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Forbes M, Lotfaliany M, Mohebbi M, Reynolds CF, Woods RL, Orchard S, Chong T, Agustini B, O'Neil A, Ryan J, Berk M. Depressive symptoms and cognitive decline in older adults. Int Psychogeriatr 2024:1-12. [PMID: 38623851 DOI: 10.1017/s1041610224000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Few studies have examined the impact of late-life depression trajectories on specific domains of cognitive function. This study aims to delineate how different depressive symptom trajectories specifically affect cognitive function in older adults. DESIGN Prospective longitudinal cohort study. SETTING Australia and the United States of America. PARTICIPANTS In total, 11,035 community-dwelling older adults with a mean age of 75 years. MEASUREMENTS Depressive trajectories were modelled from depressive symptoms according to annual Centre for Epidemiological Studies Depression Scale 10 (CES-D-10) surveys. Four trajectories of depressive symptoms were identified: low ("nondepressed"), consistently mild ("subthreshold depression"), consistently moderate ("persistent depression"), and initially low but increasing ("emerging depression"). Global cognition (Modified Mini-Mental State Examination [3MS]), verbal fluency (Controlled Oral Word Association Test [COWAT]), processing speed (Symbol Digit Modalities Test [SDMT]), episodic memory (Hopkins Verbal Learning Test - Revised [HVLT-R]), and a composite z-score were assessed over a subsequent median 2 years. RESULTS Subthreshold depression predicted impaired performance on the SDMT (Cohen's d -0.04) and composite score (-0.03); emerging depression predicted impaired performance on the SDMT (-0.13), HVLT-R (-0.09), 3 MS (-0.08) and composite score (-0.09); and persistent depression predicted impaired performance on the SDMT (-0.08), 3 MS (-0.11), and composite score (-0.09). CONCLUSIONS Depressive symptoms are associated with later impaired processing speed. These effects are small. Diverse depression trajectories have different impacts on cognitive function.
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Affiliation(s)
- Malcolm Forbes
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Mojtaba Lotfaliany
- School of Medicine, Barwon Health, Deakin University, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, VC, Australia
| | - Mohammadreza Mohebbi
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Trevor Chong
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bruno Agustini
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Adrienne O'Neil
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
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Russell SE, Wrobel AL, Lotfaliany M, Ashton MM, Kaur R, Yocum AK, Duval ER, Diaz-Byrd C, Ehrlich TJ, Marshall DF, Berk M, McInnis MG, Dean O, Turner A. Trauma and comorbid post-traumatic stress disorder in people with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study. J Affect Disord 2024; 348:275-282. [PMID: 38163569 DOI: 10.1016/j.jad.2023.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND It is estimated that up to 50 % of people with bipolar disorder (BD) also have comorbid post-traumatic stress disorder (PTSD). However, little is known about the presentation and treatment of people with this comorbidity. METHODS Data from 577 individuals diagnosed with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study of BD were explored at baseline, year two and four. Three trauma groups were created: (i) one trauma (n = 75), (ii) multiple traumas (n = 417), and comorbid PTSD (n = 85). Measures of depression, mania, sleep, number of hospitalisations, suicide attempts, and medication use were analysed using regression modelling to determine differences between the three trauma groups. RESULTS There was an increase in depression, mania, and sleep scores and a higher number of hospitalisations in participants with comorbid PTSD compared to those experiencing one trauma. Additionally, increased mania and depression scores were reported in participants experiencing multiple traumas compared to those with one trauma. There was no difference in medication use between those who experienced one trauma compared to those with comorbid PTSD. LIMITATIONS The trauma groups may include confounding with more participants experiencing PTSD than reported in this study due to screening processes. Additionally, the severity of trauma was not recorded, therefore number of traumas was utilised as a proxy. CONCLUSION Comorbid BD and PTSD is associated with worse symptom scores compared to participants reporting one trauma. Clinical implications include the addition of trauma-informed care to clinical settings to identify PTSD to provide appropriate treatments.
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Affiliation(s)
- Samantha E Russell
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Orygen, Parkville, Victoria, Australia
| | - Mojtaba Lotfaliany
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Melanie M Ashton
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia
| | - Ravleen Kaur
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tobin J Ehrlich
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Orygen, Parkville, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Olivia Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, Australia
| | - Alyna Turner
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, PO Box 281, Geelong 3220, Australia; School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan 2308, Australia.
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Haydon HM, Snoswell CL, Jones C, Carey M, Taylor M, Horstmanshof L, Hicks R, Lotfaliany M, Banbury A. Digital health literacy to enhance workforce skills and clinical effectiveness: A response to 'Digital health literacy: Helpful today, dependency tomorrow? Contingency planning in a digital age'. Australas J Ageing 2023; 42:803-804. [PMID: 37986677 DOI: 10.1111/ajag.13257] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Helen M Haydon
- Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Cindy Jones
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Melissa Carey
- Centre for Health Research, The University of Southern Queensland, Ipswich, Queensland, Australia
- University of Auckland, Auckland, New Zealand
| | - Melissa Taylor
- School of Nursing and Midwifery, Centre for Health Research, The University of Southern Queensland, Ipswich, Queensland, Australia
| | - Louise Horstmanshof
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Richard Hicks
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
| | - Mojtaba Lotfaliany
- Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Annie Banbury
- Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
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4
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Aslam H, Lotfaliany M, So D, Berding K, Berk M, Rocks T, Hockey M, Jacka FN, Marx W, Cryan JF, Staudacher HM. Fiber intake and fiber intervention in depression and anxiety: a systematic review and meta-analysis of observational studies and randomized controlled trials. Nutr Rev 2023:nuad143. [PMID: 38007616 DOI: 10.1093/nutrit/nuad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
CONTEXT Dietary fibers hold potential to influence depressive and anxiety outcomes by modulating the microbiota-gut-brain axis, which is increasingly recognized as an underlying factor in mental health maintenance. OBJECTIVE Evidence for the effects of fibers on depressive and anxiety outcomes remains unclear. To this end, a systematic literature review and a meta-analysis were conducted that included observational studies and randomized controlled trials (RCTs). DATA SOURCES The PubMed, Embase, CENTRAL, CINAHL, and PsychINFO databases were searched for eligible studies. DATA EXTRACTION Study screening and risk-of-bias assessment were conducted by 2 independent reviewers. DATA ANALYSIS Meta-analyses via random effects models were performed to examine the (1) association between fiber intake and depressive and anxiety outcomes in observational studies, and (2) effect of fiber intervention on depressive and anxiety outcomes compared with placebo in RCTs. A total of 181 405 participants were included in 23 observational studies. In cross-sectional studies, an inverse association was observed between fiber intake and depressive (Cohen's d effect size [d]: -0.11; 95% confidence interval [CI]: -0.16, -0.05) and anxiety (d = -0.25; 95%CI, -0.38, -0.12) outcomes. In longitudinal studies, there was an inverse association between fiber intake and depressive outcomes (d = -0.07; 95%CI, -0.11, -0.04). In total, 740 participants were included in 10 RCTs, all of whom used fiber supplements. Of note, only 1 RCT included individuals with a clinical diagnosis of depression. No difference was found between fiber supplementation and placebo for depressive (d = -0.47; 95%CI, -1.26, 0.31) or anxiety (d = -0.30; 95%CI, -0.67, 0.07) outcomes. CONCLUSION Although observational data suggest a potential benefit for higher fiber intake for depressive and anxiety outcomes, evidence from current RCTs does not support fiber supplementation for improving depressive or anxiety outcomes. More research, including RCTs in clinical populations and using a broad range of fibers, is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021274898.
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Affiliation(s)
- Hajara Aslam
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Mojtaba Lotfaliany
- IMPACT, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Berding
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Tetyana Rocks
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Meghan Hockey
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Felice N Jacka
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Wolfgang Marx
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - John F Cryan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Heidi M Staudacher
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
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Wrobel AL, Russell SE, Jayasinghe A, Lotfaliany M, Turner A, Dean OM, Cotton SM, Diaz-Byrd C, Yocum AK, Duval ER, Ehrlich TJ, Marshall DF, Berk M, McInnis MG. Interpersonal Trauma and Depression Severity Among Individuals With Bipolar Disorder: Findings From the Prechter Longitudinal Study of Bipolar Disorder. J Clin Psychiatry 2023; 84. [PMID: 37058607 DOI: 10.4088/jcp.22m14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Background: Experiences of interpersonal trauma, both in childhood and in adulthood, can affect the trajectory of bipolar disorder (BD). However, the degree to which childhood and/or adult trauma impacts the longitudinal trajectory of depression severity among individuals with BD actively receiving treatment remains unclear. Methods: The effects of childhood trauma (Childhood Trauma Questionnaire) and adult trauma (Life Events Checklist) on depression severity (Hamilton Depression Rating Scale) were investigated in a treatment-receiving subsample with BD (DSM-IV) of the Prechter Longitudinal Study of Bipolar Disorder (2005-present). A mixed-effects linear regression model was used to assess the trajectory of depression severity over 4 years. Results: Depression severity was evaluated in 360 participants, of whom 267 (74.8%) reported a history of interpersonal trauma. A history of childhood trauma alone (n = 110) and childhood and adult trauma combined (n = 108)-but not adult trauma alone (n = 49) -were associated with greater depression severity at the 2-year and 6-year follow-up assessments. However, the trajectory of depression severity (ie, change over time) was similar between participants with a history of childhood trauma, those with a history of adult trauma, and those with no history of interpersonal trauma. Interestingly, participants with a history of both types of trauma showed more improvement in depression severity (ie, from year 2 to year 4: β = 1.67, P = .019). Conclusions: Despite actively receiving treatment for BD, participants with a history of interpersonal trauma-particularly childhood trauma-presented with more severe depressive symptoms at several follow-up assessments. Hence, interpersonal trauma may represent an essential treatment target.
