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Eminson K, Cai YS, Chen Y, Blackmore C, Rodgers G, Jones N, Gulliver J, Fenech B, Hansell AL. Does air pollution confound associations between environmental noise and cardiovascular outcomes? - A systematic review. Environ Res 2023; 232:116075. [PMID: 37182833 DOI: 10.1016/j.envres.2023.116075] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Exposure to environmental noise is associated with adverse health effects, but there is potential for confounding and interaction with air pollution, particularly where both exposures arise from the same source, such as transport. OBJECTIVES To review evidence on confounding and interaction of air pollution in relation to associations between environmental noise and cardiovascular outcomes. METHODS Papers were identified from similar reviews published in 2013 and 2015, from the systematic reviews supporting the WHO 2018 noise guidelines, and from a literature search covering the period 2016-2022 using Medline and PubMed databases. Additional papers were identified from colleagues. Study selection was according to PECO inclusion criteria. Studies were evaluated against the WHO checklist for risk of bias. RESULTS 52 publications, 36 published after 2015, were identified that assessed associations between transportation noise and cardiovascular outcomes, that also considered potential confounding (49 studies) or interaction (23 studies) by air pollution. Most, but not all studies, suggested that the associations between traffic noise and cardiovascular outcomes are independent of air pollution. NO2 or PM2.5 were the most commonly included air pollutants and we observed no clear differences across air pollutants in terms of the potential confounding role. Most papers did not appear to suggest an interaction between noise and air pollution. Eight studies found the largest noise effect estimates occurring within the higher noise and air pollution exposure categories, but were not often statistically significant. CONCLUSION Whilst air pollution does not appear to confound associations of noise and cardiovascular health, more studies on potential interactions are needed. Current methods to assess quality of evidence are not optimal when evaluating evidence on confounding or interaction.
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Affiliation(s)
- Katie Eminson
- Centre for Environmental Health and Sustainability, University of Leicester, UK
| | - Yutong Samuel Cai
- Centre for Environmental Health and Sustainability, University of Leicester, UK
| | - Yingxin Chen
- Centre for Environmental Health and Sustainability, University of Leicester, UK
| | - Claire Blackmore
- Centre for Environmental Health and Sustainability, University of Leicester, UK
| | - Georgia Rodgers
- Noise and Public Health Group, Environmental Hazards and Emergencies Department, UK Health Security Agency (UKHSA), UK
| | | | - John Gulliver
- Centre for Environmental Health and Sustainability, University of Leicester, UK; National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, UK
| | - Benjamin Fenech
- Noise and Public Health Group, Environmental Hazards and Emergencies Department, UK Health Security Agency (UKHSA), UK; National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, UK
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, UK; National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, UK.
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2
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Jephcote C, Clark SN, Hansell AL, Jones N, Chen Y, Blackmore C, Eminson K, Evans M, Gong X, Adams K, Rodgers G, Fenech B, Gulliver J. Spatial assessment of the attributable burden of disease due to transportation noise in England. Environ Int 2023; 178:107966. [PMID: 37390771 DOI: 10.1016/j.envint.2023.107966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/14/2023] [Accepted: 05/07/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Noise pollution from transportation is one of the leading contributors to the environmental disease burden in Europe. We provide a novel assessment of spatial variations of these health impacts within a country, using England as an example. METHODS We estimated the burden of annoyance (highly annoyed), sleep disturbance (highly sleep disturbed), ischemic heart disease (IHD), stroke, and diabetes attributable to long-term transportation noise exposures in England for the adult population in 2018 down to local authority level (average adult population: 136,000). To derive estimates, we combined literature-informed exposure-response relationships, with population data on noise exposures, disease, and mortalities. Long-term average noise exposures from road, rail and aircraft were sourced from strategic noise mapping, with a lower exposure threshold of 50 dB (decibels) Lden and Lnight. RESULTS 40 %, 4.5 % and 4.8 % of adults in England were exposed to road, rail, and aircraft noise exceeding 50 dB Lden. We estimated close to a hundred thousand (∼97,000) disability adjusted life years (DALY) lost due to road-traffic, ∼13,000 from railway, and ∼ 17,000 from aircraft noise. This excludes some noise-outcome pairs as there were too few studies available to provide robust exposure-response estimates. Annoyance and sleep disturbance accounted for the majority of the DALYs, followed by strokes, IHD, and diabetes. London, the South East, and North West regions had the greatest number of road-traffic DALYs lost, while 63 % of all aircraft noise DALYs were found in London. The strategic noise mapping did not include all roads, which may still have significant traffic flows. In sensitivity analyses using modelled noise from all roads in London, the DALYs were 1.1x to 2.2x higher. CONCLUSION Transportation noise exposures contribute to a significant and unequal environmental disease burden in England. Omitting minor roads from the noise exposure modelling leads to underestimation of the disease burden.
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Affiliation(s)
- Calvin Jephcote
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Sierra N Clark
- Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK
| | | | - Yingxin Chen
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Claire Blackmore
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Katie Eminson
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Megan Evans
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Xiangpu Gong
- NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK
| | - Kathryn Adams
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Georgia Rodgers
- Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK
| | - Benjamin Fenech
- Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK.
| | - John Gulliver
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health at the University of Leicester, UK.
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Saletti PG, Mowrey WB, Liu W, Li Q, McCullough J, Aniceto R, Lin I, Eklund M, Casillas‐Espinosa PM, Ali I, Santana‐Gomez C, Coles L, Shultz SR, Jones N, Staba R, O'Brien TJ, Moshé SL, Agoston DV, Galanopoulou AS. Early preclinical plasma protein biomarkers of brain trauma are influenced by early seizures and levetiracetam. Epilepsia Open 2023; 8:586-608. [PMID: 37026764 PMCID: PMC10235584 DOI: 10.1002/epi4.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE We used the lateral fluid percussion injury (LFPI) model of moderate-to-severe traumatic brain injury (TBI) to identify early plasma biomarkers predicting injury, early post-traumatic seizures or neuromotor functional recovery (neuroscores), considering the effect of levetiracetam, which is commonly given after severe TBI. METHODS Adult male Sprague-Dawley rats underwent left parietal LFPI, received levetiracetam (200 mg/kg bolus, 200 mg/kg/day subcutaneously for 7 days [7d]) or vehicle post-LFPI, and were continuously video-EEG recorded (n = 14/group). Sham (craniotomy only, n = 6), and naïve controls (n = 10) were also used. Neuroscores and plasma collection were done at 2d or 7d post-LFPI or equivalent timepoints in sham/naïve. Plasma protein biomarker levels were determined by reverse phase protein microarray and classified according to injury severity (LFPI vs. sham/control), levetiracetam treatment, early seizures, and 2d-to-7d neuroscore recovery, using machine learning. RESULTS Low 2d plasma levels of Thr231 -phosphorylated tau protein (pTAU-Thr231 ) and S100B combined (ROC AUC = 0.7790) predicted prior craniotomy surgery (diagnostic biomarker). Levetiracetam-treated LFPI rats were differentiated from vehicle treated by the 2d-HMGB1, 2d-pTAU-Thr231 , and 2d-UCHL1 plasma levels combined (ROC AUC = 0.9394) (pharmacodynamic biomarker). Levetiracetam prevented the seizure effects on two biomarkers that predicted early seizures only among vehicle-treated LFPI rats: pTAU-Thr231 (ROC AUC = 1) and UCHL1 (ROC AUC = 0.8333) (prognostic biomarker of early seizures among vehicle-treated LFPI rats). Levetiracetam-resistant early seizures were predicted by high 2d-IFNγ plasma levels (ROC AUC = 0.8750) (response biomarker). 2d-to-7d neuroscore recovery was best predicted by higher 2d-S100B, lower 2d-HMGB1, and 2d-to-7d increase in HMGB1 or decrease in TNF (P < 0.05) (prognostic biomarkers). SIGNIFICANCE Antiseizure medications and early seizures need to be considered in the interpretation of early post-traumatic biomarkers.
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Affiliation(s)
- Patricia G. Saletti
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wenzhu B. Mowrey
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wei Liu
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Qianyun Li
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Jesse McCullough
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Roxanne Aniceto
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - I‐Hsuan Lin
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Michael Eklund
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Pablo M. Casillas‐Espinosa
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Idrish Ali
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | | | - Lisa Coles
- University of Minnesota Twin CitiesMinneapolisMinnesotaUSA
| | - Sandy R. Shultz
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Nigel Jones
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | | | - Terence J. O'Brien
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Solomon L. Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Dominick P Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PediatricsAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Denes V. Agoston
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Dominick P Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
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Heron N, Jones N, Cardwell C, Gomes C. 'If in Doubt, Sit Them Out': How Long to Return to Elite Cycling Competition following a Sports-Related Concussion (SRC)? Int J Environ Res Public Health 2023; 20:ijerph20085449. [PMID: 37107731 PMCID: PMC10138273 DOI: 10.3390/ijerph20085449] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION A concussion or sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. After a SRC diagnosis is made, a concussed individual must undergo a period away from competition while they return to their baseline level of functioning. The Union Cycliste Internationale (UCI) currently recommend a minimum of 6 days restriction from competitive cycling following a SRC but there is a growing feeling amongst those involved in brain injury research that this period is too short. Therefore, how much time should cyclists be removed from competitive sporting action following a SRC? AIMS To review the time out of competition following the diagnosis of a SRC for elite cyclists within British Cycling (BC). METHODS All medical records for elite cyclists within BC were audited for diagnoses of "concussion" or "sports-related concussions" from January 2017 until September 2022. The days out of competition following the concussion until ready to compete again (that is, returned to full training) was then calculated. All diagnoses and management of SRC were undertaken by the medical team at BC and in-keeping with current international guidelines. RESULTS Between January 2017 and September 2022, there were 88 concussions diagnosed, 54 being males and 8 in para-athletes. The median duration for time out of competition for all concussions was 16 days. There was no statistical difference between males (median 15.5 days) and females (median 17.5 days) for time out of competition (p-value 0.25). The median duration out of competition following a concussion for able-bodied athletes was 16 (80 athletes) compared to 51 days (8 athletes) in para-cyclists, which was not statistically different (p-value 0.39). CONCLUSIONS This is the first study to report SRC concussion recovery times in elite cycling, including para-athletes. Between January 2017 and September 2022, there were 88 concussions diagnosed at BC and the median duration for time out of competition for all concussions was 16 days. There was no statistically significant difference in recovery times between male and females and para- and able-bodied athletes. This data should be used to help establish minimum withdrawal times post-SRC for elite cycling participation and we call on the UCI to review this data when establishing SRC protocols for cycling, with further research required in para-cyclists.
