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Nolde JM, Atkins E, Marschner S, Hillis GS, Chalmers J, Billiot L, Nelson MR, Reid CM, Hay P, Burke M, Jansen S, Usherwood T, Rodgers A, Chow CK, Schlaich MP. Ambulatory blood pressure after 12 weeks of quadruple combination of quarter doses of blood pressure medication vs. standard medication. J Hypertens 2024; 42:1009-1018. [PMID: 38501351 DOI: 10.1097/hjh.0000000000003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND A combination of four ultra-low-dose blood pressure (BP) medications lowered office BP more effectively than initial monotherapy in the QUARTET trial. The effects on average ambulatory BP changes at 12 weeks have not yet been reported in detail. METHODS Adults with hypertension who were untreated or on monotherapy were eligible for participation. Overall, 591 participants were randomized to either the quadpill (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or monotherapy control (irbesartan 150 mg). The difference in 24-h, daytime, and night-time systolic and diastolic ambulatory BP at 12 weeks along further metrics were predefined secondary outcomes. RESULTS Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At 12 weeks, mean 24-h ambulatory SBP and DBP were 7.7 [95% confidence interval (95% CI) 9.6-5.8] and 5.3 (95% CI: 6.5-4.1) mmHg lower in the quadpill vs. monotherapy group ( P < 0.001 for both). Similar reductions in the quadpill group were observed for daytime (8.1/5.7 mmHg lower) and night-time (6.3/4.0 mmHg lower) BP at 12 weeks (all P < 0.001) compared to monotherapy. The rate of BP control (24-h average BP < 130/80 mmHg) at 12 weeks was higher in the quadpill group (77 vs. 50%; P < 0.001). The reduction in BP load was also more pronounced with the quadpill. CONCLUSION A quadruple quarter-dose combination compared with monotherapy resulted in greater ambulatory BP lowering across the entire 24-h period with higher ambulatory BP control rates and reduced BP variability at 12 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy.
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Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia
| | - Emily Atkins
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Simone Marschner
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital
- School of Medicine, The University of Western Australia, Perth, Western Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales
| | - Laurent Billiot
- The George Institute for Global Health, University of New South Wales
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Christopher M Reid
- School of Public Health & Preventive Medicine Monash University, School of Population Health, Curtin University, Perth, Western Australia
| | | | - Michael Burke
- School of Medicine, Western Sydney University, Sydney, New South Wales
| | | | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia
- Department of Cardiology, Royal Perth Hospital
- School of Medicine, The University of Western Australia, Perth, Western Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Atkins ER, Chye A, Lung T, Nolde JM, Billot L, Burke M, Chalmers J, Figtree GA, Hay P, Hillis GS, Jansen S, Marschner S, Neal B, Nelson MR, Reid CM, Usherwood T, Schlaich M, Chow CK, Rodgers A. Cost-effectiveness of ultra-low-dose quadruple combination therapy for high blood pressure. Heart 2023; 109:1698-1705. [PMID: 37553138 DOI: 10.1136/heartjnl-2022-322300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/17/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To determine the cost-effectiveness and cost-utility of a quadpill containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg in comparison with irbesartan 150 mg for people with hypertension who are either untreated or receiving monotherapy. METHODS We conducted a within-trial and modelled economic evaluation of the Quadruple UltrA-low-dose tReaTment for hypErTension trial. The analysis was preplanned, and medications and health service use captured during the trial. The main outcomes were incremental cost-effectiveness ratios (ICERs) for cost per mm Hg systolic blood pressure (BP) reduction at 3 months, and modelled cost per quality-adjusted life year (QALY) over a lifetime. RESULTS The within-trial analysis showed no clear difference in cost per mm Hg BP lowering between randomised treatments at 3 months ($A10 (95% uncertainty interval (UI) $A -18 to $A37) per mm Hg per person) for quadpill versus monotherapy. The modelled cost-utility over a lifetime projected a mean incremental cost of $A265 (95% UI $A166 to $A357) and a mean 0.02 QALYs gained (95% UI 0.01 to 0.03) per person with quadpill therapy compared with monotherapy. Quadpill therapy was cost-effective in the base case (ICER of $A14 006 per QALY), and the result was sensitive to the quadpill cost in one-way sensitivity analysis. CONCLUSIONS Quadpill in comparison with monotherapy is comparably cost-effective for short-term BP lowering. In the long-term, quadpill therapy is likely to be cost-effective. TRIAL REGISTRATION NUMBER ANZCTRN12616001144404.
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Affiliation(s)
- Emily R Atkins
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Alexander Chye
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Thomas Lung
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, The University of Western Australia, Perth, Western Australia, Australia
| | - Laurent Billot
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Michael Burke
- Kildare Road Medical Centre, Blacktown, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
- Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - Peter Hay
- Castle Hill Medical Centre, Castle Hill, New South Wales, Australia
| | - Graham S Hillis
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Shirley Jansen
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Bruce Neal
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Mark R Nelson
- Discipline of General Practice, Menzies Research Institute Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- Centre for Clinical Research and Education, Curtin University, Perth, Western Australia, Australia
| | - Tim Usherwood
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, The University of Western Australia, Perth, Western Australia, Australia
- Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Clara K Chow
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
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Nolde JM, Atkins E, Marschner S, Hillis GS, Chalmers J, Billot L, Nelson MR, Reid CM, Hay P, Burke M, Jansen S, Usherwood T, Rodgers A, Chow CK, Schlaich MP. Effect of Initial Treatment With a Single Pill Containing Quadruple Combination of Quarter Doses of Blood Pressure Medicines Versus Standard Dose Monotherapy in Patients With Hypertension on Ambulatory Blood Pressure Indices: Results From the QUARTET Study. Circulation 2023; 148:375-377. [PMID: 37486996 DOI: 10.1161/circulationaha.123.064964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth (J.M.N., M.P.S.)
| | | | - Simone Marschner
- Westmead Applied Research Centre, University of Sydney, Australia, and Department of Cardiology, Westmead Hospital, Sydney, Australia (F.A., S.M., T.U., C.K.C.)
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Australia, and School of Medicine, The University of Western Australia, Perth (G.S.H., M.PS.)
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.)
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.)
