19/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The IMPACT-ALS survey collected the experiences of people living with ALS (plwALS) across nine European countries. We aimed to better understand the functional burden of ALS to ensure the experiences of plwALS inform the development of person-centered therapies. METHODS The content was informed by the US IMPACT-ALS survey, with adjustments relevant to the European population. Questionnaires consisted of four modules, each of which was pilot tested in advance of distribution. Data were captured using the Qualtrics software and were analyzed in SPSS. RESULTS 857 respondents completed the survey, with a participation rate ranging from 0.2% to 6.3% across the nine participating countries. The majority were male and aged 55-74 years old. In the previous 2 weeks, symptoms experienced included weakness (81%), fatigue (61%), speech impairment (38%), pain (27%), and depression and other mood changes (23%). Eighty-two percent of respondents reported fears, of which the most common were leaving family too soon (68%) and death from respiratory failure (50%). Lifestyle changes since diagnosis were reported by 89% of respondents, with less time spent doing most daily activities but more time on the internet (81%), reading (56%) and communicating with family and friends (55%). Stopping progression of ALS was the most desired impact for a new therapy for 68% respondents. CONCLUSIONS The European IMPACT-ALS survey has generated insights into the complex experiences of plwALS. The data provide unique patient perspectives on common symptoms, fears, functional limitations, lifestyle changes, and wishes for future therapies that will enhance patient-centric care in ALS.
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Affiliation(s)
- Eilis Conroy
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Beatriz Vélez-Gómez
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain, and
| | - David O'Brien
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Mark Heverin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Christopher Mcdermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Miriam Galvin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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McFarlane R, Galvin M, Heverin M, Mac Domhnaill É, Murray D, Meldrum D, Bede P, Bolger A, Hederman L, Impey S, Stephens G, O'Meara C, Wade V, Al Chalabi A, Chiò A, Corcia P, van Damme P, Ingre C, McDermott C, Povedanos M, van den Berg L, Hardiman O. PRECISION ALS-an integrated pan European patient data platform for ALS. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-5. [PMID: 37221648 DOI: 10.1080/21678421.2023.2215838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is an incurable neurodegenerative condition. Despite significant advances in pre-clinical models that enhance understanding of disease pathobiology, translation of candidate drugs to effective human therapies has been disappointing. There is increasing recognition of the need for a precision medicine approach toward drug development, as many failures in translation can be attributed in part to disease heterogeneity in humans. PRECISION-ALS is an academic industry collaboration between clinicians, Computer Scientists, Information engineers, technologists, data scientists and industry partners that will address the key clinical, computational, data science and technology associated research questions to generate a sustainable precision medicine based approach toward new drug development. Using extant and prospectively collected population based clinical data across nine European sites, PRECISION-ALS provides a General Data Protection Regulation (GDPR) compliant framework that seamlessly collects, processes and analyses research-quality multimodal and multi-sourced clinical, patient and caregiver journey, digitally acquired data through remote monitoring, imaging, neuro-electric-signaling, genomic and biomarker datasets using machine learning and artificial intelligence. PRECISION-ALS represents a first-in-kind modular transferable pan-European ICT framework for ALS that can be easily adapted to other regions that face similar precision medicine related challenges in multimodal data collection and analysis.
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Affiliation(s)
- Robert McFarlane
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Éanna Mac Domhnaill
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Dara Meldrum
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | | | - Lucy Hederman
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Sinéad Impey
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Gaye Stephens
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Ciara O'Meara
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | - Vincent Wade
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
| | | | - Adriano Chiò
- University of Torino, TRICALS Consortium, Turin, Italy
| | | | | | - Caroline Ingre
- Karolinska University, TRICALS Consortium, Stockholm, Sweden
| | | | | | - Leonard van den Berg
- University Medical Centre, Utrecht, TRICALS Consortium, Utrecht, The Netherlands, and
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, TRICALS Consortium, Dublin, Ireland
- ADAPT Centre Trinity College Dublin, Dublin, Ireland
- FutureNeuro Research Centre Trinity College Dublin, Dublin, Ireland
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Conroy É, Kennedy P, Heverin M, Hardiman O, Galvin M. Care, burden and self-described positive aspects of caring in amyotrophic lateral sclerosis: an exploratory, longitudinal, mixed-methods study. BMJ Open 2023; 13:e064254. [PMID: 36669844 PMCID: PMC9872468 DOI: 10.1136/bmjopen-2022-064254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/14/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To explore factors associated with care burden and the self-described positive aspects of caring for a person living with amyotrophic lateral sclerosis (ALS) over time. DESIGN Exploratory longitudinal mixed-methods study. SETTING A national multidisciplinary tertiary clinic in Dublin, Ireland. PARTICIPANTS Participants were informal caregivers of people living with ALS (plwALS) attending the national ALS/motor neuron disease Clinic Dublin. This study focuses on informal caregivers who completed five consecutive interviews (n = 17) as part of a larger multisite study, over the course of 2.5 years. Participants were over the age of 18. Formal paid caregivers were not included. OUTCOME MEASURES Data were collected on demographic and well-being measures and an open-ended question asked about positive aspects of caregiving. Relevant statistical analysis was carried out on quantitative data and qualitative data were analysed thematically. RESULTS The caregivers in this study were predominantly female and spouse/partners of the plwALS. Hours of care provided and self-assessed burden increased substantially over time, psychological distress reached clinical significance and quality of life remained relatively stable. Positive aspects identified were thematised as meaning in life and personal satisfaction and varied in relative frequency across phases of the caregiving trajectory. CONCLUSIONS The co-occurrence of negative and positive factors influences the experiences of informal caregivers in ALS. It is important to explore and acknowledge positive aspects, how they develop and are sustained in order to inform supportive services. The cyclical adaptation identified in this study provides evidence for time sensitive targeted supports.
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Affiliation(s)
- Éilís Conroy
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Polly Kennedy
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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Chen YS, Almirall‐Sanchez A, Ilinca S, Grycuk E, Higgins D, Leon T, McGlinchey E, Rogan C, Saha S, Tjin A, Galvin M, O'Sullivan R, Lawlor B, Leroi I. COVID‐19‐related loneliness, social isolation and burden in informal caregivers worldwide. Alzheimers Dement 2022. [DOI: 10.1002/alz.064194] [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: 12/24/2022]
Affiliation(s)
| | - Arianna Almirall‐Sanchez
- Global brain health institute ‐ Trinity College Dublin Ireland
- Cuban Institute of Oncology and Radiobiology Havanna Cuba
| | | | - Emilia Grycuk
- Trinity College Dublin / School of Medicine Dublin Ireland
| | | | - Tomas Leon
- Memory and neuropsychiatry disorders Clinic (CMYN) Santiago Chile
| | | | - Carol Rogan
- Trinity College Dublin / School of Medicine, DUBLIN Ireland
| | | | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences Dublin Ireland
| | - Miriam Galvin
- Global Brain Health Institute, Trinity College Dublin Dublin Ireland
| | | | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin Dublin Ireland
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Rogan C, Higgins D, Chen YS, Grycuk E, Wormald A, Leroi I, Galvin M. Experiences of English‐speaking care partners of individuals with brain health conditions during COVID‐19: a qualitative analysis. Alzheimers Dement 2022. [DOI: 10.1002/alz.064196] [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: 12/24/2022]
Affiliation(s)
- Carol Rogan
- Trinity College Dublin / School of Medicine, DUBLIN Ireland
| | | | | | - Emilia Grycuk
- Trinity College Dublin / School of Medicine Dublin Ireland
| | - Andrew Wormald
- Trinity College Dublin/ Trinity Centre for Ageing and Intellectual Disability Dublin Ireland
| | - Iracema Leroi
- Global Brain Health Institute Dublin Ireland
- Trinity College Dublin Dublin Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity College Dublin Dublin Ireland
- Global Brain Health Institute, Trinity College Dublin Dublin Ireland
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Grycuk E, Chen Y, Almirall‐Sanchez A, Higgins D, Galvin M, Kane J, Kinchin I, Lawlor B, Rogan C, Russell G, O'Sullivan R, Leroi I, on the behalf of the CLIC Caregiver study group. Care burden, loneliness, and social isolation in caregivers of people with physical and brain health conditions in English-speaking regions: Before and during the COVID-19 pandemic. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5734. [PMID: 35574817 PMCID: PMC9324775 DOI: 10.1002/gps.5734] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/27/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Public health restrictions due to the COVID-19 (SARS CoV-2) pandemic have disproportionately affected informal caregivers of people living with long term health conditions. We aimed to explore levels of care burden, loneliness, and social isolation among caregivers of people with enduring physical and brain health conditions in English-speaking regions worldwide, by investigating outcomes before and during the COVID-19 pandemic. METHODS A cross-sectional anonymous online survey data from 2287 English-speaking caregivers of people with long term health conditions from four English-speaking regions (UK, Ireland, USA, New Zealand) included measures of care burden, loneliness, and social isolation, reported before and during the COVID-19 pandemic. Analyses were descriptive, followed by an ordinal regression model for predictors of burden. RESULTS Compared to pre-pandemic levels, all caregivers experienced a significant increase in burden, loneliness, and isolation. Caregivers of people with both brain health and physical conditions were the most burdened and had the highest levels of loneliness and isolation compared to caregivers of people with either a brain health or physical condition only. The increase in care burden among caregivers of people with brain health challenges was associated with caregiver's gender, moderate and severe emotional loneliness, magnitude and frequency of isolation during the pandemic, and care circumstances (cohabitation with the care recipient, restrictions on the ability to provide care). CONCLUSIONS Health and social care interventions should target caregivers' care circumstances and psychological outcomes, particularly in women, accounting for the significant additional burden of care, loneliness, and isolation resulting from pandemic-related restrictions.