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Affiliation(s)
- Neil Heron
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Medical Department, British Cycling, Manchester M11 4DQ, UK
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
- Correspondence:
| | - Nigel Jones
- Medical Department, British Cycling, Manchester M11 4DQ, UK
| | | | - Clint Gomes
- Medical Department, British Cycling, Manchester M11 4DQ, UK
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Schmidt M, Ling S, Ng V, Kamath B, Kortbeek S, Jones N, Miserachs M, Lepore N, Reitzel N, Zachos M, Prowse K, Syed B, Sidhu A, Shurrab S, Kozenko M, Bandsma R. A262 NEONATAL ACUTE LIVER FAILURE DUE TO PRESUMED GESTATIONAL ALLOIMMUNE LIVER DISEASE - A CASE REPORT. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991132 DOI: 10.1093/jcag/gwac036.262] [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: 03/09/2023] Open
Abstract
Background Neonatal acute liver failure (NALF) is a rare disease that is distinct from acute liver failure seen in older children and adults. Gestational alloimmune liver disease (GALD) is the most frequent cause, is initiated in utero by sensitization of the maternal immune system to a fetal hepatocyte antigen and subsequent production of maternal immunoglobulin G antibodies that cross the placenta. Maternal IgG binds to a fetal hepatocyte antigen and initiates an innate immune response involving the terminal complement cascade and membrane attach complex. The understanding of the alloimmune origin has led to the use of intravenous immunoglobulin (IVIG) treatment and exchange transfusion, significantly increasing survival. However, approximately 25% of patients may not respond and require salvage liver transplantation. In spite of an increased rate of comorbidities, concern for technical difficulties and limited graft availability, young infants eligible for transplant have been shown to have similar overall patient and graft survival rates compared to older children with other indications for liver transplant. Purpose The primary aim of our study is to report a case of NALF with successful liver transplant. Method We present the case of a preterm girl with NALF due to GALD refractory to medical management, requiring liver transplantation. Result(s) This is a 35-week preterm girl, with scant pre-natal care, birth weight of 1.825 kg and Apgar 9/9. She is the seventh child of non-consanguineous parents, with healthy siblings. On day-of-life (DOL) 1 she presented with acute kidney injury, progressive worsening metabolic acidosis and hyperammonemia and was found to be profoundly coagulopathic (INR 6), with normal liver enzymes and liver failure was diagnosed. Initial investigation ruled out congenital infections, sepsis, neonatal hemophagocytic lymphohistiocytosis and metabolic diseases. Magnetic resonance imaging of the body demonstrated findings in keeping with iron deposition in the thyroid, liver and pancreas, suggestive of GALD. Completed double volume exchange transfusion and IVIG on DOL 9 and repeat IVIG on DOL 13 and 15, with partial improvement in INR. Due to persistent ascites, conjugated hyperbilirubinemia and hyperammonemia she was transferred for urgent liver transplant assessment. Persistent liver dysfunction in the form of hyperammonemia, hypoglycemia and progressive coagulopathy led to transplant listing on DOL 30. ABO incompatible deceased donor liver transplant was completed on DOL 62 (4.075 kg, estimated dry weight 3.5 kg). The procedure was uncomplicated, liver enzymes normalized, coagulopathy and hypoglycemia resolved. She was transferred to the ward on post-operative day (POD) 6. and weaned off sedatives and transitioned to oral feeds within 2 weeks of transplant, with complex abdominal wound closure on POD 29. Conclusion(s) Successful liver transplantation is possible in neonates with acute liver failure due to GALD refractory to medical management and weighing 4kg or less. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared MICROBIOME & MICROBIAL THERAPY
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Affiliation(s)
- M Schmidt
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - S Ling
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - V Ng
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - B Kamath
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - S Kortbeek
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - N Jones
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - M Miserachs
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - N Lepore
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - N Reitzel
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - M Zachos
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - K Prowse
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - B Syed
- General Surgery, The Hospital for Sick children, Toronto
| | | | - S Shurrab
- Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - M Kozenko
- Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - R Bandsma
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
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McLarnon M, Thornton J, Knudson G, Jones N, Glover D, Murray A, Cummings M, Heron N. A Scoping Review of Transgender Policies in the 15 Most Commonly Played UK Professional Sports. Int J Environ Res Public Health 2023; 20:3568. [PMID: 36834264 PMCID: PMC9964021 DOI: 10.3390/ijerph20043568] [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] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION There has been much debate recently on the participation of transgender and gender-diverse (TGD) athletes in sport, particularly in relation to fairness, safety and inclusion. The 2021 IOC Framework on Fairness, Inclusion and Non-discrimination acknowledges the central role that eligibility criteria play in ensuring fairness, particularly in the female category, and states that athletes should not be excluded solely on the basis of their TGD identity. AIMS To identify policies that address TGD athlete participation in the 15 major United Kingdom (UK) sporting organisations and to summarise the evidence for each of these policies. METHODS A scoping review of TGD policies from the 15 major UK sporting organisations. RESULTS Eleven of the governing bodies had publicly available TGD policies. Most of the sporting associations drew guidance from the official 2015 IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism, particularly with regard to physiological testosterone levels. Many organisations referenced their policies as a guide for decision making but stated that they ultimately made case-by-case decisions on an athlete's eligibility. Relevant considerations not addressed in most policies included pre- versus post-pubertal athletes, justification for testosterone thresholds, the length of time out of competitive action (if any) for transitioning athletes, the irreversible advantage from male puberty (if any), the responsibility for and frequency of follow up for hormonal testing and the consequences for athletes outside set testosterone limits. CONCLUSIONS There is a lack of consensus among the top 15 UK sporting organizations relating to elite sport participation for TGD athletes. It would be useful for sport organizations to work together to develop greater standardization/consensus for TGD athlete policies, taking into consideration fairness, safety and inclusion in each sport.
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Affiliation(s)
- Michael McLarnon
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Jane Thornton
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Gail Knudson
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z4, Canada
| | - Nigel Jones
- Medical Department, British Cycling, Manchester M11 4DQ, UK
| | - Danny Glover
- Medical and Scientific Department, Ladies European Tour (Various), Denham UB9 5PG, UK
| | - Andrew Murray
- Sport and Exercise, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Michael Cummings
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Neil Heron
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Medical Department, British Cycling, Manchester M11 4DQ, UK
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
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Yusoff A, Davies EA, Burberry DJ, Jones N, Walters C, Beynon Howells C, Davies D, Quinn P. 1103 AN EVALUATION OF A GERIATRICIAN-LED ACUTE MEDICAL ADMISSION UNIT AT MORRISTON HOSPITAL, SWANSEA. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
The medical intake at Morriston Hospital is accepted on two units; Rapid Assessment Unit (RAU) and Acute Medical Assessment Unit. Both were acute physician-led until July 2021
Method
(Phase 1). From July 2021, RAU became geriatrician-led (Phase 2). This evaluation concerns the performance of RAU.
Phase 1 (Acute Physician-Led Unit) Between 01/08/2020-30/06/2021, there were 3102 admissions with a median length of stay (LOS) of 2 days on RAU. 37.2% of patients were discharged directly from the unit. (SBUHB data). A detailed analysis of 496 patients consecutively assessed between November 2020–January 2021 showed a median LOS on RAU of 1, 28.8% were discharged directly from RAU. Overall health board (HB) median LOS for the cohort was 7. In over 70 years, median LOS on RAU was 1, overall HB LOS 9.
Phase 2 (Geriatrician-Led Unit) 1237 patients were assessed July-December 2021, with a median LOS of 2 days. 42.8% of patients were discharged from RAU. (SBUHB data). A detailed analysis of 566 patients consecutively assessed between September-November 2021 showed a median LOS on RAU of 2, 41.7% discharged directly from RAU. Overall HB median LOS for the entire cohort was 5. For the > 70 years, median LOS on RAU was 2, overall HB LOS was 7. Patient flow through assessment areas is dependent on the function of downstream medical wards. Mean LOS within medicine at Morriston increased 1.5 days between Phase 1 and Phase 2.
Results
Acute geriatricians have delivered the 72hr LOS standard that SBUHB has set for assessment areas. The unit has achieved a reduction in overall LOS for the cohort of patients evaluated (p<.01), especially for the > 70 years (p=.007).
Conclusion
This data supported a change in practice; RAU has taken a frailty specific intake since January 2022.
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Affiliation(s)
- A Yusoff
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - E A Davies
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - D J Burberry
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - N Jones
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - C Walters
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - C Beynon Howells
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - D Davies
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - P Quinn
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
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Simmen D, Jones N. Eingriffe bei malignen Tumoren von Zunge, Mundboden, Tonsillen und Rachenhinterwand. Laryngorhinootologie 2022; 101:1016-1019. [PMID: 36513093 DOI: 10.1055/a-1928-8673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Simmen D, Jones N. Eingriffe bei benignen Tumoren und Zysten von Mundhöhle und Oropharynx. Laryngorhinootologie 2022; 101:929-931. [DOI: 10.1055/a-1928-8280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ponce SB, Young S, Harris M, Walker D, Sona M, Jones N, Kwartang J, Jankowski C, Griggs J, Berendt M, Cuevas C, Rendon AD, Beyer K. Perceptions of Radiation Therapy amongst Black Female Breast Cancer Survivors in Urban Communities. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Jones N, Ordonez-Mena JM, Roalfe AK, Goyder C, Hobbs FDR, Taylor CJ. Body mass index and survival in people with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.894] [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: 11/13/2022] Open
Abstract
Abstract
Background
People with obesity are twice as likely to develop heart failure (HF) compared to people with a healthy body mass index (BMI) [1]. However, among people with HF a higher BMI has been linked to a reduced risk of all-cause mortality, a concept known as the “obesity paradox” [2].
Purpose
To examine the association between BMI and survival in patients with chronic HF among a large primary care cohort.
Methods
We extracted data from the Clinical Practice Research Datalink of primary care records from 1st January 2000 to 31st December 2017 and included 47,531 patients with an incident diagnosis of HF, who were aged 45 years and over and who had a recorded BMI. Patients were stratified into categories of baseline BMI as underweight (BMI <18.5 kg/m2), healthy weight (BMI 18.5 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2) or obese, with obesity split into class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2) and class III (40 kg/m2 and over). The primary outcome was all-cause mortality. We used Kaplan-Meier curves and log rank tests to compare survival in people with HF, based on baseline BMI. We also report a Cox regression model for risk of all-cause mortality among people with HF comparing BMI categories.
Results
There were 25,013 deaths during the study follow-up. The average age of participants was 77.1 years (SD 10.6) and mean BMI was 27.9 (SD 6.1). In an age- and sex-adjusted analysis, people who were underweight were at increased risk of all-cause mortality compared to people with healthy weight (HR 1.52, 95% CI 1.41 to 1.64). People with overweight (HR 0.81, 95% CI 0.79 to 0.84), obesity class I (HR 0.79, 95% CI 0.76 to 0.82) and obesity class II (HR 0.78, 95% CI 0.74 to 0.82) were at decreased risk of all-cause mortality. People with obesity class III had no difference in risk of death compared to people with healthy weight (HR 0.95, 95% CI 0.88 to 1.02). In a Kaplan-Meier analysis, there was an inverse relationship between body weight and risk of death, even within the first year of follow-up.
Conclusion
In our large community cohort of people with HF, we found an inverse relationship between BMI and survival. Underweight people with HF have the poorest prognosis and should be identified as high-risk. Conversely, people with HF who are overweight or obese (class I and II) are at lower risk of death confirming the obesity paradox in a real-world primary care population. These findings suggest a more cautious approach to weight management in overweight and obese patients may be needed for people with HF in primary care.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The SurviveHF study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust and the Wellcome Institutional Strategic Fund. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication.