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.R.N.)
| | - Christopher M Reid
- School of Public Health & Preventive Medicine Monash University, School of Population Health, Curtin University, Perth, Australia (C.M.R.)
| | - Peter Hay
- Castle Hill Medical Centre Sydney, Australia (P.H.)
| | - Michael Burke
- School of Medicine, Western Sydney University, Australia (M.B.)
| | | | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.)
- Westmead Applied Research Centre, University of Sydney, Australia, and Department of Cardiology, Westmead Hospital, Sydney, Australia (F.A., S.M., T.U., C.K.C.)
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.)
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.)
- Westmead Applied Research Centre, University of Sydney, Australia, and Department of Cardiology, Westmead Hospital, Sydney, Australia (F.A., S.M., T.U., C.K.C.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth (J.M.N., M.P.S.)
- Department of Cardiology, Royal Perth Hospital, Perth, Australia, and School of Medicine, The University of Western Australia, Perth (G.S.H., M.PS.)
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.P.S.)
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Chow CK, Atkins ER, Hillis GS, Nelson MR, Reid CM, Schlaich MP, Hay P, Rogers K, Billot L, Burke M, Chalmers J, Neal B, Patel A, Usherwood T, Webster R, Rodgers A. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet 2021; 398:1043-1052. [PMID: 34469767 DOI: 10.1016/s0140-6736(21)01922-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treatment inertia is a recognised barrier to blood pressure control, and simpler, more effective treatment strategies are needed. We hypothesised that a hypertension management strategy starting with a single pill containing ultra-low-dose quadruple combination therapy would be more effective than a strategy of starting with monotherapy. METHODS QUARTET was a multicentre, double-blind, parallel-group, randomised, phase 3 trial among Australian adults (≥18 years) with hypertension, who were untreated or receiving monotherapy. Participants were randomly assigned to either treatment, that started with the quadpill (containing irbesartan at 37·5 mg, amlodipine at 1·25 mg, indapamide at 0·625 mg, and bisoprolol at 2·5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). If blood pressure was not at target, additional medications could be added in both groups, starting with amlodipine at 5 mg. Participants were randomly assigned using an online central randomisation service. There was a 1:1 allocation, stratified by site. Allocation was masked to all participants and study team members (including investigators and those assessing outcomes) except the manufacturer of the investigational product and one unmasked statistician. The primary outcome was difference in unattended office systolic blood pressure at 12 weeks. Secondary outcomes included blood pressure control (standard office blood pressure <140/90 mm Hg), safety, and tolerability. A subgroup continued randomly assigned allocation to 12 months to assess long-term effects. Analyses were per intention to treat. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12616001144404, and is now complete. FINDINGS From June 8, 2017, to Aug 31, 2020, 591 participants were recruited, with 743 assessed for eligibility, 152 ineligible or declined, 300 participants randomly assigned to intervention of initial quadpill treatment, and 291 to control of initial standard dose monotherapy treatment. The mean age of the 591 participants was 59 years (SD 12); 356 (60%) were male and 235 (40%) were female; 483 (82%) were White, 70 (12%) were Asian, and 38 (6%) reported as other ethnicity; and baseline mean unattended office blood pressure was 141 mm Hg (SD 13)/85 mm Hg (SD 10). By 12 weeks, 44 (15%) of 300 participants had additional blood pressure medications in the intervention group compared with 115 (40%) of 291 participants in the control group. Systolic blood pressure was lower by 6·9 mm Hg (95% CI 4·9-8·9; p<0·0001) and blood pressure control rates were higher in the intervention group (76%) versus control group (58%; relative risk [RR] 1·30, 95% CI 1·15-1·47; p<0·0001). There was no difference in adverse event-related treatment withdrawals at 12 weeks (intervention 4·0% vs control 2·4%; p=0·27). Among the 417 patients who continued, uptitration occurred more frequently among control participants than intervention participants (p<0·0001). However, at 52 weeks mean unattended systolic blood pressure remained lower by 7·7 mm Hg (95% CI 5·2-10·3) and blood pressure control rates higher in the intervention group (81%) versus control group (62%; RR 1·32, 95% CI 1·16-1·50). In all randomly assigned participants up to 12 weeks, there were seven (3%) serious adverse events in the intervention group and three (1%) serious adverse events in the control group. INTERPRETATION A strategy with early treatment of a fixed-dose quadruple quarter-dose combination achieved and maintained greater blood pressure lowering compared with the common strategy of starting monotherapy. This trial demonstrated the efficacy, tolerability, and simplicity of a quadpill-based strategy. FUNDING National Health and Medical Research Council, Australia.
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Affiliation(s)
- Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Emily R Atkins
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Graham S Hillis
- Royal Perth Hospital and Medical School, University of Western Australia, Perth, WA, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Christopher M Reid
- School of Public Health & Preventive Medicine Monash University, Melbourne, VIC, Australia; School of Population Health, Curtin University, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Royal Perth Hospital Research Foundation, Medical School, University of Western Australia, Perth, WA, Australia
| | - Peter Hay
- Castle Hill Medical Centre, Sydney, NSW, Australia
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Michael Burke
- School of Medicine, Western Sydney University, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; School of Public Health, Imperial College London, London, UK
| | - Anushka Patel
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Tim Usherwood
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Ruth Webster
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
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Hoon E, González-Chica DA, Vakulin A, McEvoy D, Zwar N, Grunstein R, Chai-Coetzer C, Lack L, Adams R, Hay P, Touyz S, Stocks N. Population-based analysis of sociodemographic predictors, health-related quality of life and health service use associated with obstructive sleep apnoea and insomnia in Australia. Aust J Prim Health 2021; 27:304-311. [PMID: 33653510 DOI: 10.1071/py20216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n=2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6-6.7) and 6.8% (95% CI 5.7-7.9) of subjects self-reported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions; however, lower mental HRQoL among those frequently visiting a doctor was observed only among individuals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated.