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Affiliation(s)
- Anna L Wrobel
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Samantha E Russell
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Anuradhi Jayasinghe
- Orygen, Parkville, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Mojtaba Lotfaliany
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Alyna Turner
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Corresponding author: Alyna Turner, PhD, IMPACT- School of Medicine, Deakin University, Health Education Research Bldg (HERB) - Level 3, Barwon Health, PO Box 281, Geelong, VIC, 3220, Australia
| | - Olivia M Dean
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tobin J Ehrlich
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - David F Marshall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michael Berk
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
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Roebuck G, Lotfaliany M, Agustini B, Forbes M, Mohebbi M, McNeil J, Woods RL, Reid CM, Nelson MR, Shah RC, Ryan J, Newman AB, Owen A, Freak-Poli R, Stocks N, Berk M. The effect of depressive symptoms on disability-free survival in healthy older adults: A prospective cohort study. Acta Psychiatr Scand 2023; 147:92-104. [PMID: 36281968 PMCID: PMC10026010 DOI: 10.1111/acps.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gerontology and ageing research are increasingly focussing on healthy life span (healthspan), the period of life lived free of serious disease and disability. Late-life depression (LLD) is believed to impact adversely on physical health. However, no studies have examined its effect on healthspan. This study investigated the effect of LLD and subthreshold depression on disability-free survival, a widely accepted measure of healthspan. METHODS This prospective cohort study used data from the ASPirin in Reducing Events in the Elderly study. Participants were aged ≥70 years (or ≥65 years for African-American and Hispanic participants) and free of dementia, physical disability and cardiovascular disease. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). LLD and subthreshold depression were defined as CES-D-10 scores ≥8 and 3-7, respectively. Disability-free survival was defined as survival free of dementia and persistent physical disability. RESULTS A total of 19,110 participants were followed up for a maximum of 7.3 years. In female participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors, medical comorbidities, polypharmacy, physical function and antidepressant use (HR, 1.50; 95% CI, 1.23-1.82). In male participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors (HR, 1.30; 95% CI, 1.03-1.64). Subthreshold depression was also associated with lower disability-free survival in both sexes. CONCLUSIONS LLD may be a common and important risk factor for shortened healthspan.
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Affiliation(s)
- Greg Roebuck
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Mojtaba Lotfaliany
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
| | - Bruno Agustini
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
| | - Malcolm Forbes
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | | | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne B. Newman
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel Stocks
- Discipline of General Practice, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
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7
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Haydon HM, Lotfaliany M, Jones C, Chelberg G, Horstmanshof L, Taylor M, Carey M, Snoswell CL, Hicks R, Banbury A. Health literacy, dementia knowledge and perceived utility of digital health modalities among future health professionals. Australas J Ageing 2022. [DOI: 10.1111/ajag.13149] [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] [Received: 09/02/2021] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Helen M. Haydon
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
| | - Mojtaba Lotfaliany
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health Deakin University Geelong Victoria Australia
| | - Cindy Jones
- Faculty of Health Sciences and Medicine Bond University Robina Queensland Australia
- Menzies Health Institute Queensland Southport Queensland Australia
| | - Georgina R. Chelberg
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
| | - Louise Horstmanshof
- Faculty of Health Southern Cross University Lismore New South Wales Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, Centre for Health Research The University of Southern Queensland Ipswich Queensland Australia
| | - Melissa Carey
- Centre for Health Research The University of Southern Queensland Ipswich Queensland Australia
- University of Auckland Auckland New Zealand
| | - Centaine L. Snoswell
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
| | - Richard Hicks
- School of Psychology, Faculty of Society and Design Bond University Robina Queensland Australia
| | - Annie Banbury
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
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8
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Bucknall TK, Considine J, Harvey G, Graham ID, Rycroft-Malone J, Mitchell I, Saultry B, Watts JJ, Mohebbi M, Bohingamu Mudiyanselage S, Lotfaliany M, Hutchinson A. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration. BMJ Qual Saf 2022; 31:818-830. [PMID: 35450936 PMCID: PMC9606509 DOI: 10.1136/bmjqs-2021-013785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses' vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses' CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. RESULTS From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (-2.18 days, 95% CI (-3.53 to -0.82)). CONCLUSION Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000544471p.
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Affiliation(s)
- Tracey K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Gillian Harvey
- Caring Futures Institute, Flinders University College of Nursing and Health Sciences, Bedford Park, South Australia, Australia
| | - Ian D Graham
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- School of Epidemiology and Public Health and School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Imogen Mitchell
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Bridey Saultry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mojtaba Lotfaliany
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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9
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Wrobel AL, Russell SE, Jayasinghe A, Kavanagh BE, Lotfaliany M, Turner A, Dean OM, Cotton SM, Diaz-Byrd C, Yocum AK, Duval ER, Ehrlich TJ, Marshall DF, Berk M, McInnis MG. Personality traits as mediators of the relationship between childhood trauma and depression severity in bipolar disorder: A structural equation model. Aust N Z J Psychiatry 2022:48674221115644. [PMID: 35924739 DOI: 10.1177/00048674221115644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childhood trauma is negatively associated with depression severity in bipolar disorder; however, the underlying mechanisms remain unclear. We investigated whether personality traits (neuroticism, extraversion, openness, agreeableness, conscientiousness) mediate the relationship between childhood trauma and the severity of bipolar depression. METHODS Data from 209 individuals with bipolar disorder recruited for the Prechter Longitudinal Study of Bipolar Disorder were analysed. Using structural equation modelling, we examined the direct and indirect associations between childhood trauma (Childhood Trauma Questionnaire) and depression severity (Hamilton Depression Rating Scale) - with the personality traits (NEO Personality Inventory-Revised) as mediators. RESULTS The direct effect of childhood trauma on depression severity (standardised β = 0.32, 95% bootstrap confidence interval [CI] = 0.20-0.45, p < 0.001) and the indirect effect via neuroticism (standardised β = 0.03, 95% bootstrap CI [0.002, 0.07], p = 0.039) were significant; supporting a partial mediation model. The indirect effect accounted for 9% of the total effect of childhood trauma on depression severity (standardised β = 0.09, 95% bootstrap CI [0.002, 0.19], p = 0.046). The final model had a good fit with the data (comparative fit index = 0.96; root mean square error of approximation = 0.05, 90% CI = [0.02, 0.07]). CONCLUSION Personality traits may be relevant psychological mediators that link childhood trauma to a more severe clinical presentation of bipolar depression. Consequently, a person's personality structure may be a crucial operative factor to incorporate in therapeutic plans when treating individuals with bipolar disorder who report a history of childhood trauma.
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Affiliation(s)
- Anna L Wrobel
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Samantha E Russell
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Anuradhi Jayasinghe
- Orygen, Parkville, VIC, Australia.,School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Bianca E Kavanagh
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Mojtaba Lotfaliany
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alyna Turner
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Olivia M Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sue M Cotton
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tobin J Ehrlich
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia.,Orygen, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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10
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Lotfaliany M, Hadaegh F, Mansournia MA, Azizi F, Oldenburg B, Khalili D. Performance of Stepwise Screening Methods in Identifying Individuals at High Risk of Type 2 Diabetes in an Iranian Population. Int J Health Policy Manag 2022; 11:1391-1400. [PMID: 34060272 PMCID: PMC9808334 DOI: 10.34172/ijhpm.2021.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/10/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recent evidence recommended stepwise screening methods for identifying individuals at high risk of type 2 diabetes to be recruited in the lifestyle intervention programs for the prevention of the disease. This study aims to assess the performance of different stepwise screening methods that combine non-invasive measurements with lab-based measurements for identifying those with 5-years incident type 2 diabetes. METHODS 3037 participants aged ≥30 years without diabetes at baseline in the Tehran Lipid and Glucose Study (TLGS) were followed. Thirty-two stepwise screening methods were developed by combining a non-invasive measurement (an anthropometric measurement (waist-to-height ratio, WtHR) or a score based on a non-invasive risk score [Australian Type 2 Diabetes Risk Assessment Tool, AUSDRISK]) with a lab-based measurement (different cut-offs of fasting plasma glucose [FPG] or predicted risk based on three lab-based prediction models [Saint Antonio, SA; Framingham Offspring Study, FOS; and the Atherosclerosis Risk in Communities, ARIC]). The validation, calibration, and usefulness of lab-based prediction models were assessed before developing the stepwise screening methods. Cut-offs were derived either based on previous studies or decision-curve analyses. RESULTS 203 participants developed diabetes in 5 years. Lab-based risk prediction models had good discrimination power (area under the curves [AUCs]: 0.80-0.83), achieved acceptable calibration and net benefits after recalibration for population's characteristics and were useful in a wide range of risk thresholds (5%-21%). Different stepwise methods had sensitivity ranged 20%-68%, specificity 70%-98%, and positive predictive value (PPV) 14%-46%; they identified 3%-33% of the screened population eligible for preventive interventions. CONCLUSION Stepwise methods have acceptable performance in identifying those at high risk of incident type 2 diabetes.
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Affiliation(s)
- Mojtaba Lotfaliany
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Barwon Health, Geelong, VIC, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Davood Khalili
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Beasant B, Lee G, Vaughan V, Lotfaliany M, Hosking S. Health literacy and cardiovascular disease prevention: a systematic scoping review protocol. BMJ Open 2022; 12:e054977. [PMID: 35676010 PMCID: PMC9185497 DOI: 10.1136/bmjopen-2021-054977] [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] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Health literacy is 'The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare'. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations. METHODS AND ANALYSIS A scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 'pilot' articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts. ETHICS AND DISSEMINATION This review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation. ARTICLE SUMMARY CVD is the leading cause of death around the world. This paper proposes an exploration of health literacy's relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.