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Affiliation(s)
- Emilia Grycuk
- Department of PsychiatrySchool of MedicineTrinity College DublinDublinIreland
| | - Yaohua Chen
- Global Brain Health InstituteTrinity College DublinDublinIreland,Lille CHU Univ. Lille, Inserm, CHU Lille, Lille Neurosciences & CognitionUMR‐S1172Degenerative and Vascular Cognitive DisordersLilleFrance
| | | | - Dawn Higgins
- Global Brain Health InstituteTrinity College DublinDublinIreland,Department of PsychologyMaynooth UniversityMaynoothIreland
| | - Miriam Galvin
- Global Brain Health InstituteTrinity College DublinDublinIreland,Academic Unit of NeurologyTrinity College DublinDublinIreland
| | - Joseph Kane
- Centre for Public HealthQueen's University BelfastBelfastUK
| | - Irina Kinchin
- Global Brain Health InstituteTrinity College DublinDublinIreland,Center for Health Policy and ManagementTrinity College DublinDublinIreland,University of Technology SydneyUltimoNew South WalesAustralia
| | - Brian Lawlor
- Global Brain Health InstituteTrinity College DublinDublinIreland
| | - Carol Rogan
- Dementia Research Network IrelandSchool of MedicineTrinity College DublinDublinIreland
| | - Gregor Russell
- Yorkshire and Humber NIHR Clinical Research NetworkNorthern IrelandUK
| | - Roger O'Sullivan
- Institute of Public HealthBelfastIreland,Ulster UniversityColeraineUK
| | - Iracema Leroi
- Department of PsychiatrySchool of MedicineTrinity College DublinDublinIreland,Global Brain Health InstituteTrinity College DublinDublinIreland
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Kennedy P, Conroy É, Heverin M, Leroi I, Beelen A, van den Berg L, Hardiman O, Galvin M. Burden and benefit-A mixed methods study of informal Amyotrophic Lateral Sclerosis caregivers in Ireland and the Netherlands. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5704. [PMID: 35362219 PMCID: PMC9315024 DOI: 10.1002/gps.5704] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Amyotrophic Lateral Sclerosis (ALS) is a systemic and terminal disorder of the central nervous system which causes paralysis of limbs, respiratory and bulbar muscles, impacting on physical, communication, cognitive and behavioural functioning. Informal caregivers play a key role in the care of people with ALS. This study aimed to explore experiences of burden along with any beneficial aspects of caregiving in ALS. An understanding of both burden and benefit is important to support the informal caregiver and the person with ALS. METHODS/DESIGN This exploratory mixed methods study characterizes two groups of informal caregivers in Ireland (n = 76) and the Netherlands (n = 58). In a semi-structured interview, quantitative data were collected in the form of standardized measures assessing psychological distress, quality of life and burden. Qualitative data were collected from an open ended question, in which caregivers identified positive aspects in their caregiving experience. These data types were purposefully mixed in the analysis and interpretation stages, to provide a greater depth of evidence through diverse research lenses. RESULTS The caregiver cohorts were predominantly female (69%) and spouse/partners (84%) of the person with ALS. Greater levels of self-assessed burden were found among the caregivers in the Netherlands (p < 0.05), and higher levels of quality of life among the cohort from Ireland (p < 0.05). Themes generated through qualitative analysis identified caregiver satisfaction, ability to meet the patient's needs and the (re) evaluation of meaning and existential aspects of life as positive aspects of caregiving. Existential factors were identified frequently by the caregivers in Ireland, and personal satisfaction and meeting their care recipient's needs by caregivers in the Netherlands. Three percent of all respondents reported there was nothing positive about caregiving. CONCLUSIONS Based on our findings, we suggest that both burden and the presence of positive factors should be evaluated and monitored. The possibility of concurrent positive and challenging experiences should be considered in the design and delivery of supportive interventions for informal caregivers.
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Affiliation(s)
- Polly Kennedy
- Academic Unit of NeurologySchool of MedicineTrinity College DublinDublinIreland
| | - Éilís Conroy
- Academic Unit of NeurologySchool of MedicineTrinity College DublinDublinIreland
| | - Mark Heverin
- Academic Unit of NeurologySchool of MedicineTrinity College DublinDublinIreland
| | - Iracema Leroi
- Department of Psychiatry St James' HospitalGlobal Brain Health InstituteTrinity College DublinDublinIreland
| | - Anita Beelen
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center Utrecht, and De Hoogstraat RehabilitationUtrechtThe Netherlands
| | - Leonard van den Berg
- Department of NeurologyUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Orla Hardiman
- Academic Unit of NeurologySchool of MedicineTrinity College DublinDublinIreland
- Department of NeurologyBeaumont HospitalDublinIreland
| | - Miriam Galvin
- Academic Unit of NeurologySchool of MedicineTrinity College DublinDublinIreland
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Chen YS, Beber BC, Higgins D, Galvin M, Ilinca S, Lawlor B, Leon T, Leroi I, McGlinchey E, Rogan C, Saha S, Tjin A, O'Sullivan R. COVID‐19‐related loneliness and social isolation in caregivers of people with brain health challenges: The CLIC‐Caregiver Global Survey. Alzheimers Dement 2021. [PMCID: PMC9011549 DOI: 10.1002/alz.054161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prior to COVID‐19, >90% of caregivers of people with brain health challenges (dementia, mental ill health, intellectual disability) experienced high levels of distress, burden, loneliness and social isolation. The COVID‐19 pandemic has significantly increased these impacts, particularly since these caregivers are often older and physically vulnerable themselves. The aim of this cross‐sectional study is to explore coping and caregiver burden, loneliness and social isolation in caregivers of people with brain health challenges during the COVID‐19 pandemic. Method CLIC‐Caregiver was a cross‐sectional, online, and global survey (June 2nd ‐ November 15th, 2020) using self‐administered questionnaires directed at informal caregivers of people with long‐term brain health challenges. The study was embedded within a larger survey of loneliness and social isolation for general public (‘Comparing Loneliness and Isolation in COVID‐19’ (CLIC)), including validated loneliness and isolation tools. Translated into ten different languages such as Arabic, French, Romanian, etc, the survey was disseminated over 100 countries. Respondents were included in the CLIC‐caregiver sub‐study if they answered yes to the question ‘Do you provide care and support to a family member or friend with a long‐term or life‐limiting health problem or disability (including mental health)’. The CLIC project received the initial global ethical approval from Ulster University. The data were fully anonymized. Result From the CLIC main study, 5243 (25%) identified themselves as caregivers. This proportion varied in different countries, from 12 % in Romania to 65% in France. 2323 (44%) had care recipients with dementia, 1761 with physical conditions (disability or long‐term illness), 832 with enduring mental health problems, and 404 with intellectual disability. Measures of caregiver burden, loneliness and social isolation will be compared across geographic regions, sociodemographic factors, and risk factors for poor outcomes sought. Findings will be distributed to relevant stakeholders in the form of a project report, with region and country‐specific outcomes. This will support recommendations and actions supporting caregivers of people with brain health challenges. Conclusion This represents the largest, most widespread survey on the impact of the COVID‐19 pandemic on caregivers of people with long‐term conditions to date. It will be an important resource for support agencies and to inform policy.
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Affiliation(s)
- Yaohua Sophie Chen
- CHRU Lille Lille France
- Global Brain Health Institute ‐Trinity College Dublin Ireland
- Université de Lille Lille France
| | - Bárbara Costa Beber
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | | | - Miriam Galvin
- Global Brain Health Institute, Trinity College Dublin Dublin Ireland
| | | | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin Ireland
- Trinity College Dublin Dublin Ireland
- St James Hospital Dublin Ireland
| | - Tomas Leon
- Global Brain Health Institute Dublin Ireland
- Memory and Neuropsychiatry Disorders Clinic (CMYN) Santiago Chile
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin Dublin Ireland
| | | | | | - Sanjib Saha
- Global Brain Health Institute Dublin Ireland
- Lund University Lund Sweden
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Tobin K, Maguire S, Corr B, Normand C, Hardiman O, Galvin M. Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers. BMC Health Serv Res 2021; 21:213. [PMID: 33750360 PMCID: PMC7941893 DOI: 10.1186/s12913-021-06191-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. METHODS A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant's choice. RESULTS Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. CONCLUSIONS The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.
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Affiliation(s)
- Katy Tobin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Sinead Maguire
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Roe L, Galvin M. Providing inclusive, person-centred care for LGBT+ older adults: A discussion on health and social care design and delivery. J Nurs Manag 2020; 29:104-108. [PMID: 33051942 PMCID: PMC7839502 DOI: 10.1111/jonm.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Abstract
Aim To examine how health system design and delivery can fail to support the needs of LGBT+ older adults. Background LGBT+ older adults face barriers in access to care, impacting their ability to receive person‐centred care in old age, which is central to the prevention and management of frailty, disability and disease. Evaluation Using a conceptual framework of access to care, this commentary illustrates issues LGBT+ older adults may face in accessing health and social care services in Ireland, and provides examples of how access may be improved from the published international literature. Key issue(s) Health policies, service design and delivery all impact on the ability of the health system to meet the needs of LGBT+ older adults across all levels and types of care. Conclusion Heteronormativity and discrimination must be addressed across the whole health system to achieve the health policy goal of supporting all older adults to enjoy health and well‐being. Implications for nursing management We suggest nursing professionals use a systems perspective to address the multilevel issues relating to care for LGBT+ older adults. Researchers in gerontological nursing should include the experiences and outcomes of service utilization for LGBT+ older adults in their research agenda.