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Affiliation(s)
- E Hoon
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia; and Corresponding author.
| | - D A González-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia
| | - A Vakulin
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia; and Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - D McEvoy
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia
| | - N Zwar
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Qld 4226, Australia
| | - R Grunstein
- Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia; and Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - C Chai-Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia; and Respiratory and Sleep Service, Southern Adelaide Local Health Network, Flinders Medical Centre, Bedford Park, SA 5049, Australia
| | - L Lack
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia
| | - R Adams
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia; and Respiratory and Sleep Service, Southern Adelaide Local Health Network, Flinders Medical Centre, Bedford Park, SA 5049, Australia
| | - P Hay
- Translational Health Research Institute, School of Medicine, University of Western Sydney, Building 3, David Pilgrim Avenue, Campbelltown, NSW 2560, Australia
| | - S Touyz
- School of Psychology, University of Sydney, Brennan MacCallum Building, A18 Manning Road, Camperdown, NSW 2050, Australia
| | - N Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia
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Chow CK, Atkins ER, Billot L, Chalmers J, Hillis GS, Hay P, Neal B, Nelson M, Patel A, Reid CM, Schlaich M, Usherwood T, Webster R, Rodgers A. Ultra-low-dose quadruple combination blood pressure-lowering therapy in patients with hypertension: The QUARTET randomized controlled trial protocol. Am Heart J 2021; 231:56-67. [PMID: 33017580 PMCID: PMC7531985 DOI: 10.1016/j.ahj.2020.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/27/2020] [Indexed: 10/25/2022]
Abstract
High blood pressure is the leading cause of preventable morbidity and mortality globally. Many patients remain on single-drug treatment with poor control, although guidelines recognize that most require combination therapy for blood pressure control. Our hypothesis is that a single-pill combination of 4 blood pressure-lowering agents each at a quarter dose may provide a simple, safe, and effective blood pressure-lowering solution which may also improve long-term adherence. The Quadruple UltrA-low-dose tReaTment for hypErTension (QUARTET) double-blind, active-controlled, randomized clinical trial will examine whether ultra-low-dose quadruple combination therapy is more effective than guideline-recommended standard care in lowering blood pressure. QUARTET will enroll 650 participants with high blood pressure either on no treatment or on monotherapy. Participants will be randomized 1:1 and allocated to intervention therapy of a single pill (quadpill) containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg or to control therapy of a single identical-appearing pill containing irbesartan 150 mg. In both arms, step-up therapy of open-label amlodipine 5 mg will be provided if blood pressure is >140/90 at 6 weeks. The primary outcome is the difference between groups in the change from baseline in mean unattended automated office systolic blood pressure at 12-week follow-up. The primary outcome and some secondary outcomes will be assessed at 12 weeks; there is an optional 12-month extension phase to assess longer-term efficacy and tolerability. Our secondary aims are to assess if this approach is safe, has fewer adverse effects, and has better tolerability compared to standard care control. QUARTET will therefore provide evidence for the effectiveness and safety of a new paradigm in the management of high blood pressure.
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Affiliation(s)
- Clara K Chow
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia.
| | - Emily R Atkins
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital and University of Western Australia, Perth, Western Australia, Australia
| | - Peter Hay
- Castle Hill Medical Centre, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anushka Patel
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine, University of Western Australia and Royal Perth Hospital, Perth, Western Australia
| | - Tim Usherwood
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ruth Webster
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- The Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
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Hegazi A, Ramskill N, Norbrook M, Morgan T, Dwyer E, Elgalib A, Renshaw J, Whittaker W, Milne S, Barbour A, Nathan B, Iqbal F, Esterich S, Hay P. Genital tract infections in HIV-infected pregnant women in South West London. Int J STD AIDS 2020; 31:587-592. [PMID: 32316852 DOI: 10.1177/0956462419899834] [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: 11/16/2022]
Abstract
There are minimal UK data on the prevalence of genital tract infections in HIV‐infected pregnant women. British HIV Association guidelines suggest sexually transmitted infection (STI) screening as early as possible in pregnancy with consideration given to repeat at 28 weeks’ gestation. A retrospective case notes review of HIV-infected pregnant women at four South London HIV Centres (1 January 2004–1 January 2014) was carried out. Five hundred and ninety-eight pregnancies in 384 patients were identified. Median age 32 years (interquartile range [IQR] 27–36) and 96% (n = 346) were heterosexually infected. HIV was diagnosed antenatally in 21% of pregnancies (n = 107). Seventy-seven per cent of women (n = 384) were of Black African ethnicity and 75% were born in sub-Saharan Africa with 14% UK-born. The majority of pregnancies (279/507) were reported to be unplanned with 42 women proceeding to termination of pregnancy. A regular male partner was reported in 95% of pregnancies (n = 539) with median relationship duration (n = 347) of four years (IQR 1.5–7.0); 11/324 (3.4%) women reported additional sexual partners during the pregnancy. 76.6% (n = 427) of women had an initial STI screen which was done in the first trimester in 52.1%; 32.1% of women had a repeat STI screen in pregnancy, 96% of which was done in the third trimester. Overall, 61 (14.3%) women were diagnosed with at least one STI during their pregnancy. Vaginal candidiasis and bacterial vaginosis were diagnosed in 27.6% (n = 100) and 21.7% (n = 73) of pregnancies, respectively. STI prevalence was low and obstetric outcomes favourable in this cohort of women. Further information about STI prevalence in this population may impact future screening guidelines.
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Affiliation(s)
- A Hegazi
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - N Ramskill
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - M Norbrook
- Department of Genitourinary Medicine, Kingston Hospital NHS Foundation Trust, London, UK
| | - T Morgan
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - E Dwyer
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - A Elgalib
- Department of Genitourinary Medicine, Croydon University Hospital, Croydon, UK
| | - J Renshaw
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - W Whittaker
- University of Manchester, Manchester Centre for Health Economics, Manchester, UK
| | - S Milne
- Department of Genitourinary Medicine, Croydon University Hospital, Croydon, UK
| | - A Barbour
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - B Nathan
- Department of Genitourinary Medicine, Kingston Hospital NHS Foundation Trust, London, UK
| | - F Iqbal
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
| | - S Esterich
- Epsom and Saint Helier University Hospitals NHS Trust, Epsom Hospital, Epsom, UK
| | - P Hay
- The Courtyard Clinic, Wandsworth Integrated Sexual Health, St George's University Hospital Foundation Trust, London, UK
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Trompeter N, Bussey K, Hay P, Mond J, Murray SB, Lonergan A, Griffiths S, Pike K, Mitchison D. Fear of Negative Evaluation and Weight/Shape Concerns among Adolescents: The Moderating Effects of Gender and Weight Status. J Youth Adolesc 2018; 47:1398-1408. [DOI: 10.1007/s10964-018-0872-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
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Dixit R, Khandaker G, Hay P, McPhie K, Taylor J, Rashid H, Heron L, Dwyer D, Booy R. You are here: > Home Page > Publications > Antiviral Therapy > Browse Articles > Advanced Publication Abstract PDF (53 KB) Correction Correction: A randomized study of standard versus double dose oseltamivir for treating influenza in the community. Antivir Ther 2018; 23:553. [DOI: 10.3851/imp3276] [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] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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Byrne S, Wade T, Hay P, Touyz S, Fairburn CG, Treasure J, Schmidt U, McIntosh V, Allen K, Fursland A, Crosby RD. A randomised controlled trial of three psychological treatments for anorexia nervosa. Psychol Med 2017; 47:2823-2833. [PMID: 28552083 DOI: 10.1017/s0033291717001349] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy. METHOD A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment. RESULTS Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up. CONCLUSION The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/.