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Affiliation(s)
- N Jones
- University of Oxford , Oxford , United Kingdom
| | | | - A K Roalfe
- University of Oxford , Oxford , United Kingdom
| | - C Goyder
- University of Oxford , Oxford , United Kingdom
| | - F D R Hobbs
- University of Oxford , Oxford , United Kingdom
| | - C J Taylor
- University of Oxford , Oxford , United Kingdom
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12
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Jones N, Smith M, Lay-Flurrie S, Roalfe AK, Yang Y, Hobbs FDR, Taylor CJ. Survival among people with heart failure and atrial fibrillation; a population cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.899] [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: 11/14/2022] Open
Abstract
Abstract
Background
People with chronic heart failure (HF) have a poor prognosis, with survival rates at five year follow-up close to 50%.1 More than half of patients with HF will develop atrial fibrillation (AF). The presence of AF in people with HF has been associated with a poor prognosis, irrespective of left ventricular ejection fraction. 2,3 However, the majority of studies to date have analysed prognosis among secondary care cohorts or randomised trial participants, who may not be representative of patients with chronic HF in the community.2
Purpose
To examine the association between survival in patients with HF and AF compared to either condition alone, among a large primary care cohort.
Methods
We extracted data from the Clinical Practice Research Datalink of primary care records from 1st January 2000 to 31st December 2018 and included all patients aged 45 years and over who were registered at an up-to-standard practice for a minimum of 12 months. Records were linked to Hospital Episode Statistics for secondary care data. The primary outcome was all-cause mortality. Exposure groups were defined as HF+AF, HF or AF, with exposure status treated as a time-varying covariate across follow-up. We used Cumulative Hazard plots to compare survival in people with HF and AF, compared to people with either condition alone or neither. We also report a Cox regression model for risk of all-cause mortality among people with HF and AF, adjusting for age, sex, ethnicity, smoking status and comorbid cardiovascular disease.
Results
There were 314,042 deaths during the study follow-up. The average age of participants was 58.0 years (SD 10.6) and 51.4% were women. At some point across follow-up, 94,990 people had HF alone, 147,815 had AF alone and 74,470 had both HF and AF. In an unadjusted Cox regression analysis, people with HF and AF were at the greatest risk of death (HR 17.94, 95% CI 17.75 to 18.13), followed by people with HF alone (HR 12.00, 95% CI 11.87 to 12.13), and AF alone (HR 6.14, 95% CI 6.08 to 6.21) compared to people with neither HF nor AF. In the fully adjusted analysis, the risk of death remained highest among people with HF and AF (HR 3.78, 95% CI 3.73 to 3.83), followed by people with HF alone (HR 3.06, 95% CI 3.02 to 3.10), then people with AF alone (HR 1.85, 95%, CI 1.82 to 1.87). In a cumulative hazard plot, the risk of death across follow-up was similar among people with HF and AF, compared to those with HF alone.
Conclusion
In our large community cohort, we found HF and AF was associated with a worse prognosis than either condition alone. Both HF and AF were also associated with a poor prognosis. These results support the findings of previous secondary care and trial studies regarding the importance of AF as a prognostic indicator among people with HF. Further research could aim to identify preventive strategies that might improve prognosis among this high-risk group of patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was undertaken as part of NRJ's Doctoral Research Fellowship, supported by the Wellcome Trust (grant number 203921/Z/16/Z), with additional funding for this project from the National Institute for Health Research (NIHR) Collaboration for Applied Health Research (CLAHRC) Oxford at Oxford Health NHS Foundation Trust (P2-001).
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Affiliation(s)
- N Jones
- University of Oxford , Oxford , United Kingdom
| | - M Smith
- University of Oxford , Oxford , United Kingdom
| | | | - A K Roalfe
- University of Oxford , Oxford , United Kingdom
| | - Y Yang
- University of Oxford , Oxford , United Kingdom
| | - F D R Hobbs
- University of Oxford , Oxford , United Kingdom
| | - C J Taylor
- University of Oxford , Oxford , United Kingdom
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13
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Simmen D, Jones N. Eingriffe bei Abszedierungen in der Mundhöhle. Laryngorhinootologie 2022; 101:836-838. [PMID: 36174570 DOI: 10.1055/a-1871-7171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Simmen D, Jones N. Eröffnung von Retropharyngealabszessen. Laryngorhinootologie 2022; 101:765-767. [PMID: 36041452 DOI: 10.1055/a-1871-6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Hoffmann S, Jones N, Raynal B, Von Castelmur E, Derbyshire D, Sunnerhagen M. TNA: apply for access to laboratories of excellence in molecular scale biophysics research infrastrure (MOSBRI). Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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16
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Abstract
Track cycling is a fast, exciting sport and requires a specific sports-related concussion (SRC) assessment protocol. This paper proposes the first SRC assessment protocol for use in track cycling and proposes that this should occur in three stages. Stage 1 will occur at the trackside, whilst stage 2 occurs in the changing room immediately after the event and stage 3 the day following the suspected SRC. This SRC protocol is in its first iteration and we hope it stimulates debate to allow further refinement.
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Affiliation(s)
- Clint Gomes
- Department of Medicine, English Institute of Sport, Manchester, UK
| | - Nigel Jones
- Department of Medicine, British Cycling, Manchester, UK
| | - Neil Heron
- General Practice/Centre for Public Health, Queen's University Belfast, Belfast, UK
- School of Medicine, Keele University, Keele, England
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17
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Simmen D, Jones N. Eingriffe bei entzündlichen tonsillogenen Komplikationen. Laryngorhinootologie 2022; 101:690-691. [PMID: 35915908 DOI: 10.1055/a-1821-4949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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18
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Simmen D, Jones N. Alternative: Tonsillektomie in Lokalanästhesie. Laryngorhinootologie 2022; 101:620-623. [PMID: 35738276 DOI: 10.1055/a-1821-4599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lanfranchi V, Jones N, Read J, Fegan C, Field B, Simpson E, Revitt C, Cudd P, Ciravegna F. User attitudes towards virtual home assessment technologies. J Med Eng Technol 2022; 46:536-546. [PMID: 35730495 DOI: 10.1080/03091902.2022.2089250] [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: 01/11/2023]
Abstract
Telehealth has long been highlighted as a way to solve issues of efficiency and effectiveness in healthcare and to improve patients' care and has become fundamental to address patients' needs during the COVID-19 pandemic; however previous studies have shown mixed results in the user acceptance of such technologies. Whilst many previous studies have focussed on clinical application of telehealth, we focus on the adoption of telehealth for virtual assessments visits aimed to evaluate the suitability of a property where a patient is discharged, and eventual adaptations needed. We present a study of stakeholders' attitudes towards such virtual assessment visits. The study has been carried out with healthcare professionals and patients and allowed us to identify user attitudes, barriers and facilitators for the success of virtual assessment visits from the point of view of healthcare professionals and patients. Finally, we discuss implications for designers of telehealth services and guidelines that can be derived from our study.
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Affiliation(s)
- V Lanfranchi
- Department of Computer Science, The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.,NIHR Devices for Dignity, MedTech Co-operative Affiliate, Sheffield, UK
| | - N Jones
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - J Read
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Fegan
- Department Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - B Field
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Simpson
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - C Revitt
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - P Cudd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - F Ciravegna
- Department of Computer Science, The University of Sheffield, Sheffield, UK
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20
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Jones N. Raymond George Gordon Jones. BMJ 2022. [DOI: 10.1136/bmj.o1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Hull JH, Burns P, Carre J, Haines J, Hepworth C, Holmes S, Jones N, MacKenzie A, Paton JY, Ricketts WM, Howard LS. BTS clinical statement for the assessment and management of respiratory problems in athletic individuals. Thorax 2022; 77:540-551. [DOI: 10.1136/thoraxjnl-2021-217904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Taylor C, Ordonez-Mena J, Lay-Flurrie S, Goyder C, Jones N, Roalfe A, Hobbs F. Natriuretic peptide referral thresholds and heart failure diagnosis: population-based cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0871] [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: 11/13/2022] Open
Abstract
Abstract
Background
Natriuretic peptide (NP) testing is recommended by both the European Society of Cardiology (ESC) and the National Institute for Health and Care Excellence (NICE) for people presenting with symptoms of heart failure (HF) in primary care. However, ESC and NICE guidelines suggest different NP referral thresholds: ESC recommend referral at a lower NP level (BNP≥35pg/ml / NT-proBNP≥125pg/ml) compared to NICE (BNP≥100pg/ml/NT-proBNP≥400pg/ml).
Purpose
We aimed to evaluate NP test performance for HF diagnosis for ESC and NICE guideline-defined thresholds.
Methods
Population-based cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink in England between 1st January 2000 and 31st December 2018. Participants were adults aged 45 years and above with a NP result: 74,233 had a BNP and 155,347 had a NT-proBNP measurement. The main outcome measures were diagnostic performance of NP test (sensitivity, specificity, positive predictive value, negative predictive value) by threshold.
Results
A total of 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF. The ESC NT-proBNP threshold of 125pg/ml had a sensitivity of 94.6% (94.2 to 95.0) and specificity of 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP 400pg/ml threshold. For both guidelines, nearly all patients with a NP level below the threshold did not have HF (negative predictive value ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Similar performance was found for BNP.
Conclusions
The performance of NP testing is dependent on the guideline-specified threshold for referral. In 100 people with HF, using the NICE threshold would falsely reassure 18 patients, whereas the lower ESC threshold would miss just 5 people but twice as many patients would be referred for diagnostic assessment. The optimal NP threshold for referral for HF diagnosis will depend on the healthcare setting. The trade-off between missing HF cases and overwhelming diagnostic services needs to be determined at a national level.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research
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Affiliation(s)
- C Taylor
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - J.M Ordonez-Mena
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - S Lay-Flurrie
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - C Goyder
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - N Jones
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - A Roalfe
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - F.D.R Hobbs
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
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23
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Contos G, Baca Y, Xiu J, Brown J, Holloway R, Korn WM, Herzog TJ, Jones N, Winer I. Assessment of immune biomarkers and establishing a triple negative phenotype in gynecologic cancers. Gynecol Oncol 2021; 163:312-319. [PMID: 34563366 DOI: 10.1016/j.ygyno.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Immuno-oncology (IO) has rapidly evolved, with many IO therapies either approved or under investigation for multiple malignancies. Biomarkers exist that can predict response to IO therapies including PD-L1 expression, microsatellite instability (MSI), and total mutation burden (TMB). This paper serves to analyze the presence of these biomarkers across gynecologic cancers. METHODS A total of 16,300 gynecologic cancer specimens submitted for molecular profiling to Caris Life Sciences were reviewed. Immunohistochemistry was performed using the SP142 anti-PD-L1 clone and assessed for intensity. Next-generation sequencing, immunohistochemistry, and fragment analysis were used to determine MSI status. TMB was measured by counting all non-synonymous missense mutations found per tumor not previously described as germline alterations. Chi-Square, Fisher Exact, and the Kruskal-Wallis test were used to compare cohorts. RESULTS Of 16,300 specimens, 54.1% were ovarian, 37.2% uterine, 7.2% cervical, 0.3% vulvar, 1.2% vaginal, with 0.1% unspecified. MSI-H was most frequent in uterine cancer (17.7%) and only 1% of ovarian cancers. PD-L1 expression was present in 38.3% of cervical and 62.5% of vulvar cancers, but less than 8% of ovarian and uterine cancers. TMB-H was present in 21.1% cervical, 19.7% uterine, and 5% ovarian cancers. Few specimens exhibited a "triple positive" phenotype - 0.3% ovarian, 1.5% uterine, and 1.5% cervical. Associations were seen between MSI, TMB, and PD-L1 across all cancer types. CONCLUSIONS The frequency of individual biomarkers pertinent to IO therapy varies by cancer type. HPV-driven genital tract cancers have higher frequencies of PD-L1 expression, MSI-H, and TMBH. Endometrial cancers are characterized by MSI-H and TMB, whereas ovarian cancers have a low frequency of MSI-H and modest PD-L1 or TMBH. The incidence of 'triple positive" cases was less than 2%.