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Affiliation(s)
- Bonnie Beasant
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Georgie Lee
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Vanessa Vaughan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Mojtaba Lotfaliany
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Sarah Hosking
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
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12
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Wrobel AL, Russell SE, Jayasinghe A, Lotfaliany M, Turner A, Dean OM, Cotton SM, Diaz‐Byrd C, Yocum AK, Duval ER, Ehrlich TJ, Marshall DF, Berk M, McInnis MG. Attachment insecurity partially mediates the relationship between childhood trauma and depression severity in bipolar disorder. Acta Psychiatr Scand 2022; 145:591-603. [PMID: 35243610 PMCID: PMC9314952 DOI: 10.1111/acps.13419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood trauma is associated with greater depression severity among individuals with bipolar disorder. However, the mechanisms that explain the link between childhood trauma and depression severity in bipolar disorder remain poorly understood. The mediational role of attachment insecurity in childhood and adulthood was assessed in the current study. METHODS Participants with bipolar disorder (N = 143) completed measures of childhood trauma (Childhood Trauma Questionnaire), attachment insecurity (Experiences in Close Relationships Scale) and depression severity (Hamilton Depression Rating Scale) as part of the Prechter Longitudinal Study of Bipolar Disorder. A sequential mediation model was tested using path analysis: the direct and indirect effects of childhood trauma on depression severity with attachment insecurity (attachment anxiety and avoidance) in childhood (mother and father) and adulthood (partner) as mediators were estimated. RESULTS The final path model demonstrated an excellent fit to the data (comparative fit index = 0.996; root mean square error of approximation = 0.021 [90% confidence interval = 0.000-0.073]). Supporting the hypothesised sequential mediation model, maternal attachment anxiety in childhood and romantic attachment avoidance in adulthood partially mediated the relationship between childhood trauma and depression severity; this effect accounted for 12% of the total effect of childhood trauma on depression severity. CONCLUSION Attachment insecurity in childhood and adulthood form part of the complex mechanism informing why people with bipolar disorder who have a history of childhood trauma experience greater depression severity. Addressing attachment insecurity represents a valuable psychotherapeutic treatment target for bipolar disorder.
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Affiliation(s)
- Anna L. Wrobel
- IMPACT – The Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineDeakin UniversityGeelongVictoriaAustralia,OrygenParkvilleVictoriaAustralia
| | - Samantha E. Russell
- IMPACT – The Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineDeakin UniversityGeelongVictoriaAustralia
| | - Anuradhi Jayasinghe
- OrygenParkvilleVictoriaAustralia,School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Mojtaba Lotfaliany
- IMPACT – The Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineDeakin UniversityGeelongVictoriaAustralia
| | - Alyna Turner
- IMPACT – The Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineDeakin UniversityGeelongVictoriaAustralia,School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Olivia M. Dean
- IMPACT – The Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineDeakin UniversityGeelongVictoriaAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Sue M. Cotton
- OrygenParkvilleVictoriaAustralia,Centre for Youth Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Claudia Diaz‐Byrd
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Anastasia K. Yocum
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Elizabeth R. Duval
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Tobin J. Ehrlich
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - David F. Marshall
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Michael Berk
- IMPACT – The Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineDeakin UniversityGeelongVictoriaAustralia,OrygenParkvilleVictoriaAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia,Centre for Youth Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia,Department of PsychiatryRoyal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Melvin G. McInnis
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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13
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Agustini B, Lotfaliany M, Mohebbi M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Reid CM, Tonkin A, Ryan J, Williams LJ, Forbes MP, Berk M. Trajectories of depressive symptoms in older adults and associated health outcomes. Nat Aging 2022; 2:295-302. [PMID: 37117752 DOI: 10.1038/s43587-022-00203-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 04/30/2023]
Abstract
With the progressive aging of the world's population, prolongation of a healthy lifespan in old age has become a medical research priority. The presence of depressive symptoms in later life is associated with poor health prognosis and increased mortality1,2. Here we explore distinct trajectories of depressive symptoms in later life and their association with several health-related outcomes in 19,110 older individuals followed for a median of 4.7 years. Using a latent class, mixed-modeling approach we identified four distinct trajectories of depressive symptoms with scoring patterns of consistently low, moderate, emerging and persistently high. Compared to those with minimal depressive symptoms, membership of any other class was associated with specific patterns of baseline sociodemographic and medical factors. Membership of any group with depressive symptoms was associated with a higher likelihood of health events, including physical disability, cancer and major bleeding episodes. Membership of the persistently depressed class was associated with increased mortality, while a diagnosis of dementia was generally limited to the class with initially low and progressively rising symptoms. The course of depressive symptoms in older individuals can vary widely and depend on several factors. The presence of depressive symptoms, including those that do not meet criteria for major depression, can flag a poor prognosis and risk for specific health conditions. Systematic assessment of depressive symptoms may facilitate early identification of at-risk populations.
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Affiliation(s)
- Bruno Agustini
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.
| | - Mojtaba Lotfaliany
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Malcolm P Forbes
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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14
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Kavanagh BE, O'Donohue JS, Ashton MM, Lotfaliany M, McCallum M, Wrobel AL, Croce S, Berk M, Saunders L, Lai J, Berk L. Coping with COVID-19: Exploring coping strategies, distress, and post-traumatic growth during the COVID-19 pandemic in Australia. Front Psychiatry 2022; 13:1025767. [PMID: 36339873 PMCID: PMC9630636 DOI: 10.3389/fpsyt.2022.1025767] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/23/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to explore coping strategies, distress, and post-traumatic growth among Australians with and without a history of a mental health diagnosis during the COVID-19 pandemic. MATERIALS AND METHODS Australians (N = 381) completed an online survey between 4-August 2020 and 25-October-2020. Coping strategies, distress, and post-traumatic growth were ascertained via the Brief COPE, Depression Anxiety and Stress Scale (DASS-21), and Post-Traumatic Growth Inventory (PTGI), respectively. Linear regression was conducted to examine the relationship between the Brief COPE, DASS-21, and PTGI, adjusting for sociodemographic factors. Models were conducted separately for those with/without a history of a mental health diagnosis. RESULTS Higher distress was found among those with a history of a mental health diagnosis. Significant differences in the types of coping strategies associated with distress and post-traumatic growth were identified between the groups, however, behavioral disengagement and self-blame consistently predicted depression, anxiety, and stress. For those with a history of a mental health diagnosis, positive reframing decreased anxiety. Self-distraction was associated with post-traumatic growth across both groups. CONCLUSION There are important differences in the way people with and without a history of a mental health diagnosis cope with the COVID-19 pandemic.
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Affiliation(s)
- Bianca E Kavanagh
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Josephine S O'Donohue
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Melanie M Ashton
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Mojtaba Lotfaliany
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Maddy McCallum
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Anna L Wrobel
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Sarah Croce
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia.,Orygen, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Lucy Saunders
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jerry Lai
- Deakin University, eResearch, Deakin eSolutions, Geelong, VIC, Australia.,Intersect Australia, Sydney, NSW, Australia
| | - Lesley Berk
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
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15
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Anmella G, Fico G, Lotfaliany M, Hidalgo-Mazzei D, Soto-Angona Ó, Giménez-Palomo A, Amoretti S, Murru A, Radua J, Solanes A, Pacchiarotti I, Verdolini N, Cowdery S, Dodd S, Williams LJ, Mohebbi M, Carvalho AF, Kessing LV, Vieta E, Berk M. Risk of cancer in bipolar disorder and the potential role of lithium: International collaborative systematic review and meta-analyses. Neurosci Biobehav Rev 2021; 126:529-541. [PMID: 33831461 DOI: 10.1016/j.neubiorev.2021.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
We examined bipolar disorder (BD) as a risk factor for developing cancer and the role of lithium on cancer incidence. We conducted two systematic review and meta-analyses of population-based studies providing data on these associations. We screened articles indexed in MEDLINE, Scopus, Embase, and PsycINFO up to August 2020. The first random-effects meta-analysis, based on 4,910,661 individuals from nine studies estimated an increased risk of cancer of any kind [RR = 1.24 (1.05-1.46); p < 0.01], especially breast cancer [RR = 1.33 (1.15-1.55); p < 0.01] in BD. The second random-effects meta-analysis, based on 2,606,187 individuals from five studies did not show increased risk of cancer in people with BD using lithium, and even suggested a small protective effect both in overall [RR = 0.94 (0.72-1.22); p = 0.66] and urinary cancer [RR = 0.93 (0.75-1.14); p = 0.48] although these findings did not reach statistical significance. The current evidence highlights that cancer risk is increased in individuals with BD, particularly breast cancer in women. Lithium may have a potential protective effect on cancer, including urinary cancer. The role of lithium as a mainstay of treatment for BD is reinforced by this study.