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Affiliation(s)
- Lorna Roe
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Ireland.,Centre for Health Policy and Management, Trinity College Dublin, the University of Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin, Ireland
| | - Miriam Galvin
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, the University of Dublin, Ireland
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12
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Galvin M, Gavin T, Mays I, Heverin M, Hardiman O. Individual quality of life in spousal ALS patient-caregiver dyads. Health Qual Life Outcomes 2020; 18:371. [PMID: 33225955 PMCID: PMC7682006 DOI: 10.1186/s12955-020-01551-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background Quality of life is a basic goal of health and social care. The majority of people with Amyotrophic Lateral Sclerosis (ALS) are cared for at home by family caregivers. It is important to recognize the factors that contribute to quality of life for individuals to better understand the lived experiences in a condition for which there is currently no curative treatment. Aim To explore individual quality of life of people with ALS and their informal caregivers over time. Methods Over three semi-structured home interviews, 28 patient-caregiver dyads provided information on a range of demographic and clinical features, psychological distress, caregiver burden, and individual quality of life. Quality of life data were analysed using quantitative and qualitative methods with integration at the analysis and interpretation phases. Results Individual Quality of Life was high for patients and caregivers across the interviews series, and higher among patients than their care partners at each time point. Family, hobbies and social activities were the main self-defined contributors to quality of life. The importance of health declined relative to other areas over time. Friends and finances became less important for patients, but were assigned greater importance by caregivers across the illness trajectory. Psychological distress was higher among caregivers. Caregiver burden consistently increased. Conclusion The findings from this study point to the importance of exploring and monitoring quality of life at an individual level. Self-defined contributory factors are relevant to the individual within his/her context. As an integrated outcome measure individual quality of life should be assessed and monitored as part of routine clinical care during the clinical encounter. This can facilitate conversations between health care providers, patients and families, and inform interventions and contribute to decision support mechanisms. The ascertainment of self-defined life quality, especially in progressive neurodegenerative conditions, mean health care professionals are in a better position to provide person-centred care.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.
| | - Tommy Gavin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Iain Mays
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,National ALS/MND Centre, Beaumont Hospital, Dublin, Ireland
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13
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Roe L, Galvin M, Booi L, Brandao L, Leon Salas J, McGlinchey E, Walrath D. To live and age as who we really are: Perspectives from older LGBT+ people in Ireland. HRB Open Res 2020; 3:6. [PMID: 32296753 PMCID: PMC7141166 DOI: 10.12688/hrbopenres.12990.2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
This Open Letter discusses the theme of ‘diversity in brain health’ in research, practice and policy for older LGBT+ people. It is written by a multidisciplinary group of Atlantic Fellows for Equity in Brain Health at the Global Brain Health Institute in Trinity College Dublin (TCD), from a variety of disciplines (health economics, human geography, anthropology, psychology, gerontology) and professions (researcher, clinicians, writers, practicing artists). The group developed a workshop to explore the theme of ‘Diversity and Brain Health’ through the lens of lesbian, gay, bisexual, transgender/transsexual plus (LGBT+). . Guided by two advisors (Prof Agnes Higgins, TCD; Mr Ciaran McKinney, Age and Opportunity), we invited older LGBT+ people and those interested in the topic of LGBT+ and ageing, healthcare providers, policy makers and interested members of the research community. We partnered with colleagues in the School of Law to include socio-legal perspectives. Following the workshop, Roe and Walrath wrote an opinion editorial, published in the
Irish Times during the 2019 PRIDE festival, and were subsequently invited by HRB Open Research to provide a more detailed expansion of that work. In this Open Letter we describe the theme of ‘diversity and brain health’ and some of the lessons we learned from listening to the lived experience of older LGBT+ people in Ireland today. We illustrate why it’s important to understand the lived experience of older LGBT+ people and highlight the failure of the State to evaluate the experience of LGBT+ people in policy implementation. We call on researchers, clinicians, service planners and policy makers, to recognize and address diversity as an important way to address health inequities in Ireland.
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Affiliation(s)
- Lorna Roe
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,Centre for Health Policy and Management, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Miriam Galvin
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Laura Booi
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,Discipline of Clinical Medicine, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Lenisa Brandao
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,Department of Health and Human Communication, Psychology Institute, Federal University of Rio Grande do Sul, Porte Alegre, Brazil
| | - Jorge Leon Salas
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Eimear McGlinchey
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Dana Walrath
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland
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Brizzi KT, Bridges JFP, Yersak J, Balas C, Thakur N, Galvin M, Hardiman O, Heatwole C, Ravits J, Simmons Z, Bruijn L, Chan J, Bedlack R, Berry JD. Understanding the needs of people with ALS: a national survey of patients and caregivers. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:355-363. [DOI: 10.1080/21678421.2020.1760889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kate T. Brizzi
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, MA, USA,
| | | | | | | | | | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Chad Heatwole
- Medical Center, University of Rochester, Rochester, NY, USA,
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, CA, USA,
| | | | - Lucie Bruijn
- Translational Medicine, EMEA, AVeXis, London, UK,
| | - James Chan
- Center for Biostatistics, Massachusetts General Hospital, Boston, MA, USA,
| | - Richard Bedlack
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - James D. Berry
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
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15
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Antoniadi AM, Galvin M, Heverin M, Hardiman O, Mooney C. Prediction of caregiver burden in amyotrophic lateral sclerosis: a machine learning approach using random forests applied to a cohort study. BMJ Open 2020; 10:e033109. [PMID: 32114464 PMCID: PMC7050406 DOI: 10.1136/bmjopen-2019-033109] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease that is characterised by the rapid degeneration of upper and lower motor neurons and has a fatal trajectory 3-4 years from symptom onset. Due to the nature of the condition patients with ALS require the assistance of informal caregivers whose task is demanding and can lead to high feelings of burden. This study aims to predict caregiver burden and identify related features using machine learning techniques. DESIGN This included demographic and socioeconomic information, quality of life, anxiety and depression questionnaires, for patients and carers, resource use of patients and clinical information. The method used for prediction was the Random forest algorithm. SETTING AND PARTICIPANTS This study investigates a cohort of 90 patients and their primary caregiver at three different time-points. The patients were attending the National ALS/Motor Neuron Disease Multidisciplinary Clinic at Beaumont Hospital, Dublin. RESULTS The caregiver's quality of life and psychological distress were the most predictive features of burden (0.92 sensitivity and 0.78 specificity). The most predictive features for Clinical Decision Support model were associated with the weekly caregiving duties of the primary caregiver as well as their age and health and also the patient's physical functioning and age of onset. However, this model had a lower sensitivity and specificity score (0.84 and 0.72, respectively). The ability of patients without gastrostomy to cut food and handle utensils was also highly predictive of burden in this study. Generally, our models are better in predicting the high-risk category, and we suggest that information related to the caregiver's quality of life and psychological distress is required. CONCLUSION This work demonstrates a proof of concept of an informatics solution to identifying caregivers at risk of burden that could be incorporated into future care pathways.
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Affiliation(s)
- Anna Markella Antoniadi
- UCD School of Computer Science, University College Dublin, Dublin, Ireland
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
| | - Orla Hardiman
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
| | - Catherine Mooney
- UCD School of Computer Science, University College Dublin, Dublin, Ireland
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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16
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Roe L, Galvin M, Booi L, Brandao L, Leon Salas J, McGlinchey E, Walrath D. To live and age as who we really are. HRB Open Res 2020; 3:6. [DOI: 10.12688/hrbopenres.12990.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 11/20/2022] Open
Abstract
This Open Letter discusses the theme of ‘diversity in brain health’ in research, practice and policy for older LGBT+ people. It is written by a multidisciplinary group of Atlantic Fellows for Equity in Brain Health at the Global Brain Health Institute in Trinity College Dublin (TCD), from a variety of disciplines (health economics, human geography, anthropology, psychology, gerontology) and professions (researcher, clinicians, writers, practicing artists). The group developed a workshop to explore the theme of ‘Diversity and Brain Health’ through the lens of non-normative gender identities and sexualities. Guided by two advisors (Prof Agnes Higgins, TCD; Mr Ciaran McKinney, Age and Opportunity), we invited older LGBT+ people and those interested in the topic of LGBT+ and ageing, healthcare providers, policy makers and interested members of the research community. We partnered with colleagues in the School of Law to include socio-legal perspectives. Following the workshop, Roe and Walrath wrote an opinion editorial, published in the Irish Times during the 2019 PRIDE festival, and were subsequently invited by HRB Open Access to provide a more detailed expansion of that work. In this Open Letter we describe the theme of ‘diversity and brain health’ and some of the lessons we learned from listening to the lived experience of older LGBT+ people in Ireland today. We illustrate why it’s important to understand the lived experience of older LGBT+ people and highlight the failure of the State to evaluate the experience of LGBT+ people in policy implementation. We call on researchers, clinicians, service planners and policy makers, to recognize and address diversity as an important way to address health inequities in Ireland.