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Affiliation(s)
- G Contos
- Wayne State University and Karmanos Cancer Institute, 4100 John R. St., Detroit, MI 48201, United States of America.
| | - Y Baca
- Caris Life Sciences, 4750 S. 44(th) Pl., Phoenix, AZ 85040, United States of America
| | - J Xiu
- Caris Life Sciences, 4750 S. 44(th) Pl., Phoenix, AZ 85040, United States of America
| | - J Brown
- Levine Cancer Institute, 1021 Morehead Medical Dr. #2100, Charlotte, NC 28204, United States of America.
| | - R Holloway
- Advent Health Medical Group, 2501 N. Orange Ave. Suite 786, Orlando, FL 32804, United States of America
| | - W M Korn
- Caris Life Sciences, 4750 S. 44(th) Pl., Phoenix, AZ 85040, United States of America
| | - T J Herzog
- University of Cincinnati Cancer Institute, 3255 Eden Ave. Suite 250B, Cincinnati, OH 45019, United States of America.
| | - N Jones
- University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL 36604, United States of America.
| | - I Winer
- Wayne State University and Karmanos Cancer Institute, 4100 John R. St., Detroit, MI 48201, United States of America
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Grushko M, Goldstein J, ElSeht Z, Alarcon A, Jones N, Samizadeh M, Zhu Y, Kaplan J, Arline K. 1146P Closing the target gap: A computational approach to optimizing therapeutic selection for cancer patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Staley JT, Redhead JW, O'Connor RS, Jarvis SG, Siriwardena GM, Henderson IG, Botham MS, Carvell C, Smart SM, Phillips S, Jones N, McCracken ME, Christelow J, Howell K, Pywell RF. Designing a survey to monitor multi-scale impacts of agri-environment schemes on mobile taxa. J Environ Manage 2021; 290:112589. [PMID: 33906116 DOI: 10.1016/j.jenvman.2021.112589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Agri-environment schemes (AES) are key mechanisms to deliver conservation policy, and include management to provide resources for target taxa. Mobile species may move to areas where resources are increased, without this necessarily having an effect across the wider countryside or on populations over time. Most assessments of AES efficacy have been at small spatial scales, over short timescales, and shown varying results. We developed a survey design based on orthogonal gradients of AES management at local and landscape scales, which will enable the response of several taxa to be monitored. An evidence review of management effects on butterflies, birds and pollinating insects provided data to score AES options. Predicted gradients were calculated using AES uptake, weighted by the evidence scores. Predicted AES gradients for each taxon correlated strongly, and with the average gradient across taxa, supporting the co-location of surveys across different taxa. Nine 1 × 1 km survey squares were selected in each of four regional blocks with broadly homogenous background habitat characteristics. Squares in each block covered orthogonal contrasts across the range of AES gradients at local and landscape scales. This allows the effects of AES on species at each scale, and the interaction between scales, to be tested. AES options and broad habitats were mapped in field surveys, to verify predicted gradients which were based on AES option uptake data. The verified AES gradient had a strong positive relationship with the predicted gradient. AES gradients were broadly independent of background habitat within each block, likely allowing AES effects to be distinguished from potential effects of other habitat variables. Surveys of several mobile taxa are ongoing. This design will allow mobile taxa responses to AES to be tested in the surrounding countryside, as well as on land under AES management, and potentially in terms of population change over time. The design developed here provides a novel, pseudo-experimental approach for assessing the response of mobile species to gradients of management at two spatial scales. A similar design process could be applied in other regions that require a standardized approach to monitoring the impacts of management interventions on target taxa at landscape scales, if equivalent spatial data are available.
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Affiliation(s)
- J T Staley
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK.
| | - J W Redhead
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - R S O'Connor
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - S G Jarvis
- UKCEH, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - G M Siriwardena
- British Trust for Ornithology (BTO), The Nunnery, Thetford, Norfolk, IP24 2PU, UK
| | - I G Henderson
- British Trust for Ornithology (BTO), The Nunnery, Thetford, Norfolk, IP24 2PU, UK
| | - M S Botham
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - C Carvell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - S M Smart
- UKCEH, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - S Phillips
- Natural England, Foss House, Kings Pool, 1-2 Peasholme Green, York, YO1 7PX, UK
| | - N Jones
- FERA Science Ltd, National Agri-food Innovation Campus, Sand Hutton, York, YO41 1LZ, UK
| | - M E McCracken
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - J Christelow
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - K Howell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - R F Pywell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
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Rankin A, Massey A, Falvey ÉC, Ellenbecker T, Harcourt P, Murray A, Kinane D, Niesters B, Jones N, Martin R, Roshon M, McLarnon MED, Calder J, Izquierdo D, Pluim BM, Elliott N, Heron N. Infographic. COVID-19 RT-PCR testing for elite athletes. Br J Sports Med 2021; 55:818-820. [PMID: 33455908 PMCID: PMC7817382 DOI: 10.1136/bjsports-2020-103751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 01/24/2023]
Affiliation(s)
- Alan Rankin
- Sports Medicine, SportNI Sports Institute, Newtownabbey, UK
- Sports Medicine NI, Belfast, UK
| | - Andrew Massey
- Medical and Anti-Doping Department, Federation Internationale de Football Association, Zurich, Zürich, Switzerland
| | - Éanna Cian Falvey
- Sport Medicine Department, World Rugby, Dublin, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | | | - Peter Harcourt
- Australian Football League, Docklands, Victoria, Australia
| | - Andrew Murray
- St Andrew's House Edinburgh, Scottish Government Sport and Physical Activity Policy Team, Edinburgh, Scotland, UK
- Sports Medicine, Scottish Institute of Sport, Stirling, UK
| | - Denis Kinane
- Department of Immunology, University of Bern, Bern, Switzerland
| | - Bert Niesters
- Microbiology, University of Groningen, Groningen, The Netherlands
| | - Nigel Jones
- Medical Department, British Cycling, Manchester, UK
| | - Rhodri Martin
- Sports Medicine, Sport Wales, Cardiff, UK
- Cwm Taf Morgannwg University Health Board, Abercynon, Rhondda Cynon Taf, UK
| | | | | | - James Calder
- Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
| | | | - Babette M Pluim
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- AMC/VUmc IOC Research Center of Excellence, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Niall Elliott
- Sports Medicine, Sport Scotland Institute of Sport, Stirling, UK
| | - Neil Heron
- Department of Family Practice, Queen's University Belfast, Belfast, UK
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Lindsay L, Mao HA, Cheng JE, Chuo CY, Jones N, Cascino MD, Tuckwell K. POS0792 BASELINE FACTORS ASSOCIATED WITH LUPUS FLARES: A POST-HOC ANALYSIS OF PATIENTS WITH MODERATE TO SEVERE ACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS ENROLLED IN A 48 WEEK PHASE II RANDOMIZED CLINICAL TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a chronic disease characterized by periodic flares associated with poor outcomes and subsequent organ damage (1-2). Flare prevention is important for optimal patient management and development of effective therapies.Objectives:To identify patient-level factors associated with flares among patients with moderate/severe SLE.Methods:We conducted a post-hoc analysis of 260 patients with active, autoantibody+ SLE enrolled in a phase II randomized clinical trial (Fenebrutinib) (3). The relationship between baseline demographic (age, gender, ethnicity, BMI), region (US/EU, outside US/EU), disease severity (PGA, SLEDAI-2K, BILAG domain involvement), disease duration, serologic markers (C3, C4, ANA, anti-dsDNA Ab, anti-Smith Ab), treatment arm, standard of care (SOC) and flares (BILAG and SFI) over 48 wks was assessed by survival analysis and multiple Cox Proportional Hazard models. We examined concordance between BILAG and SFI flares using Cohen’s Kappa Index.Results:The overall rate of flare was low (n=37 SFI flare, n=25 BILAG flare). Median time to first flare was 8 wks for SFI flares compared to 12 wks for BILAG flares. There was no difference in flare rate by treatment arm. Cumulative flare hazard increased over time. Concordance between SFI and BILAG flares was 0.14. Multivariable analyses identified a higher flare rate for both SFI and BILAG-defined flares in patients with severe disease at baseline (PGA >1.7, SLEDAI-2K ≥10) and <7 y disease duration.Flares were more common in patients ANA, anti-dsDNA and anti-Smith+ at baseline compared to patients with <3 + markers (p<.001). Furthermore, anti-dsDNA (p = .03) and/or anti-Smith (p = .001) positivity at baseline were better indicators of higher flare rate compared to ANA (p = 0.5). Low baseline complement level (C3 and C4) was associated with a higher flare rate (p = .03 and p = .03 respectively).Patients from non-US/EU regions had a higher flare rate compared to patients from the US/EU, despite receiving more frequent SOC therapy and higher baseline corticosteroid doses (≥10 mg/d). Overall, flare-free probability was comparable at 48 wks regardless of baseline corticosteroid dose but patients receiving <10 mg/d had a median time to flare of 4 vs 24 wks for those receiving ≥10 mg/d (p = .004).Conclusion:In this study, flares were more common among patients with more severe disease, shorter disease duration, multiple serologic markers, were from outside the US/EU, and received lower steroid doses at baseline.References:[1]Fernandez D and Kirou KA. Curr Rheumatol Rep 2016 18:14.[2]Stoll T, et al. Rheum (Oxford) 2004 43(8):1039–44.[3]Isenberg D, et al. Arth Rheum 2019 71 suppl 10.Baseline Factors (%)No Flare n=206FlareBILAG n=25SFI n=37BILAG and SFI n=8Age (mean (SD))41.8 (12)35.2 (9)40.4 (10)34.9 (8)Female199 (97)24 (96)35 (95)7 (88)PGA (mean (SD))1.7 (0.5)1.7 (0.4)1.9 (0.5)1.7 (0.6)BILAG A/B any domain197 (96)23 (92)35 (95)7 (88)SLEDAI 2K >=1087 (42)18 (72)17 (46)4 (50)Disease duration (y) (mean (SD))9.4 (7)5.3 (4)6.6 (6)2.9 (3)ANA +203 (99)24 (96)35 (95)8 (100)anti-dsDNA +102 (50)18 (72)21 (57)5 (63)anti-Smith +45 (22)13 (52)12 (32)4 (50)Low C357 (28)12 (48)13 (35)3 (38)Low C426 (13)7 (28)4 (11)1 (13)Non US/EU157 (76)21 (84)32 (87)8 (100)Corticosteroid130 (63)14 (56)21 (57)5 (63) ≥10 mg/d80 (39)9 (36)14 (38)4 (50)Immunosuppressant74 (36)12 (48)15 (41)3 (38)Antimalarial135 (66)14 (56)21 (57)5 (63)Notes: included patients 18-75 y; 1+ serologic marker of SLE; SLEDAI-2K >=8, PGA>=1; 1+ oral SOC treatmentSFI = SELENA- SLEDAI Flare IndexDisclosure of Interests:Lisa Lindsay Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Huiyan (Ashley) Mao Shareholder of: Employee of Hoffmann-La Roche Limited, Employee of: Employee of Hoffmann-La Roche Limited, Ji (Emmy) Cheng Shareholder of: Employee of Hoffmann-La Roche Limited, Employee of: Employee of Hoffmann-La Roche Limited, Ching-Yi Chuo Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Nicholas Jones Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Matthew D. Cascino Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Katie Tuckwell Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc.