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Affiliation(s)
- Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Mojtaba Lotfaliany
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Deakin University, Faculty of Health, Biostatistics Unit, Geelong, Australia
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Óscar Soto-Angona
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Stephanie Cowdery
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Seetal Dodd
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, and the Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Lana J Williams
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Deakin University, Faculty of Health, Biostatistics Unit, Geelong, Australia
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, and the Department of Psychiatry, The University of Melbourne, Parkville, Australia; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
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16
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Zafari N, Lotfaliany M, O'Keefe GJ, Kishore K, Torkamani N, MacIsaac RJ, Churilov L, Ekinci EI. Performance of 4 Creatinine-based Equations in Assessing Glomerular Filtration Rate in Adults with Diabetes. J Clin Endocrinol Metab 2021; 106:e61-e73. [PMID: 33090207 DOI: 10.1210/clinem/dgaa722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/16/2020] [Indexed: 01/30/2023]
Abstract
AIMS To evaluate diagnostic performance of glomerular filtration rate (GFR) estimated by modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), full age spectrum (FAS), and revised Lund-Malmö (r-LM) equations in adults with diabetes. METHODS Individuals were included in this cross-sectional study if they had at least 1 measurement of technetium-99m diethylenetriamine-pentaacetic acid (99mTc-DTPA) GFR (mGFR) and serum creatinine (1487 patients with 2703 measures). GFR calculated by estimation equations was compared with mGFR. Diagnostic performance was assessed using concordance correlation coefficient (CCC), bias, precision, accuracy, reduced major axis regression (RMAR), and Bland-Altman plot. Analysis was repeated in subgroups based on sex, diabetes type, Hemoglobin A1C, and GFR level. RESULTS Of all patients, 1189 (86%) had type 2 diabetes. Mean mGFR, MDRD, CKD-EPI, FAS, and revised Lund-Malmö eGFR were 66, 72, 74, 71, and 67 mL/min/1.73m2, respectively. Overall, the r-LM had the highest CCC (0.83), lowest bias (-1.4 mL/min/1.73 m2), highest precision (16.2 mL/min/1.73 m2), and highest accuracy (P10 = 39%). The RMAR (slope, intercept) in r-LM, FAS, MDRD, and CKD-EPI was 1.18, -13.35; 0.97, -2.9; 1, -6.4, and 1.04, -11.3, respectively. The Bland-Altman plot showed that r-LM had the lowest mean difference and the narrowest 95% limit of agreement (-1.0, 54.1 mL/min/1.73 m2), while mean difference was more than 5-fold higher in FAS, MDRD, and CKD-EPI (-5.2, -6.3, and -8.2, respectively). CONCLUSIONS In adults with diabetes the revised Lund-Malmö performs better than MDRD, CKD-EPI, and FAS in calculating point estimates of GFR.
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Affiliation(s)
- Neda Zafari
- Melbourne Medical School, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Mojtaba Lotfaliany
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Graeme J O'Keefe
- Department of Molecular Imaging and Therapy, Austin Health, and University of Melbourne, Melbourne, Victoria, Australia
| | - Kartik Kishore
- Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
| | - Niloufar Torkamani
- Melbourne Medical School, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne and University of Melbourne, Victoria, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Melbourne Medical School, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
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17
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Zafari N, Churilov L, Wong LYL, Lotfaliany M, Hachem M, Kiburg KV, Kong L, Torkamani N, Baxter H, MacIsaac RJ, Ekinci EI. Evaluation of the diagnostic performance of the creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation in people with diabetes: A systematic review. Diabet Med 2021; 38:e14391. [PMID: 32810875 DOI: 10.1111/dme.14391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/27/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022]
Abstract
AIMS GFR estimated with the creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr ) equation is used to screen for diabetic kidney disease and assess its severity. We systematically reviewed the process and outcome of evaluating CKD-EPICr in estimating point GFR or GFR decline over time in adults with type 1 or type 2 diabetes. METHODS In this systematic review, MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched up to August 2019. Observational studies comparing CKD-EPICr with measured GFR (mGFR) in adults with diabetes were included. Studies on people with kidney transplant, non-diabetes related kidney disease, pregnancy, potential kidney donors, and those with critical or other systematic illnesses were excluded. Two independent reviewers extracted data from published papers and disagreements were resolved by consensus. Risk-of-bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. (PROSPERO registration number: CRD42018108776). RESULTS From the 2820 records identified, 29 studies (14 704 participants) were included. All studies were at risk of bias. Bias (eight different forms) ranged from -26 to 35 ml min-1 1.73 m-2 ; precision (five different forms) ranged between 9 and 63 ml min-1 1.73 m-2 ; accuracy (five different forms) ranged between 16% and 96%; the correlation coefficient between CKD-EPICr and mGFR (four different forms) ranged between 0.38 and 0.86; and the reduced major axis regression slope ranged between 0.8 and 1.8. CONCLUSIONS Qualitative synthesis of data suggested CKD-EPICr was inaccurate in estimating point GFR or GFR decline over time. Furthermore, a lack of consistency in the methods and processes of evaluating the diagnostic performance of CKD-EPICr limits reliable quantitative assessment. The equation needs to be improved in adults with diabetes.
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Affiliation(s)
- N Zafari
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - L Churilov
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - L Y-L Wong
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - M Lotfaliany
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - M Hachem
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - K V Kiburg
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne and The University of Melbourne, Melbourne, Victoria, Australia
| | - L Kong
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - N Torkamani
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology Austin Health, Heidelberg, Victoria, Australia
| | - H Baxter
- Austin Health Sciences Library, Austin Health, Heidelberg, Victoria, Australia
| | - R J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne and The University of Melbourne, Melbourne, Victoria, Australia
| | - E I Ekinci
- Department of Medicine, Austin health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology Austin Health, Heidelberg, Victoria, Australia
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18
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Asgari S, Lotfaliany M, Fahimfar N, Hadaegh F, Azizi F, Khalili D. The external validity and performance of the no-laboratory American Diabetes Association screening tool for identifying undiagnosed type 2 diabetes among the Iranian population. Prim Care Diabetes 2020; 14:672-677. [PMID: 32522438 DOI: 10.1016/j.pcd.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this study is to assess the American Diabetes Association (ADA) risk score as a self-assessment screening tool for undiagnosed type 2 diabetes (T2DM) in Iran. METHODS In a national survey of risk factors for non-communicable diseases, we included 3458 Iranian adults. The discrimination and validity were assessed using the area under the curve (AUC), sensitivity, specificity, Youden's index, positive and negative predictive values (PPV and NPV). The frequency of high-risk Iranian population who need a glucose test and those who need intervention were also estimated. RESULTS The AUC was 73.7% and the suggested ADA score of ≥5 yielded a sensitivity of 51.6%, specificity 82.4%, NPV 98.3%, and PPV 7.9%. This threshold results in classifying 18.6% of the Iranians, equals to 8.5 million, as high-risk and 1.5% of the population, about 700,000, would need intervention. However, our study suggested score ≥4 that identified 34% of the population as high-risk and 2% of the population would need intervention. CONCLUSION Our findings support the ADA suggested threshold for identifying high-risk individuals for undiagnosed T2DM; however, a lower threshold is also recommended for higher sensitivity. The ADA screening tool could help the public health system for low-cost screening.
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Affiliation(s)
- Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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19
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Gong E, Baptista S, Russell A, Scuffham P, Riddell M, Speight J, Bird D, Williams E, Lotfaliany M, Oldenburg B. My Diabetes Coach, a Mobile App-Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial. J Med Internet Res 2020; 22:e20322. [PMID: 33151154 PMCID: PMC7677021 DOI: 10.2196/20322] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Delivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. OBJECTIVE This study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months. METHODS This randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. RESULTS A total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years; 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA1c (-0.04%, 95% CI -0.45 to 0.36; P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07; P=.04). CONCLUSIONS The MDC program was successfully adopted and used by individuals with type 2 diabetes and significantly improved the users' HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ACTRN) 12614001229662; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662.
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Affiliation(s)
- Enying Gong
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Shaira Baptista
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,The Australia Center for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Anthony Russell
- Princess Alexandra Hospital,, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Michaela Riddell
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jane Speight
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,The Australia Center for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - Dominique Bird
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emily Williams
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Mojtaba Lotfaliany
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Brian Oldenburg
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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20
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Lotfaliany M, Sathish T, Shaw J, Thomas E, Tapp RJ, Kapoor N, Thankappan KR, Oldenburg B. Effects of a lifestyle intervention on cardiovascular risk among high-risk individuals for diabetes in a low- and middle-income setting: Secondary analysis of the Kerala Diabetes Prevention Program. Prev Med 2020; 139:106068. [PMID: 32194098 DOI: 10.1016/j.ypmed.2020.106068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/09/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
We aimed to examine whether a lifestyle intervention was effective in reducing cardiovascular disease (CVD) risk in individuals at high-risk of developing diabetes in a low- and middle-income setting. The Kerala Diabetes Prevention Program was evaluated by a cluster-randomized controlled trial (2013-2016) of 1007 individuals (aged 30-60 years) at high-risk for diabetes (Indian Diabetes Risk Score ≥ 60 and without diabetes) in Kerala state, India. Sixty polling areas in Kerala were randomized to intervention or control groups by an independent statistician using a computer-generated randomization sequence. Participants from 30 intervention communities received a 12-month structured peer-support lifestyle intervention program involving 15 group sessions and linked community activities, aimed at supporting and maintaining lifestyle change. The primary outcome for this analysis was the predicted 10-year CVD risk at two years, assessed using the Framingham Risk Score. The mean age at baseline was 46.0 (SD: 7.5) years, and 47.2% were women. Baseline 10-year CVD risk was similar between study groups. The follow-up rate at two years was 95.7%. The absolute risk reduction in predicted 10-year CVD risk between study groups was 0.69% (95% CI: 0.09% to 1.29%, p=0.024) at one year and 0.69% (95% CI: 0.10% to 1.29%, p=0.023) at two years. The favorable change in CVD risk with the intervention condition was mainly due to the reduction in tobacco use (change index: -0.25, 95% CI: -0.42 to -0.09). Our findings suggest that a community-based peer-support lifestyle intervention could reduce CVD risk in individuals at high-risk of developing diabetes in India. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.