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17
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Burke T, Wilson O'Raghallaigh J, Maguire S, Galvin M, Heverin M, Hardiman O, Pender N. Group interventions for amyotrophic lateral sclerosis caregivers in Ireland: a randomised controlled trial protocol. BMJ Open 2019; 9:e030684. [PMID: 31542756 PMCID: PMC6756338 DOI: 10.1136/bmjopen-2019-030684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a rapid and fatal motor disease marked by progressive physical impairment due to muscle weakness and wasting. It is multidimensional with many patients presenting with cognitive and/or behavioural impairment. Caregivers of patients with ALS, commonly non-paid immediate family members, often take primary responsibility for the complex care needs of patients in non-medicalised setting, and many as a consequence experience caregiver burden, anxiety, and/or depression. METHODS AND ANALYSIS This randomised controlled trial (RCT) will use randomisation to allocate n=75 caregivers of patients with ALS from the national ALS clinic into three groups with an equal distribution. The RCT consists of two intervention groups and a wait list control (treatment as usual [TAU]) group. The intervention arms of the trial consist of a 'mindfulness-based stress reduction' and 'building better caregivers' manualised group-based intervention, with 9 and 6 weekly sessions, respectively. The TAU group will have access to intervention at the end of the trial period. Primary outcomes are self-report questionnaires on anxiety and depression symptoms, with caregiver burden and quality of life considered secondary outcomes. Assessment will commence at baseline, immediately following the intervention period, and after a period of 12 weeks to assess the effectiveness and efficacy of participating in an intervention. Patient cognitive and behavioural data will also be considered. Means of treatment and control groups at Time 0 and 1 will be analysed using mixed model multivariate analysis of variance followed by analysis of variance, and treatment effect-sizes will be calculated. This RCT protocol is pre-results and has been registered with an international database resulting in an International Standard Randomised Controlled Trials Number (ISRCTN53226941). ETHICS AND DISSEMINATION Ethics approval was obtained from the Beaumont Hospital Medical Research Ethics Committee. Results of the main trial will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
| | | | - Sinead Maguire
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, University of Dublin Trinity College, Dublin, Ireland
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18
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Thurn T, Borasio GD, Chiò A, Galvin M, McDermott CJ, Mora G, Sermeus W, Winkler AS, Anneser J. Physicians' attitudes toward end-of-life decisions in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:74-81. [PMID: 30789031 DOI: 10.1080/21678421.2018.1536154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims (1) to assess physicians' attitudes toward different palliative end-of-life (EOL) practices in amyotrophic lateral sclerosis (ALS) care, including forgoing artificial nutrition and hydration (FANH), continuous sedation until death (CSD), and withdrawing invasive ventilation (WIV), and toward physician-assisted dying (PAD) including physician-assisted suicide and euthanasia and (2) to explore variables influencing these attitudes. METHODS We used two clinical vignettes depicting ALS patients in different stages of their disease progression to assess the influence of suffering (physical/psycho-existential) on attitudes toward WIV and the influence of suffering and prognosis (short-term/long-term) on attitudes toward FANH, CSD, and PAD. RESULTS 50 physicians from European ALS centers and neurological departments completed our survey. Short-term prognosis had a positive impact on attitudes toward offering FANH (p = 0.014) and CSD (p = 0.048) as well as on attitudes toward performing CSD (p = 0.036) and euthanasia (p = 0.023). Predominantly psycho-existential suffering was associated with a more favorable attitude toward WIV but influenced attitudes toward performing CSD negatively. Regression analysis showed that religiosity was associated with more reluctant attitudes toward palliative EOL practices and PAD, whereas training in palliative care was associated with more favorable attitudes toward palliative EOL practices only. CONCLUSION ALS physicians seem to acknowledge psycho-existential suffering as a highly acceptable motive for WIV but not CSD. Physicians appear to be comfortable with responding to the patient's requests, but more reluctant to assume a proactive role in the decision-making process. Palliative care training may support ALS physicians in these challenging situations.
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Affiliation(s)
- Tamara Thurn
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
| | - Gian Domenico Borasio
- b Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV) , University of Lausanne , Lausanne , Switzerland
| | - Adriano Chiò
- c Department of Neuroscience "Rita Levi Montalcini" , University of Turin , Turin , Italy
| | - Miriam Galvin
- d Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Dublin , Ireland
| | - Christopher J McDermott
- e Sheffield Institute for Translational Neuroscience , University of Sheffield , Sheffield , United Kingdom
| | | | - Walter Sermeus
- g Leuven Institute for Healthcare Policy , KU Leuven , Leuven , Belgium
| | - Andrea S Winkler
- h Department of Neurology, Klinikum rechts der Isar , Technical University Munich , Munich , Germany.,i Centre for Global Health, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Johanna Anneser
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
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Vickers A, Carter L, Galvin M, Carter M, Franklin L, Morris K, Pierce J, Frese K, Blackhall F, Dive C. MA22.03 SCLC Circulating Tumour Cell Derived Explants: The Clinical Characteristics of Patients Whose Samples Generate CDX. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.503] [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: 11/17/2022]
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20
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Rack S, Brady G, Wallace A, Galvin M, Frese K, Krebs M, Dive C, Rothwell D, Ayub M, Cook N. Molecular profiling of tumour and ctDNA in a gastrointestinal cancer cohort at an academic cancer centre. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.010] [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: 11/13/2022] Open
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21
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Burke T, Hardiman O, Pinto-Grau M, Lonergan K, Heverin M, Tobin K, Staines A, Galvin M, Pender N. Longitudinal predictors of caregiver burden in amyotrophic lateral sclerosis: a population-based cohort of patient-caregiver dyads. J Neurol 2018; 265:793-808. [PMID: 29396678 DOI: 10.1007/s00415-018-8770-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Caregiver burden is a recognised consequence of caring for a patient with neurodegeneration. Amyotrophic lateral sclerosis (ALS) differs from other neurodegenerations by its rapid progression and impairment of motor, cognitive, and behavioural function, which contribute to caregiver burden. However, longitudinal factors that determine the extent of caregiver burden, and in particular the impact of psychological distress among caregivers, have not been fully established. METHODS Patients with ALS (n = 85) and their primary caregivers (n = 85) completed three serial evaluations. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The Edinburgh Cognitive-Behavioural ALS Screen (ECAS) was used to determine cognitive function in patients. The ALS Functional Rating Scale (ALSFRS-R) measured disease progression. RESULTS Using the ZBI, caregivers were categorised as high or low burden. In the low burden group, anxiety scores from the HADS predicted caregiver burden (r = 0.410, F = 3.73, p = 0.033), whereas the depression sub-score from the HADS was predictive of caregiver burden in the high burden group (r = 0.501, F = 5.87, p = 0.006) for cross-sectional analyses. Longitudinally, an elevated score on the HADS at Time 1 was the largest predictor of caregiver burden across serial assessments. CONCLUSION In a patient cohort with relatively preserved cognitive function (65%), anxiety and depression at Time 1, as measured by the HADS, were the best predictors of caregiver burden at Time 3. This observation provides a mechanism by which caregiver burden can be identified by health-care professionals and a stepped care programme of intervention initiated.
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Affiliation(s)
- Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.,Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - Marta Pinto-Grau
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Katie Lonergan
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Katy Tobin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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Abstract
OBJECTIVES Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is a debilitating terminal condition. Informal caregivers are key figures in ALS care provision. The physical, psychological and emotional impact of providing care in the home requires appropriate assistance and support. The objective of this analysis is to explore the needs of informal ALS caregivers across the caregiving course. DESIGN In an open-ended question as part of a semistructured interview, caregivers were asked what would help them in their role. Interviews took place on three occasions at 4-month to 6-month intervals. Demographic, burden and quality of life data were collected, in addition to the open-ended responses. We carried out descriptive statistical analysis and thematic analysis of qualitative data. SETTING AND PARTICIPANTS Home interviews at baseline (n=81) and on two further occasions (n=56, n=41) with informal caregivers of people with ALS attending the National ALS/MND Clinic at Beaumont Hospital, Dublin, Ireland. RESULTS The majority of caregivers were family members. Hours of care provided and caregiver burden increased across the interview series. Thematic analysis identified what would help them in their role, and needs related to external support and services, psychological-emotional factors, patient-related behaviours, a cure and 'nothing'. Themes were interconnected and their prevalence varied across the interview time points. CONCLUSION This study has shown the consistency and adaptation in what caregivers identified as helpful in their role, across 12-18 months of a caregiving journey. Support needs are clearly defined, and change with time and the course of caregiving. Caregivers need support from family, friends and healthcare professionals in managing their tasks and the emotional demands of caregiving. Identifying the specific needs of informal caregivers should enable health professionals to provide tailored supportive interventions.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Sile Carney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
| | - Iain Mays
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
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23
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Galvin M, Ryan P, Maguire S, Heverin M, Madden C, Vajda A, Normand C, Hardiman O. The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population- based study of consultations, interventions and costs. PLoS One 2017. [PMID: 28640860 PMCID: PMC5480998 DOI: 10.1371/journal.pone.0179796] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Amyotrophic Lateral Sclerosis (ALS) is a devastating neurological condition that requires coordinated, multidisciplinary clinical management. ALS is prone to misdiagnosis as its signs and symptoms may be non-specific, which may prolong patients’ journey to multidisciplinary ALS care. Methods Using chart review and national register data, we have detailed the journey of a national cohort of ALS patients (n = 155) from the time of first symptom to presentation at a multidisciplinary clinic (MDC). Key milestones were analysed, including frequency of consultations, clinical interventions, and associated economic cost. Results A majority of patients was male (60%), 65 years of age and over (54%), and had spinal onset ALS (72%). Time from onset of first symptoms to ALS diagnosis was a mean of 15.1 months (median, 11). There was a mean interval of 17.4 months (median 12.5) from first symptoms to arrival at the MDC, and a mean of 4.09 (median, 4) consultations with health care professionals. Electromyography and nerve conduction studies were among the most common interventions. Direct referral by a general practitioner (GP) to a neurologist was associated with reduced cost, but not reduced diagnostic delay. Bulbar ALS was associated with shorter time from symptom onset to diagnosis. Neurologist consultation in the first three consultations was associated with lower costs prior to the ALS clinic attendance but not a shorter time from first symptom to final diagnosis. Mean cost prior to attending the MDC was €3,486 per patient. Conclusions Expedited referral to the multidisciplinary ALS clinic would have reduced costs by an estimated €2,072 per patient. Development of a standardised pathway with early referral to neurology of patients with suspected symptoms of ALS could limit unnecessary interventions and reduce cost of care.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- * E-mail:
| | - Padhraig Ryan
- Department of Health Policy and Management, Trinity College Dublin, Ireland
| | - Sinead Maguire
- National ALS ClinicDepartment of Neurology, National Neuroscience Centre Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Caoifa Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Charles Normand
- Department of Health Policy and Management, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- National ALS ClinicDepartment of Neurology, National Neuroscience Centre Beaumont Hospital, Dublin, Ireland
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Cove-Smith L, Schmitt M, Dive C, Backen A, Mescallado N, Roberts R, Mellor H, Morris D, Naish J, Jackson A, Kirk J, Hargreaves A, Galvin M, Smith S, Brocklehurst S, Price S, Betts C, Hockings P, Woodhouse N, Radford J, Linton K. 019 Chemotherapy-induced cardiotoxicity: could a translational cardiac MRI model help identify patients at risk? Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Galvin M, Gaffney R, Corr B, Mays I, Hardiman O. From first symptoms to diagnosis of amyotrophic lateral sclerosis: perspectives of an Irish informal caregiver cohort-a thematic analysis. BMJ Open 2017; 7:e014985. [PMID: 28320799 PMCID: PMC5372020 DOI: 10.1136/bmjopen-2016-014985] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Informal caregivers play an integral part in the management of amyotrophic lateral sclerosis (ALS). The objective of this study was to explore the journey from first problem symptoms to diagnosis from the perspective of informal caregivers providing care to people with ALS. DESIGN As part of a semistructured interview, information was collected on a range of caregiver demographic details, and from an open-ended question their experiences of the time of symptom onset to diagnosis. We carried out descriptive statistical analysis and thematic analysis of qualitative data. SETTING AND PARTICIPANTS Home interviews with informal caregivers (n=74) of people with ALS attending the National ALS/Motor Neuron Disease Clinic at Beaumont Hospital, Dublin, Ireland. RESULTS This was a largely female and spousal cohort of caregivers, living with the patient for whom they provided informal care. The majority of patients were men and were spinal onset. Caregivers described the time from first symptoms to diagnosis. Using a primarily inductive approach, the coding was data driven and the codes and themes derived from the content of these descriptions. Two main themes were identified (1) problem signs and symptoms (A) noticing and (B) reaction; (2) interaction with the health services. CONCLUSIONS Exploring the perspectives of caregivers from first problem symptoms to diagnosis provides valuable insights into the development of the condition, impediments to its recognition, help-seeking behaviours and interactions with healthcare services. The journey from early symptoms to diagnosis is important for future decision-making, affects readiness for caregiving and could negatively impact on caregiver health and well-being. The early acknowledgement by healthcare professionals of stressors along the journey to diagnosis, and appreciation of their possible impact on caregivers is important. The separate needs of caregivers should be assessed on a regular basis.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Rebecca Gaffney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Iain Mays
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland
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26
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Burke T, Galvin M, Pinto-Grau M, Lonergan K, Madden C, Mays I, Carney S, Hardiman O, Pender N. Caregivers of patients with amyotrophic lateral sclerosis: investigating quality of life, caregiver burden, service engagement, and patient survival. J Neurol 2017; 264:898-904. [PMID: 28280986 DOI: 10.1007/s00415-017-8448-5] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
Few studies in amyotrophic lateral sclerosis (ALS) have profiled disease-specific features of the condition in conjunction with assessment of caregivers' burden, distress, quality of life, and investigated patient survival. Eighty-four ALS patients and their primary caregivers were enrolled. Patients completed ALS-specific measures of physical and cognitive function, while caregivers completed measures of anxiety, depression, caregiver burden, and quality of life. Patient-caregiver dyads were interviewed about their health-service utilisation. Survival data were obtained through the Irish register for ALS. Participants were dichotomised into low/high groups according to the severity of self-reported caregiver burden, based on statistically derived cut-off scores. High-burdened caregivers (n = 43) did not significantly differ from low-burdened caregivers (n = 41) with respect to disease-specific characteristics, i.e., ALSFRS-R, bulbar- or spinal-onset ALS, disease duration, or survival data. However, significant differences were reported on subjective measures of anxiety (p < 0.000), depression (p < 0.001), distress (p < 0.000), and quality of life (p < 0.000). These data demonstrate the limited impact of ALS patient-related variables, i.e., ALSFRS-R and onset, on caregiver burden in ALS, and identify the importance of the psychological composition of caregivers. This study suggests that the subjective experience of individual caregivers is an important factor influencing the severity of experienced caregiver burden.
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Affiliation(s)
- Tom Burke
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.
| | - Miriam Galvin
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Marta Pinto-Grau
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Katie Lonergan
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Caoifa Madden
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Iain Mays
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Sile Carney
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Orla Hardiman
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - Niall Pender
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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27
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Galvin M, Corr B, Madden C, Mays I, McQuillan R, Timonen V, Staines A, Hardiman O. Caregiving in ALS - a mixed methods approach to the study of Burden. BMC Palliat Care 2016; 15:81. [PMID: 27596749 PMCID: PMC5011853 DOI: 10.1186/s12904-016-0153-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 01/23/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Background Caregiver burden affects the physical, psychological and emotional well-being of the caregiver. The purpose of this analysis was to describe an informal caregiver cohort (n = 81), their subjective assessment of burden and difficulties experienced as a result of providing care to people with Amyotrophic Lateral Sclerosis (ALS). Methods Using mixed methods of data collection and analysis, we undertook a comprehensive assessment of burden and difficulties associated with informal caregiving in ALS. As part of a semi-structured interview a series of standardised measures were used to assess quality of life, psychological distress and subjective burden, and in an open-ended question caregivers were asked to identify difficult aspects of their caregiving experience. Results The quantitative data show that psychological distress, hours of care provided and lower quality of life, were significant predictors of caregiver burden. From the qualitative data, the caregiving difficulties were thematised around managing the practicalities of the ALS condition, the emotional and psychosocial impact; limitation and restriction, and impact on relationships. Conclusions The collection and analysis of quantitative and qualitative data better explores the complexity of caregiver burden in ALS. Understanding the components of burden and the difficulties experienced as a result of caring for someone with ALS allows for better supporting the caregiver, and assessing the impact of burden on the care recipient. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0153-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Galvin
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Caoifa Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Iain Mays
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Regina McQuillan
- Beaumont Hospital, Dublin 9, Ireland.,St Francis Hospice, Raheny, Dublin 5, Ireland
| | - Virpi Timonen
- School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland
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28
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Williamson S, Trapani F, Abbott B, Galvin M, Metcalf R, Hendrix M, Blackhall F, Frese K, Simpson K, Dive C. The role of vasculogenic mimicry in small cell lung cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Morrow CJ, Trapani F, Metcalf RL, Bertolini G, Hodgkinson CL, Khandelwal G, Kelly P, Galvin M, Carter L, Simpson KL, Williamson S, Wirth C, Simms N, Frankliln L, Frese KK, Rothwell DG, Nonaka D, Miller CJ, Brady G, Blackhall FH, Dive C. Tumourigenic non-small-cell lung cancer mesenchymal circulating tumour cells: a clinical case study. Ann Oncol 2016; 27:1155-1160. [PMID: 27013395 PMCID: PMC4880063 DOI: 10.1093/annonc/mdw122] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 11/09/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Over the past decade, numerous reports describe the generation and increasing utility of non-small-cell lung cancer (NSCLC) patient-derived xenografts (PDX) from tissue biopsies. While PDX have proven useful for genetic profiling and preclinical drug testing, the requirement of a tissue biopsy limits the available patient population, particularly those with advanced oligometastatic disease. Conversely, 'liquid biopsies' such as circulating tumour cells (CTCs) are minimally invasive and easier to obtain. Here, we present a clinical case study of a NSCLC patient with advanced metastatic disease, a never smoker whose primary tumour was EGFR and ALK wild-type. We demonstrate for the first time, tumorigenicity of their CTCs to generate a patient CTC-derived eXplant (CDX). PATIENTS AND METHODS CTCs were enriched at diagnosis and again 2 months later during disease progression from 10 ml blood from a 48-year-old NSCLC patient and implanted into immunocompromised mice. Resultant tumours were morphologically, immunohistochemically, and genetically compared with the donor patient's diagnostic specimen. Mice were treated with cisplatin and pemetrexed to assess preclinical efficacy of the chemotherapy regimen given to the donor patient. RESULTS The NSCLC CDX expressed lung lineage markers TTF1 and CK7 and was unresponsive to cisplatin and pemetrexed. Examination of blood samples matched to that used for CDX generation revealed absence of CTCs using the CellSearch EpCAM-dependent platform, whereas size-based CTC enrichment revealed abundant heterogeneous CTCs of which ∼80% were mesenchymal marker vimentin positive. Molecular analysis of the CDX, mesenchymal and epithelial CTCs revealed a common somatic mutation confirming tumour origin and showed CDX RNA and protein profiles consistent with the predominantly mesenchymal phenotype. CONCLUSIONS This study shows that the absence of NSCLC CTCs detected by CellSearch (EpCAM(+)) does not preclude CDX generation, highlighting epithelial to mesenchymal transition and the functional importance of mesenchymal CTCs in dissemination of this disease.
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Affiliation(s)
- C J Morrow
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - F Trapani
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - R L Metcalf
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - G Bertolini
- Tumour Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C L Hodgkinson
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - G Khandelwal
- RNA Biology Group, University of Manchester, Manchester
| | - P Kelly
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - M Galvin
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - L Carter
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - K L Simpson
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - S Williamson
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - C Wirth
- Computational Biology Support Team, Cancer Research UK Manchester Institute, University of Manchester, Manchester
| | - N Simms
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - L Frankliln
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - K K Frese
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - D G Rothwell
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - D Nonaka
- The Christie NHS Foundation Trust, Manchester
| | - C J Miller
- RNA Biology Group, University of Manchester, Manchester
| | - G Brady
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK
| | - F H Blackhall
- The Christie NHS Foundation Trust, Manchester; Institute of Cancer Sciences, University of Manchester, Manchester; Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - C Dive
- Clinical and Experimental Pharmacology Group, University of Manchester, Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK.
