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Brohan MP, Barrett PM. Hypertensive disorders of pregnancy: no longer just an "obstetrician's disease". Am J Obstet Gynecol 2024; 230:e32. [PMID: 37944840 DOI: 10.1016/j.ajog.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Matthew P Brohan
- School of Medicine, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
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Bowe AK, Barrett PM. Bridging the academic practice gap in public health-The role of the clinical academic in public health. Public Health 2024; 227:e1-e2. [PMID: 38242829 DOI: 10.1016/j.puhe.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Affiliation(s)
- A K Bowe
- INFANT Research Centre, Cork, Ireland; Department of Public Health - HSE South West, Health Service Executive, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
| | - P M Barrett
- INFANT Research Centre, Cork, Ireland; Department of Public Health - HSE South West, Health Service Executive, St. Finbarr's Hospital, Douglas Road, Cork, Ireland; School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
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Brohan MP, Daly FP, Kelly L, McCarthy FP, Khashan AS, Kublickiene K, Barrett PM. Hypertensive disorders of pregnancy and long-term risk of maternal stroke-a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:248-268. [PMID: 36990309 DOI: 10.1016/j.ajog.2023.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether hypertensive disorders of pregnancy are associated with an increased risk for ischemic stroke or hemorrhagic stroke in later life. This systematic review aimed to synthesize the available literature on the association between hypertensive disorders of pregnancy and the long-term risk for maternal stroke. DATA SOURCES PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022. STUDY ELIGIBILITY CRITERIA Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke. METHODS Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment. RESULTS The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19). CONCLUSION In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.
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Affiliation(s)
- Matthew P Brohan
- School of Public Health, University College Cork, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland.
| | - Fionn P Daly
- School of Medicine, University College Cork, Cork, Ireland
| | - Louise Kelly
- Department of General Medicine, Beaumont Hospital, Dublin, Ireland
| | - Fergus P McCarthy
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
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Barrett PM, Bruton O, Hanrahan M, White PF, Brennan A, Ertz K, Chu RW, Keogh S, Dean J, O'Mahony MT, O'Sullivan MB, Sheahan A, Murray D. A large outbreak of the Kappa mutation of COVID-19 in Cork, Ireland, April-May 2021. Ir J Med Sci 2023; 192:1573-1579. [PMID: 36369600 PMCID: PMC9651878 DOI: 10.1007/s11845-022-03212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND In May 2021, the B.1.617 variant of SARS-CoV-2 emerged in Ireland, and both Delta and Kappa sub-lineages were initially deemed variants of concern (VOCs) on a precautionary basis. We describe a large outbreak of SARS-CoV-2 B.1.617.1 (Kappa mutation) linked to a private gathering among third level students in Cork, Ireland. METHODS Surveillance data were available from the Health Service Executive COVID Care Tracker. The epidemiological sequence of infection for each new case in this outbreak was tracked and whole genome sequencing was requested on all linked cases. Enhanced public health control measures were implemented by the Department of Public Health HSE-South to contain onward spread of VOCs, including retrospective contact tracing, lengthy isolation and quarantine periods for cases and close contacts. Extensive surveillance efforts were used to describe and control onward transmission. RESULTS There were 146 confirmed SARS-CoV-2 cases linked to the outbreak. All sequenced cases (53/146; 36%) confirmed Kappa mutation. The median age was 21 years (range 17-65). The majority (88%) had symptoms of SARS-CoV-2 infection. There were 407 close contacts; the median was 3 per case (range 0-14). There were no known hospitalisations, ICU admissions or deaths. Vaccination data was unavailable, but the outbreak pre-dated routine availability of COVID-19 vaccines among younger adults in Ireland. CONCLUSION Enhanced public health control measures for new and emerging variants of SARS-CoV-2 may be burdensome for cases and close contacts. The overall public health benefit of enhanced controls may only become apparent when evidence on disease transmissibility and severity becomes more complete.
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Affiliation(s)
- P M Barrett
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
| | - O Bruton
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - M Hanrahan
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - P F White
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - A Brennan
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - K Ertz
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - R W Chu
- School of Medicine, University College Cork, Cork, Ireland
| | - S Keogh
- Cork Complex Contact Tracing Centre, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - J Dean
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - M T O'Mahony
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - M B O'Sullivan
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - A Sheahan
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - D Murray
- Department of Public Health HSE-South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
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Bambury N, Barrett PM, Crompton J, O'Mahony MT, O'Sullivan MB, Murray DE, Foley Nolan C, Sheahan A. Practicalities and Yield from Mass Swabbing for COVID-19 in Residential Care Facilities in the South of Ireland. J Aging Soc Policy 2022:1-8. [PMID: 35998210 DOI: 10.1080/08959420.2022.2110801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/16/2022] [Indexed: 10/15/2022]
Abstract
Over 19,000 residents and health-care workers in 315 RCFs were swabbed in a once - off mass swabbing of residents and staff in residential care facilities (RCFs) in the Cork/Kerry region in Ireland in April and May 2020. This exercise was in response to epidemiological evidence demonstrating increasing community transmission of COVID-19 and emerging evidence of the vulnerability of older persons, particularly those with underlying medical conditions. The effectiveness of such strategies is uncertain and may depend on both the positive case yield and efficiency of testing turn-around to ensure that timely control measures are put in place. The overall positivity rate was 0.88% (n = 172). Mass swabbing allowed early identification of some new cases and outbreaks in RCFs. This facilitated early public health interventions to protect the most vulnerable members of society.