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Affiliation(s)
- Mojtaba Lotfaliany
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Population Health Research Institute, McMaster University, Hamilton, Canada.
| | - Jonathan Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Centre for Online Health, Centre for Health Services Research, University of Queensland, Australia
| | - Robyn Jennifer Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Australia; School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
| | - Nitin Kapoor
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Kavumpurathu Raman Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India; Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Australia; WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Australia
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21
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Lotfaliany M, Mansournia MA, Azizi F, Hadaegh F, Zafari N, Ghanbarian A, Mirmiran P, Oldenburg B, Khalili D. Long-term effectiveness of a lifestyle intervention on the prevention of type 2 diabetes in a middle-income country. Sci Rep 2020; 10:14173. [PMID: 32843718 PMCID: PMC7447773 DOI: 10.1038/s41598-020-71119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/31/2020] [Indexed: 01/01/2023] Open
Abstract
This study aims to assess the effects of a community-based lifestyle intervention program on the incidence of type 2 diabetes (T2D). For this purpose, three communities in Tehran were chosen; one community received a face-to-face educational session embedded in a long-term community-wide lifestyle intervention aimed at supporting lifestyle changes. We followed up 9,204 participants (control: 5,739, intervention: 3,465) triennially from 1999 to 2015 (Waves 1-5). After a median follow-up of 3.5 years (wave 2), the risk of T2D was 30% lower in the intervention community as compared with two control communities by (Hazard-ratio: 0.70 [95% CI 0.53; 0.91]); however, the difference was not statistically significant in the following waves. After a median follow-up of 11.9 years (wave 5), there was a non-significant 6% reduction in the incidence of T2D in the intervention group as compared to the control group (Hazard-ratio: 0.94 [0.81, 1.08]). Moreover, after 11.9 years of follow-up, the intervention significantly improved the diet quality measured by the Dietary Approaches to Stop Hypertension concordance (DASH) score. Mean difference in DASH score in the intervention group versus control group was 0.2 [95% CI 0.1; 0.3]. In conclusion, the intervention prevented T2D by 30% in the short-term (3.5 years) but not long-term; however, effects on improvement of the diet maintained in the long-term.Registration: This study is registered at IRCT, a WHO primary registry ( https://irct.ir ). The registration date 39 is 2008-10-29 and the IRCT registration number is IRCT138705301058N1.
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Affiliation(s)
- Mojtaba Lotfaliany
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Mohamad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Arash Ghanbarian
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Brian Oldenburg
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran.
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22
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Kapoor N, Lotfaliany M, Sathish T, Thankappan KR, Tapp RJ, Thomas N, Furler J, Oldenburg B. Effect of a Peer-led Lifestyle Intervention on Individuals With Normal Weight Obesity: Insights From the Kerala Diabetes Prevention Program. Clin Ther 2020; 42:1618-1624. [PMID: 32718783 DOI: 10.1016/j.clinthera.2020.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/22/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Normal weight obesity (NWO) is a unique phenotype of obesity associated with high cardiovascular mortality. There is limited literature on assessing the effect of therapeutic interventions on the cardiometabolic health of these individuals. We studied the effect of a peer-led lifestyle intervention on key cardiometabolic parameters (blood glucose, blood pressure, and plasma lipids) in individuals with NWO. METHODS This study is a secondary data analysis of the Kerala Diabetes Prevention Program, a cluster-randomized controlled study that involves a peer-led, real-life lifestyle intervention for individuals from the community between the ages of 30 and 60 years with a high diabetes risk. Participants underwent a rigorous cardiometabolic evaluation at baseline and at 2-year follow-up. FINDINGS A total of 292 recruited individuals with NWO were randomized into the intervention (n = 159) and control (n = 133) arms. At 2 years of follow-up, there was minimal but statistically significant improvement in systolic blood pressure and serum HDL level in the intervention arm, but no statistical difference was seen in other lipid and glycemic parameters. IMPLICATIONS This study provides early evidence of the effect of a lifestyle intervention in a cohort of individuals with NWO. Only systolic blood pressure and serum HDL level had a mild favorable change in the intervention arm when compared with the control arm.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes, and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India; Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Science, The University of Melbourne, Melbourne, Australia.
| | - Mojtaba Lotfaliany
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Science, The University of Melbourne, Melbourne, Australia
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Science, The University of Melbourne, Melbourne, Australia; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; Department of Public Health and Community Medicine, Central University, Kasaragod, Kerala, India
| | - Robyn J Tapp
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Science, The University of Melbourne, Melbourne, Australia; The School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom; Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, United Kingdom
| | - Nihal Thomas
- Department of Endocrinology, Diabetes, and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - John Furler
- Department of General Practice, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Science, The University of Melbourne, Melbourne, Australia
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Agustini B, Lotfaliany M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Williams LJ, Berk M, Mohebbi M. Patterns of Association between Depressive Symptoms and Chronic Medical Morbidities in Older Adults. J Am Geriatr Soc 2020; 68:1834-1841. [PMID: 32402115 DOI: 10.1111/jgs.16468] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 02/11/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population. DESIGN Cross-sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. SETTING Multicentric study conducted in Australia and the United States. PARTICIPANTS A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5]). MEASUREMENTS Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 10) scale. Medical morbidities were defined according to condition-specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders. RESULTS Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07-1.32), diabetes (OR = 1.22; 95% CI = 1.05-1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28-1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03-1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27-1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10-1.42), history of cancer (OR = 1.19; 95% CI = 1.05-1.34), Parkinson's disease (OR = 2.56; 95% CI = 1.83-3.56), polypharmacy (OR = 1.60; 95% CI = 1.44-1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12-1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout (P > .05). A significant dose-response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13-1.22). CONCLUSION Late-life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high-risk individuals. J Am Geriatr Soc 68:1834-1841, 2020.
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Affiliation(s)
- Bruno Agustini
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, Iowa, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammadreza Mohebbi
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
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Azizi F, Hadaegh F, Hosseinpanah F, Mirmiran P, Amouzegar A, Abdi H, Asghari G, Parizadeh D, Montazeri SA, Lotfaliany M, Takyar F, Khalili D. Metabolic health in the Middle East and north Africa. Lancet Diabetes Endocrinol 2019; 7:866-879. [PMID: 31422063 DOI: 10.1016/s2213-8587(19)30179-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/09/2023]
Abstract
The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Donna Parizadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Montazeri
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzin Takyar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Lotfaliany M, Hoare E, Jacka FN, Kowal P, Berk M, Mohebbi M. Variation in the prevalence of depression and patterns of association, sociodemographic and lifestyle factors in community-dwelling older adults in six low- and middle-income countries. J Affect Disord 2019; 251:218-226. [PMID: 30927583 DOI: 10.1016/j.jad.2019.01.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/08/2018] [Revised: 01/07/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Data from the World Health Organization Study on global AGEing and adult health (SAGE) were used to estimate the prevalence of depression in older adults in six low- and middle-income countries (LMICs), namely China, Ghana, India, Mexico, the Russian Federation, and South Africa, and to examine the relationship between demographic and lifestyle characteristics and depression. METHOD A total of 33,421 participants aged ≥ 50 years were included. A set of diagnostic questions from the World Mental Health Survey was used within SAGE to define depression. RESULTS The crude population prevalence of depression was 7.4% [95%CI: 6.5%-8.3%] ranging from 1.5% in China to 15.2% in India. It was higher in females 8.6% [7.6%-9.6%] compared to males 6.1% [5.0%-7.2%]. The age-standardized prevalence of depression was 7.8% [6.3%-9.6%] in pooled data, 8.9% [6.9%-11.1%] in females and 6.6% [4.6%-9.0%] in males. Greater fruit (0.89[0.84-0.93]) and vegetable intake (0.94 [0.89-1.00]) was associated with a lower prevalence of depression. Furthermore, those who were older, female, underweight, and with lower education and lower wealth, had higher prevalence of depression. LIMITATIONS The cross-sectional design of this study precluded conclusions on causality. CONCLUSION In nationally-representative samples of older adults in six LMICs, an average of one in every 13 participants suffered from depression. The prevalence of depression varied considerably between countries, sexes, and with wealth and educational disadvantage. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.
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Affiliation(s)
- Mojtaba Lotfaliany
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Erin Hoare
- Food &Mood Centre, Centre for Innovation in Mental and Physical Health and Clinical Treatment, School of Medicine, Faculty of Health, Deakin University, Melbourne, Victoria 3004, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice N Jacka
- Food &Mood Centre, Centre for Innovation in Mental and Physical Health and Clinical Treatment, School of Medicine, Faculty of Health, Deakin University, Melbourne, Victoria 3004, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Black Dog Institute, Randwick, New South Wales, Australia
| | - Paul Kowal
- Division of Data, Analytics and Delivery, World Health Organization, Geneva, Switzerland; Research Centre for Generational Health and Ageing, University of Newcastle, New Lambton Heights, New South Wales 2305, Australia; Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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Lotfaliany M, Agustini B, Kowal P, Berk M, Mohebbi M. Co-occurrence of depression with chronic diseases among the older population living in low- and middle-income countries: A compound health challenge. Ann Clin Psychiatry 2019; 31:95-105. [PMID: 31046030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Few studies have examined the associations between mental and physical health conditions in low- and middle-income countries (LMICs). The aim of this study was to evaluate comorbidity of depression and other chronic diseases in community-dwelling older adults. METHODS Data were obtained from the World Health Organization Study on global AGEing and adult health (SAGE) implemented in 6 LMICs: China, Ghana, India, Mexico, the Russian Federation, and South Africa. A total of 33,508 participants age ≥50 were included in this analysis. Demographics, socioeconomic status, anthropometrics, depression, and chronic diseases status were collected using well-validated instruments in all countries. Multivariate analyses were used to examine the association between depression and comorbid conditions. RESULTS Type 2 diabetes mellitus (odds ratio: 1.39 [95% confidence interval: 1.15, 1.68]), arthritis (1.82 [1.52, 2.18]), asthma (3.20 [2.56, 4.00]), chronic lung disease (3.77 [3.08, 4.62]), angina (2.48 [2.01, 3.05]), and stroke (2.74 [2.18, 3.45]) were positively associated with depression prevalence (all P < .001). CONCLUSIONS Noting the strong association between depression and other chronic diseases in our sample of older adults from 6 LMICs, additional vigilance and screening through informal and formal health care systems would help to decrease the impact of comorbidity on the health and well-being of older populations.