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Affiliation(s)
- S Byrne
- School of Psychology, The University of Western Australia,Perth,Australia
| | - T Wade
- School of Psychology, Flinders University,Adelaide,Australia
| | - P Hay
- School of Medicine & Centre for Health Research, Western Sydney University,Sydney,Australia
| | - S Touyz
- School of Psychology, Sydney University,Sydney,Australia
| | - C G Fairburn
- Department of Psychiatry,Oxford University,Oxford,UK
| | - J Treasure
- Department of Psychological Medicine,Kings College London,London,UK
| | - U Schmidt
- Department of Psychological Medicine,Kings College London,London,UK
| | - V McIntosh
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - K Allen
- School of Psychology, The University of Western Australia,Perth,Australia
| | - A Fursland
- Centre for Clinical Interventions,Perth,Australia
| | - R D Crosby
- Department of Psychiatry and Behavioral Sciences,University of North Dakota School of Medicine and Health Sciences,Fargo, ND,USA
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Lunn A, Colyer S, Premji K, Knipe J, Fullerton D, Barber S, Moss G, Hay P. Automated estimated GFR reporting in children using a height independent formula. Arch Pediatr 2017. [DOI: 10.1016/j.arcped.2017.10.019] [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: 10/18/2022]
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Mitchison D, Touyz S, González-Chica DA, Stocks N, Hay P. How abnormal is binge eating? 18-Year time trends in population prevalence and burden. Acta Psychiatr Scand 2017; 136:147-155. [PMID: 28419425 DOI: 10.1111/acps.12735] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Although findings suggest that binge eating is becoming increasingly normative, the 'clinical significance' of this behaviour at a population level remains uncertain. We aimed to assess the time trends in binge-eating prevalence and burden over 18 years. METHOD Six cross-sectional face-to-face surveys of the Australian adult population were conducted in 1998, 2005, 2008, 2009, 2014, and 2015 (Ntotal = 15 126). Data were collected on demographics, 3-month prevalence of objective binge eating (OBE), health-related quality of life, days out of role, and distress related to OBE. RESULTS The prevalence of OBE increased six-fold from 1998 (2.7%) to 2015 (13.0%). Health-related quality of life associated with OBE improved from 1998 to 2015, where it more closely approximated population norms. Days out of role remained higher among participants who reported OBE, although decreased over time. Half of participants who reported weekly (56.6%) and twice-weekly (47.1%) OBE reported that they were not distressed by this behaviour. However, the presence of distress related to OBE in 2015 was associated with greater health-related quality-of-life impairment. CONCLUSION As the prevalence of binge eating increases over time, associated disability has been decreasing. Implications for the diagnosis of disorders associated with binge eating are discussed.
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Affiliation(s)
- D Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - S Touyz
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - D A González-Chica
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, SA, Australia
| | - N Stocks
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, SA, Australia
| | - P Hay
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Hamzah L, Jose S, Booth JW, Hegazi A, Rayment M, Bailey A, Williams DI, Hendry BM, Hay P, Jones R, Levy JB, Chadwick DR, Johnson M, Sabin CA, Post FA. Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate. J Infect 2017; 74:492-500. [PMID: 28130143 DOI: 10.1016/j.jinf.2017.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/07/2016] [Accepted: 01/17/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We aimed to study the risk factors for developing severe renal tubulopathy. METHODS We conducted an observational cohort study with retrospective identification of cases of treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted estimated glomerular filtration rate (eGFR) slopes. RESULTS Between October 2002 and June 2013, 60 (0.4%) of 15,983 patients who had received TDF developed tubulopathy after a median exposure of 44.1 (IQR 20.4, 64.4) months. Tubulopathy cases were predominantly male (92%), of white ethnicity (93%), and exposed to antiretroviral regimens that contained boosted protease inhibitors (PI, 90%). In multivariate analysis, age, ethnicity, CD4 cell count and use of didanosine or PI were significantly associated with tubulopathy. Tubulopathy cases experienced significantly greater eGFR decline while receiving TDF than the comparator group (-6.60 [-7.70, -5.50] vs. -0.34 [-0.43, -0.26] mL/min/1.73 m2/year, p < 0.0001). CONCLUSIONS Older age, white ethnicity, immunodeficiency and co-administration of ddI and PI were risk factors for tubulopathy in patients who received TDF-containing antiretroviral therapy. The presence of rapid eGFR decline identified TDF recipients at increased risk of tubulopathy.
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Affiliation(s)
- L Hamzah
- Kings College Hospital NHS Foundation Trust, London, UK; King's College London, London, UK.
| | - S Jose
- University College London, London, UK
| | - J W Booth
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - A Hegazi
- St George's Healthcare NHS Trust, London, UK
| | - M Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Bailey
- Imperial College Healthcare NHS Trust, London, UK
| | - D I Williams
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | - P Hay
- St George's Healthcare NHS Trust, London, UK
| | - R Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - J B Levy
- Imperial College Healthcare NHS Trust, London, UK
| | - D R Chadwick
- South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - M Johnson
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - C A Sabin
- University College London, London, UK
| | - F A Post
- Kings College Hospital NHS Foundation Trust, London, UK
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Hay P. Reflections on the 'State of the Evidence' for treatments in anorexia nervosa. Acta Psychiatr Scand 2016; 133:339-40. [PMID: 27084190 DOI: 10.1111/acps.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Penrith, NSW, Australia.