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Clarsen B, Pluim BM, Moreno-Pérez V, Bigard X, Blauwet C, Del Coso J, Courel-Ibáñez J, Grimm K, Jones N, Kolman N, Mateo-March M, Pollastri L, López-Rodríguez C, Ortolano Ríos R, Roshon M, Hoyos Echevarría J, Madouas G, Nordhaug LP, Patricios J, Verhagen E. Methods for epidemiological studies in competitive cycling: an extension of the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport 2020. Br J Sports Med 2021; 55:1262-1269. [PMID: 33980546 DOI: 10.1136/bjsports-2020-103906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
In 2020, the IOC released a consensus statement that provides overall guidelines for the recording and reporting of epidemiological data on injury and illness in sport. Some aspects of this statement need to be further specified on a sport-by-sport basis. To extend the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sports and to meet the sport-specific requirements of all cycling disciplines regulated by the Union Cycliste Internationale (UCI). A panel of 20 experts, all with experience in cycling or cycling medicine, participated in the drafting of this cycling-specific extension of the IOC consensus statement. In preparation, panel members were sent the IOC consensus statement, the first draft of this manuscript and a list of topics to be discussed. The expert panel met in July 2020 for a 1-day video conference to discuss the manuscript and specific topics. The final manuscript was developed in an iterative process involving all panel members. This paper extends the IOC consensus statement to provide cycling-specific recommendations on health problem definitions, mode of onset, injury mechanisms and circumstances, diagnosis classifications, exposure, study population characteristics and data collection methods. Recommendations apply to all UCI cycling disciplines, for both able-bodied cyclists and para-cyclists. The recommendations presented in this consensus statement will improve the consistency and accuracy of future epidemiological studies of injury and illness in cycling.
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Affiliation(s)
- Benjamin Clarsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Babette M Pluim
- University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Department of Sports Medicine, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, The Netherlands
| | - Víctor Moreno-Pérez
- Center for Translational Research in Physiotherapy, Miguel Hernandez University of Elche, Elche, Spain
- Medical Department, Spanish Cycling Federation, Madrid, Spain
| | - Xavier Bigard
- Medical Commission, Union Cycliste Internationale (UCI), Aigle, Switzerland
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan Del Coso
- Centre for Sport Studies, Rey Juan Carlos University, Madrid, Spain
| | | | - Katharina Grimm
- Medical Commission, Union Cycliste Internationale (UCI), Aigle, Switzerland
| | - Nigel Jones
- Medical Department, British Cycling, Manchester, UK
| | - Nikki Kolman
- Center for Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
- Knowledge Centre for Sport & Physical Activity, Ede, The Netherlands
| | - Manuel Mateo-March
- Performance and Medical Department, Movistar Cycling team, Pamplona, Spain
| | | | | | | | - Michael Roshon
- Medical Department, USA Cycling, Colorado Springs, Colorado, USA
| | | | - Gwenaëlle Madouas
- Department of Medical Services, Fédération Française de Cyclisme, Brest, France
| | | | - Jon Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
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Jones N, Francis J, Parikh R, Shaath M. 102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme.
Method
Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree).
Result
Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56).
Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’.
Conclusions
Matching patient needs to an educational programme is important.
The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.
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Affiliation(s)
- N Jones
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - J Francis
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - R Parikh
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - M Shaath
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
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Abstract
INTRODUCTION Road cycling is a very common recreational and elite sport. To facilitate consistent reporting of injuries and illness in professional road cycling we want to establish terms, definitions, and methods for injury and illness reporting in elite road cycling epidemiology studies, similar to other sports. AIMS/OBJECTIVES The aim of this study is to establish an international expert statement for injury and illness reporting in professional road cycling. METHODS We initially conducted a literature review of the injury and illness epidemiology studies in sport and identified popular terms, definitions, and methods which could be applied to road cycling. These terms were then reviewed by our expert panel, with clarification of terms and definitions and additional terms added, if required. The final consensus statement was then agreed by all authors. RESULTS The relevant definitions for use in professional road cycling epidemiology studies have been agreed. Injury rates should be reported as per 1,000 hours of cycling training, both in and outdoors, and per 1,000 hours of competition as well as per 1,000 hours of non-cycling training. DISCUSSION We encourage authors to use this expert paper when undertaking injury and illness epidemiology studies in professional road cycling to increase the rigor of the studies as well as allowing comparability between different road cycling studies and epidemiology studies in other sports.
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Affiliation(s)
- Neil Heron
- Centre for Public Health Research, Queen's University, Belfast, UK.,UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland.,Department of General Practice, Keele University, Newcastle-under-Lyme, UK
| | - Inigo Sarriegui
- Sport Medicine department, Southampton Football Club, Southampton, UK
| | - Nigel Jones
- Sport Medicine department, British Cycling, Manchester, UK
| | - Rory Nolan
- Centre for Public Health Research, Queen's University, Belfast, UK.,GP training scheme, East Cheshire NHS Trust, Macclesfield, UK
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Lawrence EG, Jones N, Greenberg N, Fear NT, Wessely S, Michael G, Taylor-Beirne S, Simms A. Mental well-being interventions in the military: The ten key principles. BMJ Mil Health 2021; 168:179-180. [PMID: 33911012 DOI: 10.1136/bmjmilitary-2020-001740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/04/2022]
Abstract
Organisations including the United Kingdom Armed Forces should seek to implement mental health interventions to increase the psychological well-being of their workforce. This editorial briefly presents ten key principles that military forces should consider before implementing such interventions. These include job-focused training; evaluating interventions; the use of internal versus external training providers; the role of leaders; unit cohesion, single versus multiple session psychological interventions; not overgeneralising the applicability of interventions; the need for repeated skills practice; raising awareness and the fallibility of screening.
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Affiliation(s)
- Erin G Lawrence
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Wessely
- Academic Department of Military Mental Health, King's College London, London, UK.,King's Centre for Military Health Research, King's College London, London, UK
| | - G Michael
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Taylor-Beirne
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
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Jones M, Jones N, Burdett H, Bergman BP, Fear NT, Wessely S, Rona RJ. Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants? BMJ Mil Health 2021; 169:218-224. [PMID: 33879526 DOI: 10.1136/bmjmilitary-2021-001787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The UK is the only permanent member of the UN Security Council that has a policy of recruiting 16 and 17 year old individuals into its regular Armed Forces. Little is known about the consequences of enlisting as a Junior Entrant (JE), although concerns have been expressed. We compare the mental health, deployment history, and pre-enlistment and post-enlistment experiences of personnel who had enlisted as JEs with personnel who joined as Standard Entrants (SEs). METHOD Participants from a large UK military cohort study completed a self-report questionnaire between 2014 and 2016 that included symptoms of probable post-traumatic stress disorder (PTSD), common mental disorders, alcohol consumption, physical symptoms and lifetime self-harm. Data from regular non-officer participants (n=4447) from all service branches were used in the analysis. JEs were defined as having enlisted before the age of 17.5 years. A subgroup analysis of participants who had joined or commenced adult service after April 2003 was carried out. RESULTS JEs were not more likely to deploy to Iraq or Afghanistan but were more likely to hold a combat role when they did (OR 1.25, 95% CI 1.00 to 1.56). There was no evidence of an increase in symptoms of common mental disorders, PTSD, multiple somatic symptoms (MSS), alcohol misuse or self-harm in JEs in the full sample, but there was an increase in alcohol misuse (OR 1.84, 95% CI 1.18 to 2.87), MSS (OR 1.51, 95% CI 1.04 to 2.20) and self-harm (OR 2.13, 95% CI 1.15 to 3.95) in JEs who had commenced adult service after April 2003. JEs remain in adult service for longer and do not have more difficulties when they leave service. CONCLUSIONS JEs do not have worse mental health than SEs, but there is uncertainty in relation to alcohol misuse, MSS and self-harm in more recent joiners. Monitoring these concerns is advisable.
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Affiliation(s)
- Margaret Jones
- Psychological Medicine, King's College London, London, UK
| | - N Jones
- Academic Department for Military Mental Health, King's College London, London, UK
| | - H Burdett
- Psychological Medicine, King's College London, London, UK
| | - B P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N T Fear
- Psychological Medicine, King's College London, London, UK
| | - S Wessely
- Psychological Medicine, King's College London, London, UK
| | - R J Rona
- Psychological Medicine, King's College London, London, UK
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Hamilton BR, Lima G, Barrett J, Seal L, Kolliari-Turner A, Wang G, Karanikolou A, Bigard X, Löllgen H, Zupet P, Ionescu A, Debruyne A, Jones N, Vonbank K, Fagnani F, Fossati C, Casasco M, Constantinou D, Wolfarth B, Niederseer D, Bosch A, Muniz-Pardos B, Casajus JA, Schneider C, Loland S, Verroken M, Marqueta PM, Arroyo F, Pedrinelli A, Natsis K, Verhagen E, Roberts WO, Lazzoli JK, Friedman R, Erdogan A, Cintron AV, Yung SHP, Janse van Rensburg DC, Ramagole DA, Rozenstoka S, Drummond F, Papadopoulou T, Kumi PYO, Twycross-Lewis R, Harper J, Skiadas V, Shurlock J, Tanisawa K, Seto J, North K, Angadi SS, Martinez-Patiño MJ, Borjesson M, Di Luigi L, Dohi M, Swart J, Bilzon JLJ, Badtieva V, Zelenkova I, Steinacker JM, Bachl N, Pigozzi F, Geistlinger M, Goulis DG, Guppy F, Webborn N, Yildiz BO, Miller M, Singleton P, Pitsiladis YP. Correction to: Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement. Sports Med 2021; 51:1417-1418. [PMID: 33835352 DOI: 10.1007/s40279-021-01467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Blair R Hamilton
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK.,The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Giscard Lima
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - James Barrett
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Leighton Seal
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Guan Wang
- Sport and Exercise Science and Sports Medicine Research and Enterprise Group, University of Brighton, Brighton, UK
| | - Antonia Karanikolou
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
| | - Xavier Bigard
- Union Cycliste Internationale (UCI), Aigle, Switzerland.,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Petra Zupet
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Andre Debruyne
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Nigel Jones
- British Association Sport and Exercise Medicine, Doncaster, UK.,British Cycling and University of Liverpool, Liverpool, UK
| | - Karin Vonbank
- Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic (KIMII), University of Vienna, Vienna, Austria
| | - Federica Fagnani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Maurizio Casasco
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Italian Federation of Sports Medicine (FMSI), Rome, Italy
| | - Demitri Constantinou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Centre for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Centre, University of Zurich, Zurich, Switzerland
| | - Andrew Bosch
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Borja Muniz-Pardos
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - José Antonio Casajus
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Christian Schneider
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Orthopaedic Center Theresie, Munich, Germany
| | - Sigmund Loland
- Department of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - Michele Verroken
- Centre of Research and Innovation for Sport, Technology and Law (CRISTAL), De Montfort University, Leicester, UK.,Sporting Integrity Ltd, Stoke Mandeville, UK
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Sports Medicine, San Antonio Catholic University of Murcia, Murcia, Spain
| | - Francisco Arroyo
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,FIMS Collaborating Center of Sports Medicine, Guadalajara, Mexico
| | - André Pedrinelli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Orthopaedics, University of São Paulo Medical School, São Paulo, Brazil
| | - Konstantinos Natsis
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Interbalkan Medical Center, FIMS Collaborating Center of Sports Medicine, Thessaloniki, Greece.,Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - William O Roberts
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - José Kawazoe Lazzoli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Biomedical Institute, Fluminense Federal University Medical School, Niterói, Brazil
| | - Rogerio Friedman
- Universidade Federal do Rio Grande do Sul, Endocrine Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Ali Erdogan
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Gloria Sports Arena, FIMS Collaborating Centre of Sports Medicine, Antalya, Turkey
| | - Ana V Cintron
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Puerto Rico Sports Medicine Federation, San Juan, Puerto Rico
| | - Shu-Hang Patrick Yung
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Asian Federation of Sports Medicine (AFSM), Hong Kong Center of Sports Medicine and Sports Science, Hong Kong, China
| | | | - Dimakatso A Ramagole
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sandra Rozenstoka
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,FIMS Collaboration Centre of Sports Medicine, Sports laboratory, Riga, Latvia
| | - Felix Drummond
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,FIMS Collaboration Centre of Sports Medicine, Instituto de Medicina do Esporte, Porto Alegre, Brazil
| | - Theodora Papadopoulou
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
| | - Paulette Y O Kumi
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Joanna Harper
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | | | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Jane Seto
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kathryn North
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Siddhartha S Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | | | - Mats Borjesson
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Center for Health and Performance, Goteborg University, Göteborg, Sweden.,Sahlgrenska University Hospital/Ostra, Region of Western Sweden, Göteborg, Sweden
| | - Luigi Di Luigi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michiko Dohi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | - James Lee John Bilzon
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department for Health, University of Bath, Bath, UK
| | - Victoriya Badtieva
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation.,Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Irina Zelenkova
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Juergen M Steinacker
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Norbert Bachl
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Institute of Sports Science, University of Vienna, Vienna, Austria.,Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Michael Geistlinger
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fergus Guppy
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK.,School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Nick Webborn
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mike Miller
- World Olympian Association, Lausanne, Switzerland
| | | | - Yannis P Pitsiladis
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy. .,Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK. .,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy. .,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland. .,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.