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30
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Rooney J, Heverin M, Vajda A, Burke T, Galvin M, Tobin K, Elamin M, Staines A, Hardiman O. Survival analysis of geospatial factors in the Irish ALS cohort. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:555-560. [PMID: 27145090 DOI: 10.1080/21678421.2016.1179326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Variations in environmental risk factors potentially influence incidence and progression in complex multifactorial diseases. Few studies have examined the association of survival in amyotrophic lateral sclerosis (ALS) with environmental geospatial variables. Here we use data from the Irish ALS cohort to perform such an analysis. Geographic data sources were used to generate small area values for four geospatial variables (population density, social deprivation, distance to coast, and distance to ALS multidisciplinary (MDT) clinic) for each ALS case on the Irish ALS register. These were combined with follow-up data and used as covariates in Royston-Parmar regression survival analysis including age of onset, site of onset, diagnostic delay, riluzole prescription and MDT clinic attendance as covariates. One thousand, two hundred and thirty-two patients with median survival of 2.31 years from disease onset were included. After addition of the individual geospatial variables in turn, none of the four variables was found to be associated with survival with a p-value <0.05. The results may reflect the public healthcare system that provides riluzole prescription and access to the MDT to all patients free of charge, and is also congruent with our recent finding that social deprivation is not associated with ALS incidence in Ireland.
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Affiliation(s)
- James Rooney
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Mark Heverin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Alice Vajda
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Tom Burke
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin.,c Beaumont Hospital , Dublin , Ireland
| | - Miriam Galvin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin.,b School of Nursing And Human Sciences , Dublin City University , Dublin , and
| | - Katy Tobin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Marwa Elamin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Anthony Staines
- b School of Nursing And Human Sciences , Dublin City University , Dublin , and
| | - Orla Hardiman
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin.,c Beaumont Hospital , Dublin , Ireland
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Galvin M, Madden C, Maguire S, Heverin M, Vajda A, Staines A, Hardiman O. Patient journey to a specialist amyotrophic lateral sclerosis multidisciplinary clinic: an exploratory study. BMC Health Serv Res 2015; 15:571. [PMID: 26700026 PMCID: PMC4690216 DOI: 10.1186/s12913-015-1229-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022] Open
Abstract
Background The multidisciplinary approach in the management of Amyotrophic Lateral Sclerosis (ALS) has been shown to provide superior care to devolved care, with better survival, improved quality of care, and quality of life. Access to expert multidisciplinary management should be a standard for patients with ALS. This analysis explores the patient journey from symptom onset and first engagement with health services, to the initial visit to a specialist ALS Multidisciplinary Clinic (MDC) in Dublin, Ireland. Methods A retrospective exploratory multi-method study details the patient journey to the MDC. Data from medical interviews and systematic chart review identifies interactions with the health services and key timelines for thirty five new patients presenting with a diagnosis of ALS during a 6 month period in 2013. Results The time from first symptom to diagnosis was a mean of 16 months (median 13 months), with a mean interval of 19 months (median 14.6) from first symptoms to arrival at the MDC. The majority of patients were seen by a general practitioner, and subsequently by neurology services. There was an average of four contacts with health services and 4.8 investigations/tests, prior to their first Clinic visit. On the first visit to the MDC patients are linked into an integrated ‘system’ that can provide specialist care and link with voluntary, palliative and community services as required. Conclusions Engagement with a multidisciplinary team has implications for service utilization and quality of life of patients and their families. We have demonstrated that barriers exist that delay referral to specialist services. Comprehensive data recording and collection, using multiple data sources can reconstruct the timelines of the patient journey, which can in turn be used to identify pathways that can expedite early referral to specialist services.
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Affiliation(s)
- M Galvin
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - C Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - S Maguire
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland.
| | - M Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - A Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - A Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland.
| | - O Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland.
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Villatte G, Erivan R, Fournier PL, Pereira B, Galvin M, Descamps S, Boisgard S. Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure™) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5years follow-up. Orthop Traumatol Surg Res 2015; 101:953-7. [PMID: 26596418 DOI: 10.1016/j.otsr.2015.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/18/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial opening-wedge high tibial osteotomy (OWHTO) provides reliable and long-lasting benefits, despite the wide range of wedge-filling and internal-fixation techniques used. The purpose of this work was to assess the clinical and radiological outcomes in a case-series of OWHTO performed using a secure bone allograft and locked plate fixation. HYPOTHESIS The clinical and radiological outcomes of OWHTO with a high-safety bone allograft and locked plate fixation are similar to those reported in previous case-series studies. MATERIALS AND METHODS A single-centre retrospective design was used to study 69 knees in 64 patients with a mean age of 51.8years (31-53years) and a preoperative hip-knee-ankle (HKA) angle of 173° (165°-180°). The wedge was filled with secure Osteopure™ bone allograft and fixation was achieved using an Integra Surfix(®) locked plate. Mean follow-up was 7.5years (5-9.3years). Clinical and functional outcomes were assessed by determining the IKS and KOOS-PS scores and recording complications related or unrelated to the allograft. The main criterion for assessing OWHTO survival was the time to revision surgery for symptom recurrence. Radiological assessment criteria were the HKA angle, tibial slope, patellar height, and osteoarthritis grade. GESTO criteria were used to evaluate the behaviour of the allograft. RESULTS Of the 69 knees, 64 (92.8%) were re-evaluated. The survival rate after 9.3years was 95%±2.7% (3 failures managed with arthroplasty). The functional IKS score improved significantly, by 20 points (P<0.001). Mean increases of 7.8° for the HKA angle and 3.5° for tibial slope were recorded. Bone healing without radiological abnormalities was consistently achieved within 6months. There were no complications related to the allograft (infections, allergies; local or systemic toxicity). DISCUSSION The clinical, radiological, and safety outcomes documented in our study were similar to those reported in earlier work. LEVEL OF EVIDENCE IV, retrospective case-series study.
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Affiliation(s)
- G Villatte
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - R Erivan
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P-L Fournier
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - B Pereira
- Service Biostatistique, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Galvin
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - S Descamps
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Laboratoire C-Biosenss, EA 4676, Université d'Auvergne 1, 63000 Clermont-Ferrand, France
| | - S Boisgard
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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Burke T, Elamin M, Galvin M, Hardiman O, Pender N. Caregiver burden in amyotrophic lateral sclerosis: a cross-sectional investigation of predictors. J Neurol 2015; 262:1526-32. [PMID: 25904206 DOI: 10.1007/s00415-015-7746-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/20/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
The objective of the study was to investigate whether cognitive and behavioural impairment in Amyotrophic Lateral Sclerosis (ALS) contributes to caregiver burden, and whether carer burden affects patient outcome. Thirty-three dyads of incident patients with ALS and their primary caregivers (n = 33) completed a series of measures to determine cognitive and behavioural profiles, (patients) and carer burden (carers) to investigate the psychological impact of ALS, and the impact of behavioural change since the onset of ALS. Caregivers were divided into high- and low-burden groups using previously established norms. High burden in carers was associated with significantly higher apathy (p = 0.009), disinhibition (p = 0.005), and executive dysfunction (p = 0.015) in patients. Regression analyses for burden confirmed significant predictors such as change in apathy (r = 0.390, F = 5.19, p = 0.03), disinhibition (r = 0.530, F = 11.32, p = 0.002), and executive dysfunction (r = 0.372, F = 4.66, p = 0.039), with total behaviour change contributing to 31 % of caregiver burden (r = 0.563, F = 4.17, p = 0.015). Total distress as measured by the Hospital Anxiety and Depression Scale was also a significant predictor of caregiver burden, contributing to 38.5 % of variance (r = 0.621, F = 18.79, p < 0.000). Caregiver burden did not affect survival (p = 0.496). Caregiver burden in ALS is modulated by patient's cognitive and behavioural status, but does not significantly impact patient survival.
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Affiliation(s)
- Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland,
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Abstract
Most health-care professionals are trained to promote and maintain life and often have difficulty when faced with the often rapid decline and death of people with terminal illnesses such as amyotrophic lateral sclerosis (ALS). By contrast, data suggest that early and open discussion of end-of-life issues with patients and families allows time for reflection and planning, can obviate the introduction of unwanted interventions or procedures, can provide reassurance, and can alleviate fear. Patients' perspectives regarding end-of-life interventions and use of technologies might differ from those of the health professionals involved in their care, and health-care professionals should recognise this and respect the patient's autonomy. Advance care directives can preserve autonomy, but their legal validity and use varies between countries. Clinical management of the end of life should aim to maximise quality of life of both the patient and caregiver and, when possible, incorporate appropriate palliation of distressing physical, psychosocial, and existential distress. Training of health-care professionals should include the development of communication skills that help to sensitively manage the inevitability of death. The emotional burden for health-care professionals caring for people with terminal neurological disease should be recognised, with structures and procedures developed to address compassion, fatigue, and the moral and ethical challenges related to providing end-of-life care.