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Low N, Hegazi A, Chan SY, Hay P, Herzog SA. P08.21 Sex and pelvic inflammatory disease: what’s the relationship? case-control study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.367] [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: 11/04/2022]
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da Luz FQ, Hay P, Gibson AA, Touyz SW, Swinbourne JM, Roekenes JA, Sainsbury A. Does severe dietary energy restriction increase binge eating in overweight or obese individuals? A systematic review. Obes Rev 2015; 16:652-65. [PMID: 26094791 DOI: 10.1111/obr.12295] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/16/2015] [Accepted: 04/30/2015] [Indexed: 11/28/2022]
Abstract
Severe dietary energy restriction is often used for overweight or obese individuals to achieve rapid weight loss and related health improvements. However, the extent of putative adverse effects on eating behaviour is unknown. We thus systematically searched seven databases for studies that assessed binge eating before and after severe dietary energy restriction (low or very low energy diets) in overweight or obese individuals. Fifteen clinically supervised interventions from 10 publications (nine of which involved only women) were included. Among individuals with clinically relevant pre-treatment binge eating disorder, severe dietary energy restriction significantly decreased binge eating in all four interventions involving this population, at least during the weight loss programme. In contrast, no consistent association between severe dietary energy restriction and the onset of bingeing was found in 11 interventions involving individuals without pre-treatment binge eating disorder, with four such interventions showing significant increases, two showing no change, and five showing significant decreases in binge eating. We conclude that clinically supervised severe dietary energy restriction appears safe and beneficial for overweight or obese individuals with pre-treatment binge eating disorder, and does not necessarily trigger binge eating in those without binge eating disorder.
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Affiliation(s)
- F Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
- CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - P Hay
- Centre for Health Research and School of Medicine, The University of Western Sydney, Sydney, NSW, Australia
| | - A A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - S W Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - J M Swinbourne
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - J A Roekenes
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - A Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
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Perry MEO, Taylor GP, Sabin CA, Conway K, Flanagan S, Dwyer E, Stevenson J, Mulka L, McKendry A, Williams E, Barbour A, Dermont S, Roedling S, Shah R, Anderson J, Rodgers M, Wood C, Sarner L, Hay P, Hawkins D, deRuiter A. Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates. HIV Med 2015. [PMID: 26200570 DOI: 10.1111/hiv.12277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r). METHODS A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared. RESULTS A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%). CONCLUSIONS Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.
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Affiliation(s)
- M E O Perry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G P Taylor
- Imperial College Healthcare NHS Trust, London, UK
| | - C A Sabin
- Research Department of Infection and Population Health, University College London, London, UK
| | - K Conway
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Flanagan
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - E Dwyer
- Croydon University Hospital NHS Trust, London, UK
| | - J Stevenson
- Croydon University Hospital NHS Trust, London, UK
| | - L Mulka
- Imperial College Healthcare NHS Trust, London, UK
| | - A McKendry
- The North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - S Dermont
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Roedling
- (Mortimer Market Centre) Central and North West London NHS Foundation Trust, London, UK
| | - R Shah
- Barnet and Chase Farm Hospital NHS Trust, London, UK
| | - J Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - M Rodgers
- Croydon University Hospital NHS Trust, London, UK
| | - C Wood
- The North Middlesex University Hospital NHS Trust, London, UK
| | - L Sarner
- Barts Health NHS Trust, London, UK
| | - P Hay
- St George's NHS Trust, London, UK
| | - D Hawkins
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A deRuiter
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lunn A, Jeffs K, Hay P. FP228A LOCALLY VERIFIED HEIGHT INDEPENDANT FORMULA FOR ESTIMATING GLOMERULAR FILTRATION RATE (EGFR) IN CHILDREN - IS AUTOMATIC EGFR REPORTING IN CHILDREN FEASIBLE? Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv173.10] [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: 11/14/2022] Open
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Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, Bamford B, Pike K, Crosby R. Treating Severe and Enduring Anorexia Nervosa: a Randomized Control Trial. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30281-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Madden S, Miskovic-Wheatley J, Wallis A, Kohn M, Lock J, Le Grange D, Jo B, Clarke S, Rhodes P, Hay P, Touyz S. A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med 2015; 45:415-427. [PMID: 25017941 PMCID: PMC4301212 DOI: 10.1017/s0033291714001573] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN. METHOD We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT). RESULTS The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group. CONCLUSIONS Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.
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Affiliation(s)
- S. Madden
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
| | - J. Miskovic-Wheatley
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Westmead Clinical School, The University of Sydney, Australia
| | - A. Wallis
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
| | - M. Kohn
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - J. Lock
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - D. Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
| | - B. Jo
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - S. Clarke
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - P. Rhodes
- School of Psychology, The University of Sydney, Australia
| | - P. Hay
- Centre for Health Research, School of Medicine, The University of Western Sydney and School of Medicine, James Cook University, Australia
| | - S. Touyz
- School of Psychology, The University of Sydney, Australia
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Dixit R, Khandaker G, Hay P, McPhie K, Taylor J, Rashid H, Heron L, Dwyer D, Booy R. A randomized study of standard versus double dose oseltamivir for treating influenza in the community. Antivir Ther 2014; 20:689-98. [DOI: 10.3851/imp2807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, Bamford B, Pike KM, Crosby RD. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med 2013; 43:2501-2511. [PMID: 23642330 DOI: 10.1017/s0033291713000949] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN. METHOD Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes. RESULTS Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM. CONCLUSIONS Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.