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Affiliation(s)
| | | | | | | | - Mohammadreza Mohebbi
- Faculty of Health, Deakin University, Melbourne Campus at Burwood, Burwood, Australia. E-MAIL:
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Khalili D, Asgari S, Lotfaliany M, Zafari N, Hadaegh F, Momenan AA, Nowroozpoor A, Hosseini-Esfahani F, Mirmiran P, Amiri P, Azizi F. Long-Term Effectiveness of a Lifestyle Intervention: A Pragmatic Community Trial to Prevent Metabolic Syndrome. Am J Prev Med 2019; 56:437-446. [PMID: 30777162 DOI: 10.1016/j.amepre.2018.10.029] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate the long-term effectiveness of a community-based lifestyle education on primary prevention of metabolic syndrome in a middle-income country. STUDY DESIGN This study followed 3,180 individuals free of metabolic syndrome who were under the coverage of three health centers in Tehran from 1999 until 2015. They were undergoing triennial examinations resulting in four re-exams. People in one of three areas received interventions consisting of family-, school-, and community-based educational programs, including a face-to-face educational session at baseline. Data were analyzed considering the incidence of metabolic syndrome at each re-exam and also repeated-measure analysis including all re-exams together. Weighting was considered to correct selection bias because of loss to follow-up. Data were analyzed in 2017. RESULTS After 3 years, 149 of 852 participants in the intervention and 471 of 2,328 people in control area developed metabolic syndrome at first re-exam resulting in a RR of 0.78 (95% CI=0.67, 0.92). The difference between groups remained unchanged up to the 6-year follow-up (RR=0.79, 95% CI=0.66, 0.93, at second re-exam), but disappeared during the third and fourth re-exams (RR=1.04, 95% CI=0.91, 1.18 and RR=1.03, 95% CI=0.91, 1.16, respectively). Marginal models for longitudinal data showed a significant interaction between intervention and time of re-exams. Further analyses showed that the effect of the intervention might have been rooted in improvement of lipid profile and glucose level. CONCLUSIONS In a middle-income country, face-to-face educational sessions followed by a long-term maintenance community-level educational program could reduce the risk of metabolic syndrome for up to 6 years. A booster face-to-face session is recommended to retain this preventive effect. TRIAL REGISTRATION This study is registered at Iran Registry for Clinical Trials (http://irct.ir) IRCT138705301058N1.
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Affiliation(s)
- Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir-Abbas Momenan
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Nowroozpoor
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firoozeh Hosseini-Esfahani
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Lotfaliany M, Hadaegh F, Asgari S, Mansournia MA, Azizi F, Oldenburg B, Khalili D. Non-invasive Risk Prediction Models in Identifying Undiagnosed Type 2 Diabetes or Predicting Future Incident Cases in the Iranian Population. Arch Iran Med 2019; 22:116-124. [PMID: 31029067] [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] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Iran needs pragmatic screening methods for identifying those with undiagnosed type 2 diabetes or at high risk of developing it. The aim of this study was to assess performance of three non-invasive risk prediction models, i.e. the Finnish Diabetes Risk Score (FINDRISC), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), and the American Diabetes Association Risk Score (ADA), for identifying those with undiagnosed type 2 diabetes (prevalent type 2 diabetes at baseline without any treatment) or those who would develop type 2 diabetes within 5 years of follow-up. METHODS 3467 participants aged ≥30 years without treated type 2 diabetes in the Tehran Lipid and Glucose Study (TLGS) were included in this study. The discrimination power of models was assessed by area under the curve (AUC), their calibrations were assessed by calibration plots and Hosmer-Lemeshow test, and their net benefits were assessed by decision curves. RESULTS 430 participants had undiagnosed type 2 diabetes at baseline and 203 developed type 2 diabetes during 5 years of followup. AUSDRISK had the highest AUC (0.77) as compared to FINDRISC (0.75; P value: 0.014), and the ADA model (0.73; P value: <0.001). The original model for AUSDRISK and calibrated versions of FINDRISC and ADA models had acceptable calibration (Hosmer-Lemeshow chi-square <20) and these models were clinically useful in a wide range of risk thresholds as their net benefit was higher than no-screening scenarios. CONCLUSION The original AUSDRISK model and recalibrated models for FINDRISC and ADA are valid and effective tools for identifying those with undiagnosed or 5-year incident type 2 diabetes in Iran.
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Affiliation(s)
- Mojtaba Lotfaliany
- School of Population and Global Health, University of Melbourne, Australia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Australia
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Thomas E, Lotfaliany M, Grace SL, Oldenburg B, Taylor CB, Hare DL, Rangani WT, Dheerasinghe DAF, Cadilhac DA, O'Neil A. Effect of cardiac rehabilitation on 24-month all-cause hospital readmissions: A prospective cohort study. Eur J Cardiovasc Nurs 2018; 18:234-244. [PMID: 30547678 DOI: 10.1177/1474515118820176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. AIM The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. METHODS Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013-June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. RESULTS Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31-0.91 p-value:0.022) and length of stay (coefficient -1.21 days, 95% confidence interval: -2.46-0.26; marginally significant p-value: 0.055) in adjusted models. CONCLUSION This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.
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Affiliation(s)
- Emma Thomas
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Mojtaba Lotfaliany
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Sherry L Grace
- 2 School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Brian Oldenburg
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - C Barr Taylor
- 3 Department of Psychiatry, Stanford and Palo Alto Universities, USA
| | - David L Hare
- 4 School of Medicine, University of Melbourne, Australia.,5 Department of Cardiology, Austin Hospital, Australia
| | - Wp Thanuja Rangani
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | | | - Dominique A Cadilhac
- 6 School of Clinical Sciences at Monash Health, Monash University, Australia.,7 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Adrienne O'Neil
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
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Lotfaliany M, Bowe SJ, Kowal P, Orellana L, Berk M, Mohebbi M. Depression and chronic diseases: Co-occurrence and communality of risk factors. J Affect Disord 2018; 241:461-468. [PMID: 30149333 DOI: 10.1016/j.jad.2018.08.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 04/16/2018] [Revised: 06/06/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of current study is to assess the cross-sectional association of chronic non-communicable diseases (diabetes mellitus, arthritis, asthma, chronic lung disease, angina, and stroke) with both diagnosed and undiagnosed depression in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1, a study of adults in six low- and middle-income countries. METHODS A total of 41,810 participants, aged ≥ 18 years, were included. Depression status was assessed by standard methods derived from the World Mental Health Survey (WHH-CIDI). Undiagnosed depression was defined as a depressed person who did not report history of diagnosis/treatment for depression. Associations between depression/undiagnosed depression and chronic diseases, adjusting for country of residence, demographics and chronic diseases risk factors were assessed. RESULTS Depression was detected in 2508 (6.0%) cases, from whom 2098 (87%) were undiagnosed. Diabetes (Odds ratio:1.47[95%CI:1.24,1.75]), arthritis (2.14[1.82,2.52]), asthma (3.36[2.73,4.14]), chronic lung disease (3.74[3.10,4.51]), angina (3.20[2.66,3.85]), and stroke (3.14[2.55,3.86]) were associated with depression (p-values < 0.001). Being older, female, underweight, and having lower education, and lower income were positively associated with depression. The estimated odds ratios were similar for undiagnosed depression. LIMITATIONS Cross-sectional design of study prevent us to determine whether depression followed exposures in time. About 12% of the participant did not have data for depression status and were excluded from the study. CONCLUSIONS Most depression cases were undiagnosed. Depression/undiagnosed depression were strongly associated with chronic diseases; stronger than what has been reported in developed countries.
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Affiliation(s)
- Mojtaba Lotfaliany
- Deakin University, Geelong, Victoria, Australia. Biostatistics Unit, Faculty of Health
| | - Steven J Bowe
- Deakin University, Geelong, Victoria, Australia. Biostatistics Unit, Faculty of Health
| | - Paul Kowal
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
| | - Liliana Orellana
- Deakin University, Geelong, Victoria, Australia. Biostatistics Unit, Faculty of Health
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia
| | - Mohammadreza Mohebbi
- Deakin University, Geelong, Victoria, Australia. Biostatistics Unit, Faculty of Health.
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Lotfaliany M, Akbarpour S, Zafari N, Mansournia MA, Asgari S, Azizi F, Hadaegh F, Khalili D. World Bank Income Group, Health Expenditure or Cardiometabolic Risk Factors? A Further Explanation of the Wide Gap in Cardiometabolic Mortality Between Worldwide Countries: An Ecological Study. Int J Endocrinol Metab 2018; 16:e59946. [PMID: 30464769 PMCID: PMC6208042 DOI: 10.5812/ijem.59946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 02/24/2018] [Accepted: 06/30/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For addressing the burden of non-communicable diseases and policymaking, the world health organization uses World Bank income group to classify countries. This calcification method might not be optimal. This study aimed to investigate the role of World Bank income group, health expenditure, and cardiometabolic risk factors of countries in explaining the gap between their cardiometabolic mortality. METHODS In total, 190 countries were categorized into four income groups according to the World Bank definition. The energy consumption, health expenditure, and data of sex-specified age-standardized prevalence of obesity, hypercholesterolemia, hypertension, diabetes, smoking, and physical inactivity in 2008 and cardiometabolic mortality in 2012 were used. Multivariable-adjusted mixed-effect linear regression models were applied to relate country-level predictors to their mortality outcomes. RESULTS While the lowest cardiometabolic mortality was recorded in high-income countries in both genders, the highest rates were recorded in the low-income category for women and in low and middle-income for men. Countries had lower cardiometabolic mortality for women compared to men; however, such a difference was not shown in low-income countries. World Bank income group of countries, per se, explained one-third of the variation in their mortality outcomes while adding health expenditure, energy consumption, and cardiometabolic risk factors increased the explanatory power of the model considerably. Moreover, the more the health expenditure, the weaker the association of prevalence of hypertension with cardiometabolic mortality. CONCLUSIONS Adding countries' health expenditure and/or the prevalence of risk factors to their World Bank income group may contribute to the better explanation of the gap between them in cardiometabolic mortality.