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Affiliation(s)
- Sheelah Connolly
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin 2, Republic of Ireland.
| | - Miriam Galvin
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Republic of Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin 2, Republic of Ireland; Department of Neurology, Beaumont Hospital, Beaumont Road, Dublin 9, Republic of Ireland
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Palazzo C, Jourdan C, Descamps S, Nizard R, Anract P, Hamadouche M, Boisgard S, Galvin M, Ravaud P, Poiraudeau S. Fulfilment of patients’ and surgeons’ expectations in total hip arthroplasty. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.268] [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: 10/26/2022]
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Palazzo C, Jourdan C, Descamps S, Nizard R, Anract P, Hamadouche M, Boisgard S, Galvin M, Ravaud P, Poiraudeau S. Place des attentes dans la satisfaction des patients après arthroplastie totale de hanche. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grimes T, Fitzsimons M, Galvin M, Delaney T. Relative accuracy and availability of an Irish National Database of dispensed medication as a source of medication history information: observational study and retrospective record analysis. J Clin Pharm Ther 2013; 38:219-24. [DOI: 10.1111/jcpt.12036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/26/2012] [Indexed: 12/27/2022]
Affiliation(s)
- T. Grimes
- School of Pharmacy and Pharmaceutical Sciences; Trinity College; Dublin Ireland
| | - M. Fitzsimons
- Department of Pharmacy; Tallaght Hospital; Dublin Ireland
| | - M. Galvin
- Department of Pharmacy; Naas General Hospital; Kildare Ireland
| | - T. Delaney
- Quality & Patient Safety Directorate; Health Service Executive; Dublin Ireland
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O'Connell JE, Galvin M, Kearns G. Reconstruction of the severely atrophic mandible with iliac crest grafts and endosteal implants: a report of two cases. J Ir Dent Assoc 2009; 55:237-241. [PMID: 19928372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- J E O'Connell
- Department of Oral and Maxillofacial Surgery Mid Western Regional Hospital, Limerick
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Abstract
AbstractObjective:To evaluate the contribution of composite foods to vegetable and fruit intakes in Irish adults and to compliance with dietary guidelines for vegetable and fruit intake.Design:Data were analysed from the North/South Ireland Food Consumption Survey of 18–64-year-old adults (n= 1379; 662 men, 717 women), which used a 7-day food diary to estimate food intake.Results:The mean intake of vegetables (excluding potatoes) was 140g day−1(men 149g day−1; women 132g day−1), of fruit was 136 g day−1(men 133g day−1; women 140 g day−1) and of potatoes was 227 g day−1(men 296g day−1; women 163 g day−1). The mean daily intakes of vegetables, fruit and potatoes from composite foods were 37 g (26%), 6 g (5%) and 17 g (7%), respectively. The mean intake of vegetables from composite foods was unrelated to age or gender, but increased with increasing social class and level of education attained. The proportions of men and women meeting the recommendation for ≥400g day−1(5 servings of 80 g per day) of vegetables and fruit were 21% (15% excluding composite foods) and 19% (12% excluding composite foods), respectively. Compliance with the dietary recommendation decreased with decreasing levels of educational attainment and social class.Conclusion:Intakes of vegetables and fruit are low compared with current dietary recommendations, particularly in those of lower levels of educational attainment and social class. Composite foods are an important source of vegetables (less importantly of fruit) and should be included when estimating vegetable intakes. Failure to do so may result in bias in estimates of intake and of compliance with dietary guidelines for population groups, as well as misclassification of individuals by level of intake.
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Affiliation(s)
- M M O'Brien
- Department of Food and Nutritional Sciences, University College Cork, Republic of Ireland.
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Morgan SM, Galvin M, Ross RP, Hill C. Evaluation of a spray-dried lacticin 3147 powder for the control of Listeria monocytogenes and Bacillus cereus in a range of food systems. Lett Appl Microbiol 2001; 33:387-91. [PMID: 11696102 DOI: 10.1046/j.1472-765x.2001.01016.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The potential of a powdered preparation of the bacteriocin, lacticin 3147, was investigated for the inhibition of Listeria monocytogenes and Bacillus cereus. METHODS AND RESULTS A 10% solution of reconstituted demineralized whey powder was fermented with Lactococcus lactis DPC3147 for the generation of a lacticin 3147 containing powdered product. A 99.9% reduction in L. monocytogenes numbers occurred in the presence of the lacticin 3147 powder within 2 h in natural yogurt, and an 85% reduction was observed in cottage cheese within the same time frame. Counts of B. cereus were reduced by 80% in soup, in the presence of 1% (w/w) lacticin 3147 powder, within 3 h. CONCLUSIONS A powdered preparation of lacticin 3147 was effective for the control of Listeria and Bacillus in natural yogurt, cottage cheese and soup. SIGNIFICANCE AND IMPACT OF THE STUDY The bioactive lacticin 3147 powder may find broad applications for control of Gram-positive pathogens/spoilage bacteria in a range of foods.
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Affiliation(s)
- S M Morgan
- Teagasc, Dairy Products Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
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Livingstone MB, Robson PJ, McCarthy S, Kiely M, Harrington K, Browne P, Galvin M, Wareham NJ, Rennie KL. Physical activity patterns in a nationally representative sample of adults in Ireland. Public Health Nutr 2001; 4:1107-16. [PMID: 11820924 DOI: 10.1079/phn2001192] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate habitual levels of physical activity in a nationally representative sample of adults in Ireland. DESIGN Cross-sectional survey using a self-administered questionnaire. Usual levels of work, recreational and household activities were evaluated in relation to anthropometric, demographic and socio-economic characteristics. The amount and intensity of all activities were quantified by assigning metabolic equivalents (METS) to each activity. SETTING Republic of Ireland and Northern Ireland, 1997-1999. SUBJECTS Random sample of 1379 adults aged 18-64 years. RESULTS Men were approximately twice as active in work and recreational activity (139.7 +/- 83.9 METS) as women (68.5 +/- 49.8 METS; P<0.001) but women were three times more active in household tasks (65.9 +/- 58.7 METS vs. 22.6 +/- 24.6 METS; P<0.001). Overall levels of physical activity declined with increasing age, particularly leisure activity in men. In women the decline in work activity was offset by spending more time in household pursuits. Twenty-five per cent of the subjects were extremely overweight (body mass index (BMI>28 kg m(-2)) or obese (BMI >30 kg m (-2)). Fewer obese subjects reported higher levels of work and leisure activities. However, a higher percentage of obese women reported participation in the higher levels of household activities. Participation rates in recreational activities were low. Walking was the most important leisure activity of both men (41%) and women (60%). In terms of hours per week spent in vigorous physical activity, men were more active than women, professional and skilled non-manual women were more active than women in other social classes, and younger subjects (aged 18-35 years) were more active than older subjects. CONCLUSIONS The holistic approach used in the assessment of physical activity in this study has revealed important and subtle differences in the activity patterns of men and women. Failure to fully characterise the respective activity patterns of men and women could lead to ill-informed public health policy aimed at promoting and sustaining lifetime habits of physical activity. The results suggest that simple population-focused programmes to promote physical activity are unlikely to offer the same chance of long-term success as more sensitive and individualised strategies.
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Affiliation(s)
- M B Livingstone
- Northern Ireland Centre for Diet and Health, University of Ulster, Coleraine, Co. Londonderry.
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García-Villarreal L, Daniels S, Shaw SH, Cotton D, Galvin M, Geskes J, Bauer P, Sierra-Hernández A, Buckler A, Tugores A. High prevalence of the very rare Wilson disease gene mutation Leu708Pro in the Island of Gran Canaria (Canary Islands, Spain): a genetic and clinical study. Hepatology 2000; 32:1329-36. [PMID: 11093740 DOI: 10.1053/jhep.2000.20152] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [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] [Indexed: 12/26/2022]
Abstract
The molecular basis of Wilson disease (WD), an autosomal recessive disorder, is the presence of mutations in the ATP7B gene, a copper transporting ATPase. Hospital records indicated a higher prevalence of WD (1 in 2,600) in some counties in the northeastern region of the island of Gran Canaria (Canary Islands, Spain) that was around 10-fold higher than that described for European populations (1 in 30,000). The ATP7B gene was analyzed for mutations in 24 affected subjects, revealing a high prevalence of the rare Leu708Pro mutation present in 12 homozygous and 7 heterozygous individuals. In these patients, who constitute one of the largest described cohorts of WD homozygotes, we found a variable clinical presentation of the disease, although the biochemical picture was homogenous and characteristic, thereby confirming that the Leu708Pro change is indeed a mutation associated with WD. Haplotype analysis of subjects homozygous for the Leu708Pro mutation showed a conserved shared region smaller than 1 centimorgan (cM), and the region of linkage disequilibrium between the Leu708Pro mutation and neighboring microsatellite markers extended approximately 4.6 cM. When comparing the amount of linkage disequilibrium versus genetic distance from the disease mutation, it was estimated that a common ancestral Leu708Pro chromosome may have been introduced in Gran Canaria over 56 generations ago, dating it back to pre-Hispanic times. The prevalence, and the tight geographical distribution of the Leu708Pro chromosome suggests that the Canary Islands can be considered a genetic isolate for linkage disequilibrium studies.
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Affiliation(s)
- L García-Villarreal
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Abstract
A physical map of the CXC chemokine locus on chromosome 4 has been constructed by PCR analysis and PFGE mapping of YAC clones. The genes for IL8, GRO1, PPBP, PF4, SCYB5 (ENA-78) and SCYB6 (GCP-2) have been co-localized on a 335-kb genomic fragment. The GRO2 and GRO3 genes did not map within this region and based on analysis of a YAC contig overlapping IL8 we speculate that GRO2 and GRO3 map downstream of this region. We have also assigned the novel CXC chemokine gene, SCYB9B (alias H174/betaR1) to chromosome 4q21, upstream and within 12 kb of INP10. Like INP10 and MIG, INP10 and SCYB9B are arranged in a head to tail manner. The chromosomal arrangement of these genes appears to reflect the evolution of this multigene family and supports the theory that it arose by gene duplication.