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Affiliation(s)
- S Touyz
- School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, University of Sydney, NSW, Australia
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Samuel M, Jose S, Winston A, Nelson M, Johnson M, Chadwick D, Fisher M, Leen C, Gompels M, Gilson R, Post FA, Hay P, Sabin CA. The effects of age on associations between markers of HIV progression and markers of metabolic function including albumin, haemoglobin and lipid concentrations. HIV Med 2013; 15:311-6. [PMID: 24245861 PMCID: PMC4265250 DOI: 10.1111/hiv.12103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We investigated whether age modified associations between markers of HIV progression, CD4 T lymphocyte count and HIV RNA viral load (VL), and the following markers of metabolic function: albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). METHODS A retrospective analysis of data from the United Kingdom Collaborative HIV Cohort was carried out. Analyses were limited to antiretroviral-naïve subjects to focus on the impact of HIV disease itself. A total of 16670 subjects were included in the analysis. Multilevel linear regression models assessed associations between CD4 count/VL and each of the outcomes. Statistical tests for interactions assessed whether associations differed among age groups. RESULTS After adjustment for gender and ethnicity, there was evidence that lower CD4 count and higher VL were associated with lower TC, LDL-C, haemoglobin and albumin concentrations but higher triglyceride concentrations. Age modified associations between CD4 count and albumin (P < 0.001) and haemoglobin (P = 0.001), but not between CD4 count and HDL-C, LDL-C and TC, or VL and any outcome. Among participants aged < 30, 30-50 and > 50 years, a 50 cells/μL lower CD4 count correlated with a 2.4 [95% confidence interval (CI) 1.7-3.0], 3.6 (95% CI 3.2-4.0) and 5.1 (95% CI 4.0-6.1) g/L lower haemoglobin concentration and a 0.09 (95% CI 0.07-0.11), 0.12 (95% CI 0.11-0.13) and 0.16 (95% CI 0.13-0.19) g/L lower albumin concentration, respectively. CONCLUSIONS We present evidence that age modifies associations between CD4 count and plasma albumin and haemoglobin levels. A given reduction in CD4 count was associated with a greater reduction in haemoglobin and albumin concentrations among older people living with HIV. These findings increase our understanding of how the metabolic impact of HIV is influenced by age.
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Affiliation(s)
- M Samuel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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24
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Harding-Esch EM, Hegazi A, Okolo O, Pond MJ, Nori AV, Nardone A, Baraitser P, Campbell L, Hay P, Sadiq ST. P2.163 Do “In-Clinic” Molecular and Non-Molecular Rapid Tests Improve Patient Management?: Abstract P2.163 Table 1. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Pond MJ, Nori AV, Hou Y, Patel S, Laing KG, Allen RL, Hay P, Butcher PD, Sadiq ST. P1.012 Urinary Cytokine Profiles in Non-Specific, Mycoplasma Genitalium and Chlamydia Trachomatis Urethritis. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0233] [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: 11/04/2022]
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Mohammed H, Obi C, Bignell C, Dean G, Hay P, Robinson A, Ross JDC, Chisholm S, Ison C, Hughes G. P3.284 Factors Associated with Variations in Culture Confirmation For Neisseria Gonorrhoea: A Study of Patients Attending Five Genitourinary Medicine Clinics in England. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0740] [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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Abstract
We describe a case of acute HIV infection in the third trimester of pregnancy associated with an extremely high viral load and the use of raltegravir to prevent HIV mother-to-child transmission.
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Affiliation(s)
- A Hegazi
- Department of Genitourinary Medicine, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK
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28
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Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, Tookey P, Welch S, Wilkins E, de Ruiter A. British HIV Association guidelines for the management of HIV infection in pregnant women 2012. HIV Med 2012; 13 Suppl 2:87-157. [PMID: 22830373 DOI: 10.1111/j.1468-1293.2012.01030_2.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of human immunodeficiency virus (HIV)-positive pregnant women in the UK. The scope includes guidance on the use of antiretroviral therapy (ART) both to prevent HIV mother-to-child transmission (MTCT) and for the welfare of the mother herself, guidance on mode of delivery and recommendations in specific patient populations where other factors need to be taken into consideration,such as coinfection with other agents. The guidelines are aimed at clinical professionals directly involved with, and responsible for, the care of pregnant women with HIV infection.
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Affiliation(s)
- G P Taylor
- Section of Infectious Diseases, Imperial College London, UK
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Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, Tookey P, Welch S, Wilkins E, de Ruiter A. British HIV Association guidelines for the management of HIV infection in pregnant women 2012. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.01030.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- GP Taylor
- Communicable Diseases; Section of Infectious Diseases; Imperial College London; UK
| | - P Clayden
- UK Community Advisory Board representative/HIV treatment advocates network; London; UK
| | - J Dhar
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - K Gandhi
- Heart of England NHS Foundation Trust; Birmingham; UK
| | | | - K Harding
- Guy's and St Thomas′ Hospital NHS Foundation Trust; London; UK
| | - P Hay
- St George's Healthcare NHS Trust; London; UK
| | - J Kennedy
- Homerton University Hospital NHS Foundation Trust; London; UK
| | - N Low-Beer
- Chelsea and Westminster Hospital NHS Foundation Trust; London; UK
| | - H Lyall
- Imperial College Healthcare NHS Trust; London; UK
| | - A Palfreeman
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - P Tookey
- UCL Institute of Child Health; London; UK
| | - S Welch
- Paediatric Infectious Diseases; Heart of England NHS Foundation Trust; Birmingham; UK
| | - E Wilkins
- Infectious Diseases and Director of the HIV Research Unit; North Manchester General Hospital; Manchester; UK
| | - A de Ruiter
- Genitourinary Medicine; Guy's and St Thomas' NHS Foundation Trust; London; UK
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Patel S, Aroney R, Bird M, Rice P, Hay P. P126 Improving the management of antenatal women with positive syphilis serology within a genitourinary medicine service. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.126] [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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31
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Ahmed N, Sidebottom A, Hirani M, Hay P. Condylar hyperplasia and its management—the role of the bone scan. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.240] [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: 11/29/2022]
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32
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Chan SY, Hegazi A, Beardall A, Hay P. P27 An audit on the management of pelvic inflammatory disease (PID): Abstract P27 Table 1. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.27] [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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33
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Chan SY, King R, Borgulya G, Pakianathan M, Sadiq ST, Hay P, Planche T. P183 How likely is environmental contamination of Chlamydia trachomatisDNA to lead to false positive results in patients attending our clinic? Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.183] [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: 11/04/2022]
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34
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Engstrom C, Green A, Hay P, Friis P, Myers P, Fraser J, Schafer J. eCAPS—An innovative web-based online system for clinical assessment of practical skills in joint examination. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Smith E, Hay P, Campbell L, Trollor JN. A review of the association between obesity and cognitive function across the lifespan: implications for novel approaches to prevention and treatment. Obes Rev 2011; 12:740-55. [PMID: 21991597 DOI: 10.1111/j.1467-789x.2011.00920.x] [Citation(s) in RCA: 474] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- E Smith
- Brain and Ageing Research Program, School of Psychiatry, University of New South Wales, Sydney, Australia.