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Affiliation(s)
- Mojtaba Lotfaliany
- School of Population and Global Health, University of Melbourne, Victoria, Australia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Davood Khalili, MD, MPH, PhD, Assistant Professor of Epidemiology, Yaman St, P.O. Box 19395-4763, Tehran, Iran. Tel: +98-2122432500, Fax: +98-2122416264, E-mail:
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Zafari N, Lotfaliany M, Mansournia MA, Khalili D, Azizi F, Hadaegh F. Optimal cut-points of different anthropometric indices and their joint effect in prediction of type 2 diabetes: results of a cohort study. BMC Public Health 2018; 18:691. [PMID: 29866083 PMCID: PMC5987476 DOI: 10.1186/s12889-018-5611-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 05/25/2018] [Indexed: 01/02/2023] Open
Abstract
Background To determine the anthropometric indices that would predict type 2 diabetes (T2D) and delineate their optimal cut-points. Methods In a cohort study, 7017 Iranian adults, aged 20–60 years, free of T2D at baseline were investigated. Using Cox proportional hazard models, hazard ratios (HRs) for incident T2D per 1 SD change in body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and hip circumference (HC) were calculated. The area under the receiver operating characteristics (ROC) curves (AUC) was calculated to compare the discriminative power of anthropometric variables for incident T2D. Cut-points of each index were estimated by the maximum value of Youden’s index and fixing the sensitivity at 75%. Using the derived cut-points, joint effects of BMI and other obesity indices on T2D hazard were assessed. Results During a median follow-up of 12 years, 354 men, and 490 women developed T2D. In both sexes, 1 SD increase in anthropometric variables showed significant association with incident T2D, except for HC in multivariate adjusted model in men. In both sexes, WHtR had the highest discriminatory power while HC had the lowest. The derived cut-points for BMI, WC, WHtR, WHR, and HC were 25.56 kg/m2, 89 cm, 0.52, 0.91, and 96 cm in men and 27.12 kg/m2, 87 cm, 0.56, 0.83, and 103 cm in women, respectively. Assessing joint effects of BMI and each of the obesity measures in the prediction of incident T2D showed that among both sexes, combined high values of obesity indices increase the specificity for the price of reduced sensitivity and positive predictive value. Conclusions Our derived cut-points differ between both sexes and are different from other ethnicities. Electronic supplementary material The online version of this article (10.1186/s12889-018-5611-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Thankappan KR, Sathish T, Tapp RJ, Shaw JE, Lotfaliany M, Wolfe R, Absetz P, Mathews E, Aziz Z, Williams ED, Fisher EB, Zimmet PZ, Mahal A, Balachandran S, D'Esposito F, Sajeev P, Thomas E, Oldenburg B. A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program. PLoS Med 2018; 15:e1002575. [PMID: 29874236 PMCID: PMC5991386 DOI: 10.1371/journal.pmed.1002575] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. METHODS AND FINDINGS The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30-60 years) were those with an Indian Diabetes Risk Score (IDRS) ≥60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66-1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: -1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (≥5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US$22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate. CONCLUSIONS A low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.
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Affiliation(s)
- Kavumpurathu R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- * E-mail:
| | - Robyn J. Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Jonathan E. Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mojtaba Lotfaliany
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - Elezebeth Mathews
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Zahra Aziz
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Edwin B. Fisher
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, North Carolina, United States of America
| | - Paul Z. Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Fabrizio D'Esposito
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Priyanka Sajeev
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- Kerala Social Security Mission, Trivandrum, Kerala, India
| | - Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Victoria, Australia
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Eslami A, Lotfaliany M, Akbarpour S, Azizi F, Hadaegh F. Trend of cardiovascular risk factors in the older Iranian population: 2002-2014. Geriatr Gerontol Int 2017; 18:130-137. [PMID: 28857406 DOI: 10.1111/ggi.13154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/18/2017] [Accepted: 06/30/2017] [Indexed: 12/22/2022]
Abstract
AIM Current study aimed to investigate the sex-stratified secular trend of cardiovascular disease risk factors among an older population in Iran during a median follow-up period of 8.76 years. METHODS A total of 1490 participants (733 women) aged ≥60 years were evaluated in four study phases of 2002-2005, 2005-2008, 2008-2011 and 2011-2014. The trends of cardiovascular disease risk factors for each sex were estimated using generalized estimating equations. RESULTS The age-adjusted prevalence of diabetes, hypertension, central obesity, and chronic kidney disease at the baseline was 24%, 43%, 55%, and 32% in men and 31%, 57%, 60% and 53% in women, respectively, and had noticeable upward trend during the study period to reach 35%, 56%, 61% and 51% in men, and 42%, 71%, 74% and 67% in women, respectively. However, lipid profile parameters showed favorable trends. Despite the increasing trend in drug consumption, approximately 27% of women with diabetes and 37% of men with diabetes did not use antidiabetic medication, respectively; the results were 23% and 35% for hypertensive women and men, respectively. Among men, there was a decreasing trend towards low physical activity, from 40% at baseline to 26% at the most recent follow up. The prevalence of smoking remained steady throughout follow up. CONCLUSIONS Despite the benefits of lipid lowering, the status of other risk factor profiles are often suboptimal in both sexes. There remains much room for improvement in risk factors management, particularly for hypertension, smoking and adiposity status, and a need for an intervention. Geriatr Gerontol Int 2018; 18: 130-137.
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Affiliation(s)
- Ali Eslami
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Non-Communicable Disease Control Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sardarinia M, Akbarpour S, Lotfaliany M, Bagherzadeh-Khiabani F, Bozorgmanesh M, Sheikholeslami F, Azizi F, Hadaegh F. Risk Factors for Incidence of Cardiovascular Diseases and All-Cause Mortality in a Middle Eastern Population over a Decade Follow-up: Tehran Lipid and Glucose Study. PLoS One 2016; 11:e0167623. [PMID: 27930696 PMCID: PMC5145170 DOI: 10.1371/journal.pone.0167623] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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] [Received: 04/04/2016] [Accepted: 11/17/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To examine the association between potentially modifiable risk factors with cardiovascular disease (CVD) and all-cause mortality and to quantify their population attributable fractions (PAFs) among a sample of Tehran residents. METHODS Overall, 8108 participants (3686 men) aged≥30 years, were investigated. To examine the association between risk factors and outcomes, multivariate sex-adjusted Cox proportional hazard regression analysis were conducted, using age as time-scale in two models including general/central adiposity: 1)adjusted for different independent variables including smoking, education, family history of CVD and sex for both outcomes and additionally adjusted for prevalent CVD for all-cause mortality 2)further adjusted for obesity mediators (hypertension, diabetes, lipid profile and chronic kidney disease). Separate models were used including either general or central adiposity. RESULTS During median follow-up of >10 years, 827 first CVD events and 551 deaths occurred. Both being overweight (hazard ratio (HR), 95%CI: 1.41, 1.18-1.66, PAF 13.66) and obese (1.51, 1.24-1.84, PAF 9.79) played significant roles for incident CVD in the absence of obesity mediators. Predicting CVD, in the presence of general adiposity and its mediators, significant positive associations were found for hypercholesterolemia (1.59, 1.36-1.85, PAF 16.69), low HDL-C (1.21, 1.03-1.41, PAF 12.32), diabetes (1.86, 1.57-2.27, PAF 13.87), hypertension (1.79, 1.46-2.19, PAF 21.62) and current smoking (1.61, 1.34-1.94, PAF 7.57). Central adiposity remained a significant positive predictor, even after controlling for mediators (1.17, 1.01-1.35, PAF 7.55). For all-cause mortality, general/central obesity did not have any risk even in the absence of obesity mediators. Predictors including diabetes (2.56, 2.08-3.16, PAF 24.37), hypertension (1.43, 1.11-1.84, PAF 17.13), current smoking (1.75, 1.38-2.22, PAF 7.71), and low education level (1.59, 1.01-2.51, PAF 27.08) were associated with higher risk, however, hypertriglyceridemia (0.83, 0.68-1.01) and being overweight (0.71, 0.58-0.87) were associated with lower risk. CONCLUSIONS Modifiable risk factors account for more than 70% risk for both CVD and mortality events.