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Affiliation(s)
- N O'Donovan
- Department of Microbiology, University College Cork, Cork, Ireland
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Abstract
OBJECTIVE Following several reports of linkage of obesity related phenotypes to human chromosome 20q we sought to determine whether variations of the melanocortin 3 receptor (MC3R) gene are associated with obesity. DESIGN We screened the MC3R gene coding region and approximately 2 kb of 5' and 3' flanking sequences for DNA variants in unrelated extremely obese women and average weight controls using polymerase chain reaction (PCR) single strand conformation polymorphism (SSCP) analysis and DNA sequencing. SUBJECTS 124 unrelated extremely obese women (body mass index, (BMI)>/=40 kg/m2) and 85 average weight controls (BMI<27 kg/m2). MEASUREMENTS Radiation hybrid (RH) mapping was performed to localize the MC3R gene. 5' and 3' flanking sequences of MC3R gene were cloned. PCR-SSCP and DNA sequencing were used to detect mutations in the MC3R gene coding region and flanking sequences. RESULTS RH mapping localized the MC3R gene to 20q13, between markers D20S100 and D20S149. 1083 bp 5' and 653 bp 3' flanking region of the MC3R gene were cloned. A missense mutation (+241, codon 81 ATT/GTT, Ile-->Val) was found in the MC3R coding region. Four more variants were detected in the 5' flanking sequence: -201(C-->G), -239 (A-->G), -762(A-->T) and -769(T-->C). Compared with controls, no significant allele frequency differences were found. Racial differences were found for the +241, -201, -239 and -762 polymorphisms. CONCLUSIONS Several sequence variants were found in the MC3R gene coding region and in 5' flanking sequences. However, none of the variants were associated with obesity phenotypes. The linkage of extreme human obesity on 20q13 is likely caused by genes other than MC3R. International Journal of Obesity (2000) 24, 206-210
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Affiliation(s)
- W D Li
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Morgan SM, Galvin M, Kelly J, Ross RP, Hill C. Development of a lacticin 3147-enriched whey powder with inhibitory activity against foodborne pathogens. J Food Prot 1999; 62:1011-6. [PMID: 10492475 DOI: 10.4315/0362-028x-62.9.1011] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The broad-spectrum bacteriocin lacticin 3147, produced by Lactococcus lactis DPC3147, is inhibitory to a wide range of gram-positive food spoilage and pathogenic organisms. A 10% solution of demineralized whey powder was fermented with DPC3147 at a constant pH of 6.5. The fermentate was spray dried, and the resulting powder exhibited inhibitory activity. The ability of the lacticin 3147-enriched powder to inhibit Listeria monocytogenes Scott A and Staphylococcus aureus 10 was assessed in buffer at both acidic (pH 5) and neutral (pH 7) pH. In addition, the ability of the powder to inhibit L. monocytogenes Scott A in an infant milk formulation was assessed. Resuspension of approximately 10(8) midexponential phase L. monocytogenes Scott A cells in a 10% solution of the lacticin 3147-enriched powder resulted in a 1,000-fold reduction in viable cells at pH 5 and pH 7 after 3 h at 30 degrees C. In the case of S. aureus 10, resuspension of 2.5 x 10(7) midexponential phase cells in a 15% solution of the lacticin 3147-enriched powder at pH 5 resulted in only a 10-fold reduction in viable cell counts, compared with a 1,000-fold reduction at pH 7, following incubation for 3 h at 30 degrees C. The use of the lacticin 3147 powder in an infant milk formulation resulted in greater than a 99% kill of L. monocytogenes within 3 h at 30 degrees C. These results suggest that this bioactive lacticin 3147 food ingredient may find applications in many different foods, including those with pH close to neutrality.
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Affiliation(s)
- S M Morgan
- Dairy Products Research Centre, Teasgasc, Moorepark, Fermoy, Co. Cork, Republic of Ireland
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Ross RP, Galvin M, McAuliffe O, Morgan SM, Ryan MP, Twomey DP, Meaney WJ, Hill C. Developing applications for lactococcal bacteriocins. Antonie Van Leeuwenhoek 1999; 76:337-46. [PMID: 10532388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
While much of the applied research carried out to date with bacteriocins has concerned nisin, lactococci produce other bacteriocins with economic potential. An example is the two component bacteriocin lacticin 3147, which is active over a wide pH range and has a broad spectrum of activity against gram-positive bacteria. Since the genetic determinants for lacticin 3147 are encoded on a large self-transmissible plasmid, the bacteriocin genes may be conveniently transferred to different lactococcal starters. The resulting food-grade strains can then be used to make a significant impact on the safety and quality of a variety of fermented foods, through the inhibition of undesirable microflora. The bacteriocin is heat stable so it can also be used as an ingredient in a powdered form such as a spray-dried fermentate. Given the observation that lacticin 3147 is effective at physiological pH, there is also considerable potential for biomedical applications. Field trials have demonstrated its efficacy in the prevention of mastitis infections in dairy cows. In contrast to lacticin 3147, the lactococcin bacteriocins A, B and M have a narrow spectrum of activity limited to lactococci. Strains which produce these inhibitors can be exploited in the acceleration of cheese ripening by assisting the premature lysis of starter cultures.
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Affiliation(s)
- R P Ross
- Teagasc, Dairy Products Research Centre, Fermoy, Co. Cork, Republic of Ireland.
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Marcelino LA, Galvin M, Martins GM, Proença MJ, Mayrand E, Rueff JA, Monteiro CJ. Fast and reliable screening of mutations in human tumors: use of multiple fluorescence-based long linker arm nucleotides assay (mf-LLA). Biotechniques 1999; 26:1134-8, 1140-2, 1144 passim. [PMID: 10376153 DOI: 10.2144/99266rr01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human tumor samples were screened for point mutations by adapting a mobility-shift assay to automated DNA sizing. This screen identifies the type of point mutation and relative amount of mutated DNA sequences present in a sample. Test samples having known hypoxanthine-guanine phosphoribosyl transferase (hprt)/exon-3 sequence mutations were characterized by: (i) PCR amplification, (ii) fluorescent dye-primer extension with 36-atom linker derived deoxycytosine or deoxyuridine triphosphate and the remaining three natural nucleotides and (iii) sizing of the resulting fluorescently labeled modified strands, using an automated DNA sequencer. Routinely, a range of sizes is observed among the sequence variants of a single DNA target sequence. This is because nucleotide analogs are incorporated into DNA strands in a sequence-dependent manner, resulting in composition-dependent electrophoretic mobility. Thus, point mutations are identified as shifts in mobility between the fluorescently labeled modified strands of the control and test samples. The twenty different hprt/exon-3 single-base substitution mutations tested were easily identified, even at fourfold dilution with control DNA.
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Galvin M, Hill C, Ross RP. Lacticin 3147 displays activity in buffer against gram-positive bacterial pathogens which appear insensitive in standard plate assays. Lett Appl Microbiol 1999; 28:355-8. [PMID: 10347889 DOI: 10.1046/j.1365-2672.1999.00550.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lacticin 3147 is a broad-spectrum bacteriocin produced by Lactococcus lactis subsp. lactis DPC3147, which has been shown to be active against a range of food-borne bacteria. The reported inhibitory range for lacticin is extended to include methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis, penicillin-resistant Pneumococcus, Propionibacterium acne and Streptococcus mutans. This extended host range is not obvious from traditional agar plate-based methods, but reductions in bacterial cell numbers by up to 6 log10 cfu ml-1 was observed after 2 h in time-kill curve studies conducted in broth, suggesting that the bacteriocin may have potential as a therapeutic agent in the treatment of human infections.
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Affiliation(s)
- M Galvin
- National Food Biotechnology Centre, University College Cork, Ireland
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Maetz HM, Walton W, Smith M, Lincoln R, Galvin M, Tryon C, Hayden C, McMacken M, Ring K, Potts L, Edmondson J. "A satellite primer on tuberculosis:" a collaboration in distance education. J Public Health Manag Pract 1998; 4:46-55. [PMID: 10187066 DOI: 10.1097/00124784-199809000-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
"A Satellite Primer on Tuberculosis" was offered as a distance-based certificate course on tuberculosis (TB) fundamentals to a national audience of over 5,000 individuals. The course was a collaborative effort of a school of public health, a state health department, and the Centers for Disease Control and Prevention. Instruction was provided through print-based self-study modules that were complemented by live, interactive satellite conferences. Course completers, over 70 percent of whom were nurses and employees of public health departments, scored significantly higher on a course posttest than on a pretest, and the vast majority felt the course provided valuable training.
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Affiliation(s)
- H M Maetz
- Department of Epidemiology and International Health, University of Alabama at Birmingham School of Public Health, USA
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Abstract
OBJECTIVES To define discrete developmental levels of understanding regarding the ways in which normal children and adolescents link remembered and current attachment experiences to their moral belief system and to study the correlation between this progression and previously identified stages of conscience conceptualization. METHOD Using the moralization of attachment section from the semistructured Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were individually interviewed. Analysis of the interviews resulted in five levels of understanding. RESULTS By analyses of variance and covariance, the five attachment levels showed significant correlation with the five conceptualization stages. Conceptualization stage showed a stronger correlation than age. CONCLUSIONS In normal development, moralization of attachment is a domain of conscience functioning which follows a five-level hierarchical developmental progression; first, the child's sense of security and empathic responsiveness become paired with a sense of moral obligation; caretaker rules are then incorporated; an understanding of how empathy modifies strict rule-following develops; idols and ideals are chosen that reflect earlier learning in attachment relationships; finally, a visualization of the self as moral standard-bearer or teacher unfolds.
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Affiliation(s)
- B M Stilwell
- Child Psychiatry Services, Indiana University School of Medicine, Indianapolis, USA
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