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36
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Herzog SA, Althaus CL, Heijne JCM, Oakeshott P, Kerry S, Hay P. P1-S1.33 Timing of progression of Chlamydia trachomatis infection to pelvic inflammatory disease - a Mathematical Modelling Study. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.33] [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: 11/04/2022]
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37
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Barnett-Vanes A, Oakeshott P, Musa M, Hay P. Antenatal patients' attitudes to HIV testing for their male partners: a cross-sectional questionnaire survey from Uganda. Br J Vener Dis 2011; 87:291. [DOI: 10.1136/sextrans-2011-050022] [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: 11/04/2022]
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38
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Aghaizu A, Adams EJ, Turner K, Kerry S, Hay P, Simms I, Oakeshott P. What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the Prevention Of Pelvic Infection (POPI) trial. Sex Transm Infect 2011; 87:312-7. [DOI: 10.1136/sti.2010.048694] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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39
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Affiliation(s)
- L Durber
- St George's Hospital, University of London, London SW17 ORE, UK
| | - P Oakeshott
- St George's Hospital, University of London, London SW17 ORE, UK
| | - K Prime
- St George's Hospital, University of London, London SW17 ORE, UK
| | - P Hay
- St George's Hospital, University of London, London SW17 ORE, UK
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40
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Vaca M, Guadalupe I, Erazo S, Tinizaray K, Chico ME, Cooper PJ, Hay P. High prevalence of bacterial vaginosis in adolescent girls in a tropical area of Ecuador. BJOG 2010; 117:225-8. [PMID: 19874295 DOI: 10.1111/j.1471-0528.2009.02397.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bacterial vaginosis (BV) is a common clinical syndrome, but data are scarce on the BV prevalence in tropical regions among sexually active and virgin adolescents. To estimate the prevalence of BV among adolescent girls in an Ecuadorian coastal town, girls were asked to complete a questionnaire on risk factors for BV and vaginal samples were examined. Bacterial vaginosis was present in 31.5% of 213 girls, and the prevalence was similar in self-reported virgin and sexually active girls (OR 1.06, 95% CI, 0.51-2.21, P = 0.88), although the power of this analysis was limited. The prevalence of BV was high among Ecuadorian adolescent girls, and did not appear to be associated with sexual activity.
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Affiliation(s)
- M Vaca
- Laboratorio de Investigaciones, Hospital Pedro Vicente Maldonado, Pichincha Province, Ecuador
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41
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Varma N, Hay P, Varma R, Majewska W, Oakeshott P. Low use and awareness of long-acting reversible contraception in women attending a South London genitourinary medicine clinic. Int J STD AIDS 2010; 21:226. [DOI: 10.1258/ijsa.2009.009513] [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: 11/18/2022]
Affiliation(s)
- N Varma
- Departments of Genitourinary Medicine and Community Health SciencesSt George's, University of London, London SW17 ORE, UK
| | - P Hay
- Departments of Genitourinary Medicine and Community Health SciencesSt George's, University of London, London SW17 ORE, UK
| | - R Varma
- Departments of Genitourinary Medicine and Community Health SciencesSt George's, University of London, London SW17 ORE, UK
| | - W Majewska
- Departments of Genitourinary Medicine and Community Health SciencesSt George's, University of London, London SW17 ORE, UK
| | - P Oakeshott
- Departments of Genitourinary Medicine and Community Health SciencesSt George's, University of London, London SW17 ORE, UK
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42
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Baisley K, Changalucha J, Weiss HA, Mugeye K, Everett D, Hambleton I, Hay P, Ross D, Tanton C, Chirwa T, Hayes R, Watson-Jones D. Bacterial vaginosis in female facility workers in north-western Tanzania: prevalence and risk factors. Sex Transm Infect 2009; 85:370-5. [PMID: 19473997 PMCID: PMC2709714 DOI: 10.1136/sti.2008.035543] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine prevalence of, and risk factors for, bacterial vaginosis (BV) among herpes simplex virus (HSV) 2 seropositive Tanzanian women at enrollment into a randomised, placebo-controlled trial of HSV suppressive treatment. METHODS 1305 HSV-2 seropositive women aged 16-35 years working in bars, guesthouses and similar facilities were interviewed, examined and tested for HIV, syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, BV, candidiasis and trichomoniasis. Factors associated with BV were analysed using logistic regression to estimate odds ratios and 95% confidence intervals. RESULTS BV prevalence was 62.9%; prevalence of Nugent score 9-10 was 16.1%. Independent risk factors for BV were work facility type, fewer dependents, increasing alcohol consumption, sex in the last week (adjusted OR 2.03; 95% CI 1.57 to 2.62), using cloths or cotton wool for menstrual hygiene, HIV (adjusted OR 1.41; 95% CI 1.09 to 1.83) and Trichomonas vaginalis infection. There was no association between BV and the frequency or method of vaginal cleansing. However, BV was less prevalent among women who reported inserting substances to dry the vagina for sex (adjusted OR 0.44; 95% CI 0.25 to 0.75). CONCLUSION BV was extremely prevalent among our study population of HSV-2 positive female facility workers in North-western Tanzania. Although recent sex was associated with increased BV prevalence, vaginal drying was associated with lower BV prevalence. Further studies of the effects of specific practices on vaginal flora are warranted.
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Affiliation(s)
- K Baisley
- London School of Hygiene & Tropical Medicine, London, UK.