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34
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Hamilton BR, Lima G, Barrett J, Seal L, Kolliari-Turner A, Wang G, Karanikolou A, Bigard X, Löllgen H, Zupet P, Ionescu A, Debruyne A, Jones N, Vonbank K, Fagnani F, Fossati C, Casasco M, Constantinou D, Wolfarth B, Niederseer D, Bosch A, Muniz-Pardos B, Casajus JA, Schneider C, Loland S, Verroken M, Marqueta PM, Arroyo F, Pedrinelli A, Natsis K, Verhagen E, Roberts WO, Lazzoli JK, Friedman R, Erdogan A, Cintron AV, Yung SHP, Janse van Rensburg DC, Ramagole DA, Rozenstoka S, Drummond F, Papadopoulou T, Kumi PYO, Twycross-Lewis R, Harper J, Skiadas V, Shurlock J, Tanisawa K, Seto J, North K, Angadi SS, Martinez-Patiño MJ, Borjesson M, Di Luigi L, Dohi M, Swart J, Bilzon JLJ, Badtieva V, Zelenkova I, Steinacker JM, Bachl N, Pigozzi F, Geistlinger M, Goulis DG, Guppy F, Webborn N, Yildiz BO, Miller M, Singleton P, Pitsiladis YP. Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement. Sports Med 2021; 51:1401-1415. [PMID: 33761127 PMCID: PMC7988249 DOI: 10.1007/s40279-021-01451-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.
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Affiliation(s)
- Blair R Hamilton
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Giscard Lima
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - James Barrett
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Leighton Seal
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Guan Wang
- Sport and Exercise Science and Sports Medicine Research and Enterprise Group, University of Brighton, Brighton, UK
| | - Antonia Karanikolou
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
| | - Xavier Bigard
- Union Cycliste Internationale (UCI), Aigle, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Petra Zupet
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Andre Debruyne
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Nigel Jones
- British Association Sport and Exercise Medicine, Doncaster, UK
- British Cycling and University of Liverpool, Liverpool, UK
| | - Karin Vonbank
- Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic (KIMII), University of Vienna, Vienna, Austria
| | - Federica Fagnani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Maurizio Casasco
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Italian Federation of Sports Medicine (FMSI), Rome, Italy
| | - Demitri Constantinou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Centre for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Centre, University of Zurich, Zurich, Switzerland
| | - Andrew Bosch
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Borja Muniz-Pardos
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - José Antonio Casajus
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Christian Schneider
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Orthopaedic Center Theresie, Munich, Germany
| | - Sigmund Loland
- Department of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - Michele Verroken
- Centre of Research and Innovation for Sport, Technology and Law (CRISTAL), De Montfort University, Leicester, UK
- Sporting Integrity Ltd, Stoke Mandeville, UK
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, San Antonio Catholic University of Murcia, Murcia, Spain
| | - Francisco Arroyo
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaborating Center of Sports Medicine, Guadalajara, Mexico
| | - André Pedrinelli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Orthopaedics, University of São Paulo Medical School, São Paulo, Brazil
| | - Konstantinos Natsis
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Interbalkan Medical Center, FIMS Collaborating Center of Sports Medicine, Thessaloniki, Greece
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - William O Roberts
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - José Kawazoe Lazzoli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Biomedical Institute, Fluminense Federal University Medical School, Niterói, Brazil
| | - Rogerio Friedman
- Universidade Federal do Rio Grande do Sul, Endocrine Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Ali Erdogan
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Gloria Sports Arena, FIMS Collaborating Centre of Sports Medicine, Antalya, Turkey
| | - Ana V Cintron
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Puerto Rico Sports Medicine Federation, San Juan, Puerto Rico
| | - Shu-Hang Patrick Yung
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Asian Federation of Sports Medicine (AFSM), Hong Kong Center of Sports Medicine and Sports Science, Hong Kong, China
| | | | - Dimakatso A Ramagole
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sandra Rozenstoka
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaboration Centre of Sports Medicine, Sports laboratory, Riga, Latvia
| | - Felix Drummond
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaboration Centre of Sports Medicine, Instituto de Medicina do Esporte, Porto Alegre, Brazil
| | - Theodora Papadopoulou
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
| | - Paulette Y O Kumi
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Joanna Harper
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | | | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Jane Seto
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kathryn North
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Siddhartha S Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | | | - Mats Borjesson
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Center for Health and Performance, Goteborg University, Göteborg, Sweden
- Sahlgrenska University Hospital/Ostra, Region of Western Sweden, Göteborg, Sweden
| | - Luigi Di Luigi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michiko Dohi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | - James Lee John Bilzon
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department for Health, University of Bath, Bath, UK
| | - Victoriya Badtieva
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
- Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Irina Zelenkova
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Juergen M Steinacker
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Norbert Bachl
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Michael Geistlinger
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fergus Guppy
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Nick Webborn
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mike Miller
- World Olympian Association, Lausanne, Switzerland
| | | | - Yannis P Pitsiladis
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy.
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK.
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.
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35
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Shurlock J, Muniz-Pardos B, Tucker R, Bachl N, Papadopoulou T, Holloway G, Jones N, Bigard X, Vonbank K, Niederseer D, Meyer J, Nowak D, Debruyne A, Zupet P, Löllgen H, Steinacker JM, Wolfarth B, Bilzon JLJ, Ionescu A, Dohi M, Swart J, Constantinou D, Badtieva V, Zelenkova I, Casasco M, Geistlinger M, Fossati C, Fagnani F, Di Luigi L, Webborn N, Angeloudis K, Guppy FM, Singleton P, Miller M, Pigozzi F, Pitsiladis YP. Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic. Sports Med Open 2021; 7:19. [PMID: 33721127 PMCID: PMC7957452 DOI: 10.1186/s40798-021-00309-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/28/2021] [Indexed: 01/09/2023]
Abstract
In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.
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Affiliation(s)
| | - Borja Muniz-Pardos
- GENUD (Growth, Exercise, Nutrition and Development) research group, University of Zaragoza, Zaragoza, Spain
| | | | - Norbert Bachl
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Theodora Papadopoulou
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- British Association Sport and Exercise Medicine, Doncaster, UK
- Defence Medical Rehabilitation Centre (DMRC), Loughborough, UK
| | - Graham Holloway
- British Association Sport and Exercise Medicine, Doncaster, UK
| | - Nigel Jones
- British Association Sport and Exercise Medicine, Doncaster, UK
- British Cycling and University of Liverpool, Liverpool, UK
| | - Xavier Bigard
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Union Cycliste Internationale (UCI), Aigle, Switzerland
| | - Karin Vonbank
- Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic (KIMII), University of Vienna, Vienna, Austria
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Centre, University of Zurich, Zurich, Switzerland
| | - Joachim Meyer
- German Respiratory Society (DGP), Berlin, Germany
- Lung Center Bogenhausen-Harlaching, Munich Clinic, Munich, Germany
| | - Dennis Nowak
- German Respiratory Society (DGP), Berlin, Germany
- LMU Klinikum, Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center, member DZL, German Center for Lung Research, Munich, Germany
| | - Andre Debruyne
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Petra Zupet
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Juergen M Steinacker
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - James L J Bilzon
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- British Association Sport and Exercise Medicine, Doncaster, UK
- Department for Health, University of Bath, Bath, UK
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Michiko Dohi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | - Demitri Constantinou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Centre for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Victoriya Badtieva
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
- Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Irina Zelenkova
- GENUD (Growth, Exercise, Nutrition and Development) research group, University of Zaragoza, Zaragoza, Spain
- Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Maurizio Casasco
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Italian Federation of Sports Medicine (FMSI), Rome, Italy
| | - Michael Geistlinger
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Unit International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Austria
| | - Chiara Fossati
- University of Rome "Foro Italico", Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | | | - Luigi Di Luigi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- University of Rome "Foro Italico", Rome, Italy
| | - Nick Webborn
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Konstantinos Angeloudis
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy
| | - Fergus M Guppy
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK
| | | | - Mike Miller
- World Olympians Association, Lausanne, Switzerland
| | - Fabio Pigozzi
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- University of Rome "Foro Italico", Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Yannis P Pitsiladis
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.
- University of Rome "Foro Italico", Rome, Italy.
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy.
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK.