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Affiliation(s)
- Mahsa Sardarinia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Farideh Bagherzadeh-Khiabani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Sheikholeslami
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jahangiri-Noudeh Y, Akbarpour S, Lotfaliany M, Zafari N, Khalili D, Tohidi M, Mansournia MA, Azizi F, Hadaegh F. Trends in cardiovascular disease risk factors in people with and without diabetes mellitus: a Middle Eastern cohort study. PLoS One 2014; 9:e112639. [PMID: 25461381 PMCID: PMC4251920 DOI: 10.1371/journal.pone.0112639] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/05/2014] [Indexed: 12/21/2022] Open
Abstract
AIMS/HYPOTHESIS To investigate secular trends in cardiovascular disease (CVD) risk factors during a decade of follow-up in a Middle Eastern cohort, and to compare observed trends between diabetic and non-diabetic populations. METHODS In a population of 6181 participants (2622 males and 3559 females), diabetes status and CVD risk factors were evaluated in 4 study phases from 1999-2011. 1045 subjects had type 2 diabetes mellitus at baseline and 5136 participants were diabetes-free. To examine the trends of CVD risk factors, generalized estimation equation models were constructed. The interaction between the diabetes status and each phase of the study was checked in a separate model. RESULTS During the follow-up period diabetic females significantly gained better control of their blood pressure, serum low density lipoprotein cholesterol and general and central obesity measures compared to non-diabetic counterparts, although 60% of them had high BP and 64% had high serum LDL-C levels till the end of the study. Diabetic males however, experienced significantly better control on their serum LDL-C and general and central obesity measures compared to their non-diabetic controls; but 24% of them were still smoker, 63% had high BP and 60% had high serum LDL-C levels at the end of the follow-up (all Ps interaction <0.05). Use of lipid-lowering and antihypertensive medications increased consistently in both diabetic and non-diabetic populations. CONCLUSIONS/INTERPRETATION Although CVD risk factors have been controlled to some extent among diabetic population in Iran, still high numbers of people with diabetes have uncontrolled CVD risk factors that prompt more attention.
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Affiliation(s)
- Younes Jahangiri-Noudeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
- * E-mail:
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Moghaddam MM, Mohebi R, Hosseini F, Lotfaliany M, Azizi F, Saadat N, Hadaegh F. Distribution of ideal cardiovascular health in a community-based cohort of Middle East population. Ann Saudi Med 2014; 34:134-42. [PMID: 24894782 PMCID: PMC6074868 DOI: 10.5144/0256-4947.2014.134] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To improve cardiovascular (CV) health of American population, the American Heart Association (AHA) developed definitions of ideal, intermediate, and poor CV health based on 7 accessible health metrics. The applicability of this construct and the distribution of its components in the community-based populations in the Middle East region have not been reported. DESIGN AND SETTINGS A prospective population-based cohort study conducted from 1999 to 2011. METHODS We used data from phase 4 of Tehran Lipid and Glucose Study (2009-2011) (2861 women and 2004 men, aged >= 20 years) to estimate the frequency of CV health levels (ideal, intermediate, and poor) in adults of both genders, and the frequency of each metric at each level of CV health. The median or mean of each CV health metric was also estimated in the whole spectrum of CV health in all subgroups. RESULTS Only 1 adult participant met all 7 ideal CV health metrics; 25.01% of women and 26% of men had intermediate CV health; 74.8% of women and 74% of men exhibited poor CV health. Only 19.7% of women and 10.3% of men had 5 or more ideal CV health metrics. Nonsmoking was the most frequent ideal health behavior. A total of 89.6% of participants had 1 or 2 ideal CV health behaviors. Ideal smoking and fasting plasma glucose had the highest frequency of CV health factors among others. CONCLUSION The frequency of ideal CV health was extremely low in this cohort of adults. The frequency of intermediate CV health was also low, and it may be significantly lower in the general population.
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Affiliation(s)
| | | | | | | | | | | | - Farzad Hadaegh
- Dr. Farzad Hadaegh, Research Institute for Endocrine Sciences,, Shahid Beheshti University of Medical Sciences,, PO Box 4763, Tehran 19395, Iran, T: +982122409301-5, F: +982122402463,
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Kheirandish M, Asgari S, Lotfaliany M, Bozorgmanesh M, Saadat N, Tohidi M, Azizi F, Hadaegh F. Secular trends in serum lipid levels of a Middle Eastern adult population; 10 years follow up in Tehran lipid and glucose study. Lipids Health Dis 2014; 13:20. [PMID: 24456699 PMCID: PMC3912503 DOI: 10.1186/1476-511x-13-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/16/2014] [Indexed: 02/20/2023] Open
Abstract
Background To examine trends in the population levels of serum lipids among a Middle-Eastern adult population with high prevalence of dyslipidemia. Methods A population-based cohort of adult Iranian participants, aged ≥20 years underwent four consecutive examinations between 1999–2001 and 2008–2011. Trends in age and multivariate-adjusted mean lipid levels were calculated using generalized estimating equations. Results At each of the 4 assessments, there were significant decreases in levels of total cholesterol (TC) (multivariate-adjusted means, 5.21 vs. 4.88 mmol/L in men; 5.42 vs. 5.07 mmol/L in women), triglycerides (TGs) (2.11 vs. 1.94 mmol/L in men; 1.88 vs. 1.74 mmol/L in women), and an increase in HDL-C level in both genders (0.95 vs. 1.058 mmol/L in men; 1.103 vs. 1.246 mmol/L in women) in multivariate analyses (all Ps <0.001); however, body mass index (BMI) significantly increased simultaneously (25.92 vs. 27.45 kg/m2 in men; 27.76 vs. 30.02 kg/m2 in women) (P < 0.001). There were significant (P < 0.001) increases in fasting plasma glucose (FPG) levels only among men (5.35 vs. 5.73 mmol/L). Results did not change after excluding participants that had cardiovascular disease or used lipid lowering drugs during follow-up. There were significant decreases in the prevalence of hypercholesterolemia, low HDL-C, hypertriglyceridemia (all Ps <0.001) during follow-up. Furthermore, the consumption of lipid lowering drugs significantly increased (P <0.001). Conclusion During a 10 years follow-up, favorable trends were observed in the population levels of TC, triglycerides, HDL-C, which could not be fully accounted for by the increase observed in the consumption of lipid lowering drugs. These favorable trends were counterbalanced by the progressive increase in general obesity and FPG level.
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Affiliation(s)
| | | | | | | | | | | | | | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, #24, Parvaneh st, Yemen st, Chamran Exp, P,O, Box: 19395-4763, Tehran, Islamic Republic of Iran.
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Hadaegh F, Hasheminia M, Lotfaliany M, Mohebi R, Azizi F, Tohidi M. Incidence of metabolic syndrome over 9 years follow-up; the importance of sex differences in the role of insulin resistance and other risk factors. PLoS One 2013; 8:e76304. [PMID: 24086723 PMCID: PMC3785433 DOI: 10.1371/journal.pone.0076304] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022] Open
Abstract
To determine, the predictors of incident metabolic syndrome (MetS) in a community-based cohort of West Asians, during a mean follow-up of 9.3 years, a sample of 2858 non-MetS Iranian adults aged ≥ 20 years were examined at baseline and followed at three year intervals during three consecutive phases. The MetS was defined using the joint interim statement. Cox proportional hazard regression was used to determine the independent variables associated with incident MetS. Overall, 1117 new cases MetS were identified resulting in an incidence rate of 550.9/10000 person years (95% CI: 519.5-584.2). The corresponding incidence rates among women and men were 433.5/10000 person years (95% CI: 398.8-471.2) and 749.2/10000 person years (95% CI: 689.9-813.5), respectively. Baseline-adjusted predictors of developing MetS included all of the MetS components, being overweight or obese in both gender, and family history of diabetes and age only in women. There were significant effect modifications of gender on age (P<0.001), high blood pressure (0.026), high waist circumference (P<0001) and obesity categories (all P ≤ 0.01) in multivariate analysis. After considering HOMA–IR in the model, among women, all of the MetS predictors as well as those with HOMA-IR ≥ 2.23 showed a significant risk for incident MetS [HR: 1.63 (1.16-2.28)]; however, among men all the MetS components (WC was marginally significant) as well as the fourth quartile of HOMA-IR [HR: 1.50 (1.03-2.17)] and being overweight showed a significant risk. Finally, in the pooled analysis, we showed that female gender had lower risk for incident MetS than male [HR: 0.58 (0.47-0.70)]. In the Iranian population, high incidence of MetS, especially among men, was shown. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident MetS.
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Affiliation(s)
- Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohebi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
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Mirhosseini SM, Fakhri M, Mozaffary A, Lotfaliany M, Behzadnia N, Ansari Aval Z, Ghiasi SMS, Boloursaz MR, Masjedi MR. Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention. Interact Cardiovasc Thorac Surg 2012; 16:495-500. [PMID: 23250960 DOI: 10.1093/icvts/ivs491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions. METHODS From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized. RESULTS There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1-85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362-6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009-50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100-3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048-2.90 P = 0.032) were the three independent predictors of postoperative death. CONCLUSIONS In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients.
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Affiliation(s)
- Seyed Mohsen Mirhosseini
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ahmadi ZH, Mirhosseini SM, Fakhri M, Mozaffary A, Lotfaliany M, Nejatollahi SMR, Marashi SA, Behzadnia N, Sharif-Kashani B. First successful combined heart and kidney transplant in Iran: a case report. EXP CLIN TRANSPLANT 2012; 11:361-3. [PMID: 23113666 DOI: 10.6002/ect.2012.0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Combined heart and kidney transplant has become an accepted therapy for patients with coexisting heart and kidney failure. This method, compared with single-organ transplant, has a better outcome. Here, we report the first successful combined heart and kidney transplant in Iran. The patient was a 36-year-old man with end-stage renal disease owing to IgA nephropathy, admitted to Masih Daneshvari Hospital in Tehran, Iran for progressive dyspnea and chest pain. In-patient evaluations revealed cardiomyopathy leading to end-stage heart failure. Owing to concurrent heart and kidney end-stage diseases, combined cardiorenal transplant was done. Eight months after his transplant, routine follow-ups have not shown any signs of acute rejection. He is now New York Heart Association functional class I. Both cardiac and renal functions are within normal ranges. Good outcome during follow-up for this case justifies simultaneous heart plus kidney transplants as an alternate treatment for patients with advanced disease of both organs.
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Affiliation(s)
- Zargham-Hossein Ahmadi
- From the Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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