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43
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Darby A, Hay P, Quirk F, Mond J, Buettner PG, Paxton SJ, Kennedy L. Better psychological health is associated with weight stability in women with eating disorders. Eat Weight Disord 2009; 14:13-22. [PMID: 19367136 DOI: 10.1007/bf03327790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/24/2022] Open
Abstract
AIM To explore the associations between changes in weight, eating disorder psychopathology and psychological distress in a community sample of women with eating disorders over two years. METHOD One hundred and twenty two women identified with disordered eating in a baseline population survey agreed to participate in a follow-up study, of whom 87 (71%), mean age 28+/-6.2, completed the two-year follow-up. Body mass index, eating disorder psychopathology, psychological distress, and demographic details were assessed at both time points. RESULTS Over the two years there was a mean weight gain of 1.76 kg (SD=7.03), 11 (13%) women lost > or =5 kg, 25 (29%) gained > or =5 kg, and 49 (58%) remained weight stable (i.e., within 5 kg of baseline weight). Comparisons between those who had lost, gained and remained weight stable showed few significant differences, however, women who remained weight stable were the least psychologically distressed at baseline and those who lost weight had the greatest reduction in shape concern. Body mass index at baseline, and change in level of binge eating episodes were not associated with weight change. CONCLUSIONS Disordered eating behaviours have little influence on weight change over two years in community women with disordered eating. Low levels of psychological distress at baseline may promote weight stability. Concerns about shape are likely to increase with increased weight.
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Affiliation(s)
- A Darby
- School of Medicine, James Cook University, Queensland, Australia
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44
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Read P, Costelloe S, Mullen J, O'Shea S, Lyons F, Hay P, Welch J, Larbalestier N, Taylor GP, de Ruiter A. New mutations associated with resistance not detected following zidovudine monotherapy in pregnancy when used in accordance with British HIV Association guidelines*. HIV Med 2008; 9:448-51. [DOI: 10.1111/j.1468-1293.2008.00594.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Phillips DR, Hay P. Current perspectives on the management and prevention of antiretroviral-associated lipoatrophy. J Antimicrob Chemother 2008; 62:866-71. [DOI: 10.1093/jac/dkn318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Mahungu TW, Else LJ, Smith CJ, Cuthbertson Z, Podlekareva D, Hay P, Dragsted UB, Khoo SH, Johnson MA, Back DJ, Youle M. A study to evaluate the efficacy, safety and tolerability of co-administered lopinavir/ritonavir (LPVr) and nevirapine (NVP) in HIV-infected adults. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p6] [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: 11/10/2022] Open
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47
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Abstract
BACKGROUND Nevirapine has been widely used in pregnancy for its efficacy, low pill burden, bioavailability and rapid transplacental transfer. Concern about nevirapine toxicity during pregnancy has emerged over recent years. OBJECTIVES The aims of the study were to document the frequency of cutaneous and hepatic toxicity secondary to nevirapine use during pregnancy and to compare rates in women starting nevirapine during the current pregnancy with those in women who had commenced nevirapine prior to the current pregnancy. DESIGN This was a retrospective, comparative, five-centre study carried out in London, UK, in 1997-2003. METHODS All HIV-1-infected women who received nevirapine as part of combination antiretroviral therapy (ART) during pregnancy were included in the study. Data on demographics, HIV infection risk, Centers for Disease Control and Prevention (CDC) status, surrogate markers at initiation of therapy, other medications hepatitis B and C virus coinfection and clinical data relating to potential toxicity were collated and analysed. RESULTS Fifteen of 235 eligible women (6.4%) developed rash and eight (3.4%) developed hepatotoxicity, including four with coexistent rash, giving a combined incidence of 19 potential cases of nevirapine toxicity during pregnancy (8.1%). Alternative causes of rash/hepatotoxicity were suspected in seven cases and only 10 mothers (5.8%) discontinued nevirapine. Of the 170 women who commenced nevirapine during this pregnancy, 13 (7.6%) developed rash and eight (4.7%) hepatotoxicity, a combined incidence of 10%. Only two of 65 women with nevirapine exposure prior to this pregnancy developed rash (3.1%). CONCLUSIONS Nevirapine-containing ART was well tolerated in this cohort of pregnant women. Although pregnancy did not appear to increase the risk of nevirapine-associated toxicity compared to published adult data, CD(4) count may be less predictive of toxicity in pregnancy.
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Affiliation(s)
- U Natarajan
- Department of Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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48
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Simms I, Stephenson JM, Mallinson H, Peeling RW, Thomas K, Gokhale R, Rogers PA, Hay P, Oakeshott P, Hopwood J, Birley H, Hernon M. Risk factors associated with pelvic inflammatory disease. Sex Transm Infect 2006; 82:452-7. [PMID: 16901918 PMCID: PMC2563866 DOI: 10.1136/sti.2005.019539] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2006] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate factors associated with pelvic inflammatory disease (PID). METHODS A case-control study was used to investigate demographic and behavioural factors, and causative agents associated with PID. RESULTS A total of 381 participants were recruited: 140 patients, and 105 and 136 controls in tubal ligation and general practice groups, respectively. When compared with a PID-free tubal ligation control group, increased risk of PID was associated with: age <25 years; age at first sexual intercourse <20 years; non-white ethnicity; not having had children; a self-reported history of a sexually transmitted disease; and exposure to Chlamydia trachomatis. When compared with a general practice control group, increased risk was associated with: age <25 years; age at first sexual intercourse <15 years; lower socioeconomic status; being single; adverse pregnancy outcome; a self-reported history of a sexually transmitted disease; and exposure to C trachomatis. Of the cases, 64% were not associated with any of the infectious agents measured in this study (idiopathic). CONCLUSIONS A high proportion of cases were idiopathic. PID control strategies, which currently focus on chlamydial screening, have to be reviewed so that they can prevent all cases of PID. Behavioural change is a key factor in the primary prevention of PID, and potential modifiable risk factors were associated with PID.
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Affiliation(s)
- I Simms
- Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
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Abstract
OBJECTIVE To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status. DESIGN General population cross-sectional survey. SUBJECTS A total of 4891 young women from the community aged 18-42 years, of which 630 were in the obese weight range. MEASUREMENTS Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10). RESULTS Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, 'hard' exercise and subjective bulimic episodes also contributed to the model predicting psychological distress. CONCLUSION As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.
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Affiliation(s)
- A Darby
- Discipline of Psychiatry, School of Medicine, James Cook University, Queensland, Australia.
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Ugwumadu A, Yanamandra N, Hay P. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET study. BJOG 2006; 113:851-2. [PMID: 16827776 DOI: 10.1111/j.1471-0528.2006.00978.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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