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Flanagan M, Little R, Siddiqui I, Jones N, Ng V. A215 MDR3 DEFICIENCY MIMICKING WILSON DISEASE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.213] [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: 11/13/2022] Open
Abstract
Abstract
Background
The chronic phenotype of ALF includes a broad differential diagnosis. Class III multi-drug resistance P-glycoprotein 3 (MDR3) deficiency, also referred to as progressive familial intrahepatic cholestasis type 3, is an autosomal recessive genetic disorder. It is caused by a defect on the ABCB4 gene located on chromosome 7, which encodes MDR3. MDR3 is responsible for transporting phosphatidylcholine across the canalicular membrane, thereby allowing it to be incorporated into bile micelles. MDR3 deficiency results in increased levels of free bile acids and detergent bile. Progressive cholangiopathy ensues from this detergent bile and indirectly leads to cholestasis and liver failure in severe cases. Significantly increased urinary and hepatic copper (Cu), which are hallmarks of Wilson disease, have also been reported in patients with acute hepatitis and cholestasis including patients with MDR3 deficiency
Aims
We report a case of a girl who presented with a chronic phenotype of PALF, who had multiple features of Wilson disease and so was treated as such until genetic analysis confirmed MDR3 deficiency
Methods
Results
A 6 year old girl presented to the ED with a 1mth history of epistaxis and a 1wk history of abdominal pain and distension, facial edema, pallor and fever. Her family history was significant for parental consanguinity and maternal itch during pregnancy. On examination she had clubbing, scleral icterus and a distended abdomen with hepatosplenomegaly. Her bloodwork showed bicytopenia (HGB 53 & Plts 63) along with liver dysfunction (INR 2.9, albumin 25, conjugated bilirubin 9) and raised liver enzymes (transaminases & GGT >10xULN). Her total serum bile acids were raised at 134. An US showed hepatosplenomegaly with multiple hyperechoic nodules and perisplenic varices. She was extensively worked up for malignancy, autoimmune and metabolic disease. Serum ceruloplasmin was reduced, ophthalmology examination showed no KF rings and her 24hr urinary Cu was 10xULN. Liver Cu quantification was markedly raised at 40xULN. Liver biopsy showed cirrhosis with fibrosis related minimal non-specific portal and septal inflammation. Additionally, complete loss of canalicular staining on immunohistochemistry for MDR3 protein was noted, suggestive of MDR3 deficiency. Based on the Cu levels, a provisional diagnosis of Wilson disease was made and Cu chelation therapy was commenced pending genetic testing. A cholestatic gene panel subsequently showed homozygous pathogenic variant for the ABCB4 gene. Trientine was stopped and she was commenced on ursodeoxycholic acid. Though biochemically she remains largely unchanged, she is clinically stable whilst awaiting a liver transplant
Conclusions
This case highlights the diagnostic difficulties associated with Cu test result interpretation in patients with chronic cholestatic liver disease and urges a thorough consideration of alternative diagnoses of PALF
Funding Agencies
None
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Affiliation(s)
- M Flanagan
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Little
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - I Siddiqui
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - N Jones
- The Hospital for Sick Children, Toronto, ON, Canada
| | - V Ng
- Division of Pediatric GI/Hepatology/Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
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Adhikhari D, Henderson T, Dolce M, Banks AR, Zaim H, Onwuka A, Jones N. An evaluation of PlayStreets in the South Side neighborhood of Columbus, Ohio. Perspect Public Health 2021; 141:97-101. [PMID: 33602030 DOI: 10.1177/1757913921990411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Outdoor play, physical activity, and social cohesion are crucial indicators of community health. PlayStreets, a street play initiative to engage local children and families in outdoor play, physical activity, and social interactions, were implemented in a low-income neighborhood in Columbus, Ohio throughout the summer of 2019. This article aims to describe the implementation of a hospital-sponsored PlayStreets model executed through support from a community health initiative and to assess neighborhood impact through parent and child surveys. METHODS Approximately 350 children attended the events and 69 surveys were collected. Descriptive statistics were used to analyze survey data. RESULTS The mean age of children was 7 years, and the majority of children who attended were male. If not for PlayStreets, 55% of caregivers reported that their children would be inside. Event satisfaction levels were high, and 54% of caregivers said that they had more contact with their neighbors because of the events. CONCLUSIONS Hospital buy-in and community support were crucial to the success of the event. We found that this model can successfully engage the local community while increasing opportunity for childhood outdoor play, physical activity, and neighborhood social interaction.
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Affiliation(s)
- D Adhikhari
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - T Henderson
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - M Dolce
- Nationwide Children's Hospital, Columbus, OH, USA
| | - A R Banks
- Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - H Zaim
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - A Onwuka
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - N Jones
- Nationwide Children's Hospital, Columbus, OH, USA
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Hamilton BR, Martinez-Patiño MJ, Barrett J, Seal L, Tucker R, Papadopoulou T, Bigard X, Kolliari-Turner A, Löllgen H, Zupet P, Ionescu A, Debruyne A, Jones N, Steinacker JM, Vonbank K, Lima G, Fagnani F, Fossati C, Di Luigi L, Pigozzi F, Casasco M, Geistlinger M, Wolfarth B, Seto JT, Bachl N, Twycross-Lewis R, Niederseer D, Bosch A, Swart J, Constantinou D, Muniz-Pardos B, Casajus JA, Badtieva V, Zelenkova I, Bilzon JLJ, Dohi M, Schneider C, Loland S, Verroken M, Marqueta PM, Arroyo F, Pedrinelli A, Natsis K, Verhagen E, Roberts WO, Lazzoli JK, Friedman R, Erdogan A, Cintron AV, Yung SHP, van Rensburg DCJ, Ramagole DA, Rozenstoka S, Drummond F, Webborn N, Guppy FM, Pitsiladis YP. Response to the United Nations Human Rights Council's Report on Race and Gender Discrimination in Sport: An Expression of Concern and a Call to Prioritise Research. Sports Med 2020; 51:839-842. [PMID: 33289907 PMCID: PMC7721858 DOI: 10.1007/s40279-020-01380-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Blair R Hamilton
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK.,Centre for Stress and Age-Related Disease, University of Brighton, Eastbourne, UK.,The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - James Barrett
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Leighton Seal
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Theodora Papadopoulou
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,British Association Sport and Exercise Medicine, Doncaster, UK.,Defense Medical Rehabilitation Centre (DMRC), Loughborough, UK
| | - Xavier Bigard
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Union Cycliste Internationale (UCI), Aigle, Switzerland
| | | | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Petra Zupet
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Andre Debruyne
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Nigel Jones
- British Association Sport and Exercise Medicine, Doncaster, UK.,British Cycling and University of Liverpool, Liverpool, UK
| | - Juergen M Steinacker
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Karin Vonbank
- Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic (KIMII), University of Vienna, Vienna, Austria
| | - Giscard Lima
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Federica Fagnani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Luigi Di Luigi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Fabio Pigozzi
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Maurizio Casasco
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Italian Federation of Sports Medicine (FMSI), Rome, Italy
| | - Michael Geistlinger
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Unit International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Austria
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - Jane T Seto
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
| | - Norbert Bachl
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Institute of Sports Science, University of Vienna, Vienna, Austria.,Austrian Institute of Sports Medicine, Vienna, Austria
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich University Heart Centre, University of Zurich, Zurich, Switzerland
| | - Andrew Bosch
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Demitri Constantinou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Centre for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Borja Muniz-Pardos
- GENUD Research Group, Faculty of Sport and Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - José Antonio Casajus
- GENUD Research Group, Faculty of Sport and Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Victoriya Badtieva
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation.,Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Irina Zelenkova
- GENUD Research Group, Faculty of Sport and Health Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
| | - James L J Bilzon
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,British Association Sport and Exercise Medicine, Doncaster, UK.,Department for Health, University of Bath, Bath, UK
| | - Michiko Dohi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Christian Schneider
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Orthopaedic Center Theresie, Munich, Germany
| | - Sigmund Loland
- Institute of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - Michele Verroken
- Sporting Integrity Ltd, Stoke Mandeville, UK.,Centre of Research and Innovation for Sport, Technology and Law (CRISTAL), Faculty of Business and Law, De Montfort University, Leicester, UK
| | | | - Francisco Arroyo
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,FIMS Collaborating Center of Sports Medicine, Guadalajara, Mexico
| | - André Pedrinelli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Orthopaedics, University of São Paulo Medical School, São Paulo, Brazil
| | - Konstantinos Natsis
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Intebalkan Medical Centre, FIMS Collaborating Centre of Sports Medicine, Thessaloniki, Greece
| | - Evert Verhagen
- Amsterdam Collaboration On Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - William O Roberts
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - José Kawazoe Lazzoli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Biomedical Institute, Fluminense Federal University Medical School, Niterói, Brazil
| | - Rogerio Friedman
- Universidade Federal Do Rio Grande Do Sul, Endocrine Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Ali Erdogan
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Gloria Sports Arena, FIMS Collaborating Centre of Sports Medicine, Antalya, Turkey
| | - Ana V Cintron
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Puerto Rico Sports Medicine Federation, San Juan, Puerto Rico
| | - Shu-Hang Patrick Yung
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Asian Federation of Sports Medicine (AFSM), Hong Kong Center of Sports Medicine and Sports Science, Hong Kong, China
| | - Dina C Janse van Rensburg
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Dimakatso A Ramagole
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sandra Rozenstoka
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,FIMS Collaboration Centre of Sports Medicine, Sports Laboratory, Riga, Latvia
| | - Felix Drummond
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.,FIMS Collaboration Centre of Sports Medicine, Instituto de Medicina Do Esporte, Porto Alegre, Brazil
| | - Nick Webborn
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Fergus M Guppy
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK.,Centre for Stress and Age-Related Disease, University of Brighton, Eastbourne, UK
| | - Yannis P Pitsiladis
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK. .,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland. .,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland. .,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
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Irizar P, Leightley D, Stevelink S, Rona R, Jones N, Gouni K, Puddephatt JA, Fear N, Wessely S, Goodwin L. Drinking motivations in UK serving and ex-serving military personnel. Occup Med (Lond) 2020; 70:259-267. [PMID: 31961932 PMCID: PMC7305700 DOI: 10.1093/occmed/kqaa003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drinking motivations within the UK military have not been studied despite the high prevalence of alcohol misuse in this group. AIMS We aimed to characterize drinking motivations and their demographic, military and mental health associations in UK serving and ex-serving personnel. METHODS Serving and ex-serving personnel reporting mental health, stress or emotional problems occurring in the last 3 years were selected from an existing cohort study. A semi-structured telephone interview survey examined participants' mental health, help-seeking, alcohol use and drinking motivations. RESULTS Exploratory factor analysis of drinking motivations in military personnel (n = 1279; response rate = 84.6%) yielded 2 factors, labelled 'drinking to cope' and 'social pressure'. Higher drinking to cope motivations were associated with probable anxiety (rate ratio [RR] = 1.4; 95% confidence interval [CI] = 1.3-1.5), depression (RR = 1.3; 95% CI = 1.2-1.4) and post-traumatic stress disorder (RR = 1.4; 95% CI = 1.3-1.6). Higher social pressure motivations were associated with probable anxiety (odds ratio = 1.1; 95% CI = 1.0-1.1). Alcohol misuse and binge drinking were associated with reporting higher drinking to cope motivations, drinking at home and drinking alone. CONCLUSIONS Amongst military personnel with a stress, emotional or mental health problem, those who drink to cope with mental disorder symptoms or because of social pressure, in addition to those who drink at home or drink alone, are more likely to also drink excessively.
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Affiliation(s)
- P Irizar
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - D Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Stevelink
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Rona
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - K Gouni
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J-A Puddephatt
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - N Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - L Goodwin
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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40
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Harden L, Jones N, Whelan C, Phillips A, Simms A, Greenberg N. A systematic review of psychological training or interventions given to UK military personnel prior to deployment. BMJ Mil Health 2020; 167:63-69. [PMID: 33109732 DOI: 10.1136/bmjmilitary-2019-001296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions. METHODS A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24. RESULTS 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found. CONCLUSIONS Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics.
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Affiliation(s)
- Larissa Harden
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - C Whelan
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
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41
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Santillo M, Sivyer K, Krusche A, Mowbray F, Jones N, Peto TEA, Walker AS, Llewelyn MJ, Yardley L. Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine. J Antimicrob Chemother 2020; 74:3362-3370. [PMID: 31430366 PMCID: PMC6798845 DOI: 10.1093/jac/dkz333] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 12/18/2018] [Revised: 05/07/2019] [Accepted: 07/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background Hospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors. Objectives To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics. Methods A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development. Results A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions. Conclusions The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.
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Affiliation(s)
- M Santillo
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - K Sivyer
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - A Krusche
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - F Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - N Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T E A Peto
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,NIHR Biomedical Centre, Oxford, UK
| | - A S Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,NIHR Biomedical Centre, Oxford, UK
| | - M J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - L Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
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42
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Tennyson M, Redlaff J, Biosse-Duplan G, Lewin M, Jones N, Layard Horsfall H. Massive blood loss protocol 'Code Red' at Papworth Hospital: A closed loop audit. J Perioper Pract 2020; 31:334-340. [PMID: 32895000 PMCID: PMC8733415 DOI: 10.1177/1750458920943361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim To investigate if the massive blood loss protocol ‘Code Red’ at a specialist cardiothoracic hospital was activated according to local and national guidelines by a closed loop audit. Methods Electronic and paper patient care systems were searched in 2015 and 2018 to access records for the ‘Code Red’ activations. Activation of the massive blood loss protocol was compared against the national standards set by The British Committee for Standards in Haematology. The percentage of cases meeting each of the ten standards in the specialist cardiac unit’s Protocol for the Management of Massive Blood Loss in Adults (adapted from the national standards) were evaluated. Results ‘Code Red’ protocol was activated on 18 occasions in 2015 and nine occasions in 2018, representing just 0.83 and 0.26% of emergency surgeries, respectively. Between 2015 and 2018, there was a 6% increase of ‘Code Red’ cases being appropriately activated, a 26% increase in the prompt notification of the haematology department upon activation, alongside a 30% increase in the timely delivery of blood products, and a 25% decrease in the average amount of blood transferred prior to ‘Code Red’ activation. Conclusion There has been an improvement in the standards of care and management of massive blood loss this specialist cardiac centre despite the target timeframe being reduced from 30 to 15min between 2015 and 2018. Preparation for and anticipation of massive blood loss has likely decreased the number of incidences requiring ‘Code Red’ activation, permitting delivery of safe patient care.
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Affiliation(s)
| | - J Redlaff
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - G Biosse-Duplan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - M Lewin
- Department of Transfusion, Addenbrooke's Hospital, Cambridge, UK
| | - N Jones
- Department of Cardiothoracic Anaesthesia and Critical Care Medicine, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - H Layard Horsfall
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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43
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Kilowski K, Dietrich M, Xiu J, Jones N, Powell M, Galvan Turner V, Erickson B, Mutch D, Thaker P, ElNaggar A, Dizon D, Ahmad S, Herzog T, Korn W, Holloway R. 844P KRAS mutant epithelial ovarian carcinomas (EOC) represent distinct genomic genotypes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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44
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Sinno A, Pinkerton J, Febbraro T, Jones N, Khanna N, Temkin S, Iglesias D, Pothuri B. Hormone therapy (HT) in women with gynecologic cancers and in women at high risk for developing a gynecologic cancer: A Society of Gynecologic Oncology (SGO) clinical practice statement. Gynecol Oncol 2020; 157:303-306. [DOI: 10.1016/j.ygyno.2020.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
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45
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Kintz E, Williams NJ, Jones N, van der Es M, Lake IR, O'Brien SJ, Hunter PR. Regional differences in presence of Shiga toxin-producing Escherichia coli virulence-associated genes in the environment in the North West and East Anglian regions of England. Lett Appl Microbiol 2020; 71:179-186. [PMID: 32333799 DOI: 10.1111/lam.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
Shiga toxin-producing Escherichia coli is carried in the intestine of ruminant animals, and outbreaks have occurred after contact with ruminant animals or their environment. The presence of STEC virulence genes in the environment was investigated along recreational walking paths in the North West and East Anglia regions of England. In all, 720 boot sock samples from walkers' shoes were collected between April 2013 and July 2014. Multiplex PCR was used to detect E. coli based on the amplification of the uidA gene and investigate STEC-associated virulence genes eaeA, stx1 and stx2. The eaeA virulence gene was detected in 45·5% of the samples, where stx1 and/or stx2 was detected in 12·4% of samples. There was a difference between the two regions sampled, with the North West exhibiting a higher proportion of positive boot socks for stx compared to East Anglia. In univariate analysis, ground conditions, river flow and temperature were associated with positive boot socks. The detection of stx genes in the soil samples suggests that STEC is present in the English countryside and individuals may be at risk for infection after outdoor activities even if there is no direct contact with animals. SIGNIFICANCE AND IMPACT OF THE STUDY: Several outbreaks within the UK have highlighted the danger of contracting Shiga toxin-producing Escherichia coli from contact with areas recently vacated by livestock. This is more likely to occur for STEC infections compared to other zoonotic bacteria given the low infectious dose required. While studies have determined the prevalence of STEC within farms and petting zoos, determining the risk to individuals enjoying recreational outdoor activities that occur near where livestock may be present is less researched. This study describes the prevalence with which stx genes, indicative of STEC bacteria, were found in the environment in the English countryside.
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Affiliation(s)
- E Kintz
- Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - N J Williams
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Liverpool, UK
| | - N Jones
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - M van der Es
- Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - I R Lake
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - S J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - P R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa
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Tsai K, Hirschi-Budge KM, Davis T, Llavina S, Tullis B, Jones N, Fowers R, Graff T, Reynolds PR, Arroyo J. RAGE and phospho‐ATM correlation during DNA Double Strand Breaks in trophoblast cells. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Background While it is known that some UK Armed Forces (UK AF) personnel and veterans experience physical and mental health problems, the possible future healthcare needs of military veterans are unknown. Aims To estimate the number of military personnel who may experience physical and/or psychological health problems associated with their military service. Methods Data were obtained via Freedom of Information requests to several sources, including Defence Statistics. Raw data from research studies were also used where available. Data were analysed using meta-analytic methods to determine the rate of physical, mental or comorbid health problems in AF personnel. Results Musculoskeletal problems were the predominant reason for medical discharge from service. In terms of mental health, meta-analyses estimated that veteran reservists (part-time military members) previously deployed to operational areas had the highest proportion of general health problems (35%), previously deployed veteran regulars (those in full time military employment) and veteran reservists had the highest proportion of post-traumatic stress disorder (9%), and regular personnel with a deployment history had the highest proportion of alcohol problems (14%). Overall, our findings suggest that at least 67515 veterans are likely to suffer from mental and/or physical health problems at some point as a result of their service between 2001 and 2014. Conclusions The results of this study highlight that the difficulties personnel may face are largely musculoskeletal or mental health-related. These findings may help with planning the provision of future physical and mental health care and support for those who serve in the UK AF.
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Affiliation(s)
- V Williamson
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - J Diehle
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - R Dunn
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
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48
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Xia S, Laselva O, Bear CE, Jones N. A115 MODELING CYSTIC FIBROSIS (CF) INTESTINAL DISEASE USING PATIENT DERIVED TISSUES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.114] [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: 11/14/2022] Open
Abstract
Abstract
Background
Cystic Fibrosis is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene, which encodes for a chloride/bicarbonate anion channel expressed on the apical membrane of most epithelial tissues, such as the lungs, liver, pancreas, small and large intestines, and reproductive tissues. CFTR is responsible for the transport of chloride and bicarbonate ions to maintain tissue surface hydration and pH balance of epithelial tissues. Historically, recurrent lung infections have been the most common cause of mortality in CF patients. With advances in clinical care and therapeutics, the current mean survival age of Canadian patients has increased to 52.3 years. However, this increase in survival has also been associated with an elevated risk of developing gastrointestinal cancers in CF adults. Compared to the general public, CF patients are 10 times more likely to develop cancer. This risk is increased to 25-20 times in patients that have undergone organ transplantations. Although the exact molecular mechanism regarding increased cancer risk in CF remains unclear, chronic intestinal inflammation has been known to contribute to elevated cancer development.
Aims
CF patients display an increased baseline inflammatory status that is exacerbated with microbiome exposure leading to possible increased risk for inflammation-mediated cancer development.
Methods
To reduce inter-patient heterogeneity, we have differentiated human intestinal organoids using induced pluripotent stem cells from homozygous F508del CF patients and gene edited isogenic non-CF (Wt-CFTR) controls. We conducted gene expression studies using RT-qPCR to determine baseline differences in gene expression prior to environmental exposures and following exposure to LPS and flagellin.
Results
We determined the expression levels of stem cell, intestinal epithelial cell, innate immunity genes and differentiation markers and found expression of such genes were not significantly different between 3D CF and gene-edited non-CF organoids. We are currently conducting RNA sequencing to survey expression pattern of all genes to definitively determine possible fundamental changes in the CF intestinal epithelium and determining the effect of LPS and flagellin treatment to determine if there is an altered response to inflammatory stimuli.
Conclusions
iPSC derived HIOs is a novel, patient based, and renewable model that can be used to dissect the primary intestinal pathologies in CF. Transcriptomic data of CF HIOs at steady state will provide insights to possible developmental defects. Complex interactions between the host intestinal epithelia and the commensal microbiome can also be investigated using this model.
Funding Agencies
CAG
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Affiliation(s)
- S Xia
- Cell Biology, Hospital For Sick Children, Toronto, ON, Canada
| | - O Laselva
- Cell Biology, Hospital For Sick Children, Toronto, ON, Canada
| | - C E Bear
- Cell Biology, Hospital For Sick Children, Toronto, ON, Canada
| | - N Jones
- The Hospital for Sick Children, Toronto, ON, Canada
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Jones N, Jones M, Greenberg N, Phillips A, Simms A, Wessely S. UK military women: mental health, military service and occupational adjustment. Occup Med (Lond) 2020; 70:235-242. [DOI: 10.1093/occmed/kqaa019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Recently, the UK Armed Forces have revised the ground close combat role to include women.
Aims
To assess the potential mental health impact of this initiative we examined gender differences in deployment patterns, work strain, occupational factors, mental health, alcohol use and help-seeking following operational deployment.
Methods
The study was a secondary analysis of self-report survey data; 8799 men (88%) and 1185 women (12%) provided data. A sub-sample (47%, n = 4659) provided data concerning post-deployment help-seeking. The latter consisted of 408 women (8.8%) and 4251 men (91%).
Results
With the exception of alcohol misuse, which was significantly lower for women, women reported significantly more common mental disorder symptoms, subjective depression and self-harm. Women were significantly more likely to seek help from healthcare providers. Men were significantly more likely to have deployed operationally and for longer cumulative periods. Subjective work strain, but not job control, was significantly lower for women whose military careers were significantly shorter. Post-traumatic stress disorder (PTSD) symptom intensity was similar to men.
Conclusions
With the exception of PTSD and alcohol misuse, UK military women experience more mental health-related problems than military men. This finding was not related to the more arduous aspects of military service as women served for shorter times, deployed less and for shorter cumulative periods and were less likely to report work-related stress.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - M Jones
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - S Wessely
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
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50
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. British military women: combat exposure, deployment and mental health. Occup Med (Lond) 2019; 69:549-558. [PMID: 31404463 DOI: 10.1093/occmed/kqz103] [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: 11/12/2022] Open
Abstract
BACKGROUND Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. AIMS To explore the mental health impact of combat exposure among military women. METHODS Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. RESULTS Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70-2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11-2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53-0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49-0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53-0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84-1.77). Overall, outcomes were minimally impacted by level of combat exposure. CONCLUSIONS Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK.,King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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