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Kublickiene K, Khashan AS. Does gestational diabetes increase the risk of maternal kidney disease? A Swedish national cohort study. PLoS One 2022; 17:e0264992. [PMID: 35271650 PMCID: PMC8912264 DOI: 10.1371/journal.pone.0264992] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background Gestational diabetes (GDM) is associated with increased risk of type 2 diabetes (T2DM) and cardiovascular disease. It is uncertain whether GDM is independently associated with the risk of chronic kidney disease. The aim was to examine the association between GDM and maternal CKD and end-stage kidney disease (ESKD) and to determine whether this depends on progression to overt T2DM. Methods A population-based cohort study was designed using Swedish national registry data. Previous GDM diagnosis was the main exposure, and this was stratified according to whether women developed T2DM after pregnancy. Using Cox regression models, we estimated the risk of CKD (stages 3–5), ESKD and different CKD subtypes (tubulointerstitial, glomerular, hypertensive, diabetic, other). Findings There were 1,121,633 women included, of whom 15,595 (1·4%) were diagnosed with GDM. Overall, GDM-diagnosed women were at increased risk of CKD (aHR 1·81, 95% CI 1·54–2·14) and ESKD (aHR 4·52, 95% CI 2·75–7·44). Associations were strongest for diabetic CKD (aHR 8·81, 95% CI 6·36–12·19) and hypertensive CKD (aHR 2·46, 95% CI 1·06–5·69). These associations were largely explained by post-pregnancy T2DM. Among women who had GDM + subsequent T2DM, strong associations were observed (CKD, aHR 21·70, 95% CI 17·17–27·42; ESKD, aHR 112·37, 95% CI 61·22–206·38). But among those with GDM only, associations were non-significant (CKD, aHR 1·11, 95% CI 0·89–1·38; ESKD, aHR 1·58, 95% CI 0·70–3·60 respectively). Conclusion Women who experience GDM and subsequent T2DM are at increased risk of developing CKD and ESKD. However, GDM-diagnosed women who never develop overt T2DM have similar risk of future CKD/ESKD to those with uncomplicated pregnancies.
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Affiliation(s)
- Peter M. Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
- * E-mail:
| | - Fergus P. McCarthy
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marius Kublickas
- Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ali S. Khashan
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
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Daly FP, O'Donnell K, Davoren MP, Noone C, Weatherburn P, Quinlan M, Foley B, Igoe D, Barrett PM. Potential alcohol use disorder (AUD) among men who have sex with men (MSM) in Ireland. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) appears to disproportionately affect men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this.
Methods
The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM residing in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥ 2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD.
Results
In total, 1,793 MSM met inclusion criteria, and 31% screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95%CI 1.01-2.18), native to Ireland (vs. non-native) (aOR 1.49 95%CI 1.12-1.96), unemployed (vs. employed) (aOR 1.80 95%CI 1.02-3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95%CI 1.14-2.63) (other illicit drugs, aOR 2.28 95%CI 1.67-3.09), reported anxiety/depression (vs. none) (aOR 1.73 95%CI 1.12-2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95%CI 1.09-2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95%CI 0.46-0.93).
Conclusions
The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.
Key messages
The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.
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Affiliation(s)
- FP Daly
- School of Medicine and Health, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - K O'Donnell
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - MP Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Ireland, Cork, Ireland
| | - C Noone
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | | | - M Quinlan
- Gay Health Network, Ireland, Dublin, Ireland
| | - B Foley
- Gay Health Network, Ireland, Dublin, Ireland
| | - D Igoe
- Health Protection Surveillance Centre, Health Service Executive, Dublin, Ireland
| | - PM Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Department of Public Health HSE-South, St. Finbarr’s Hospital, Cork, Ireland
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Daly FP, O'Donnell K, Davoren MP, Noone C, Weatherburn P, Quinlan M, Foley B, Igoe D, Barrett PM. Potential alcohol use disorder among MSM in Ireland - Findings from the European MSM internet survey (EMIS 2017). Drug Alcohol Depend 2021; 223:108698. [PMID: 33878574 DOI: 10.1016/j.drugalcdep.2021.108698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) disproportionately affects men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this. METHODS The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD. RESULTS In total, 1793 MSM met inclusion criteria. 31 % screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95 %CI 1.01-2.18), native to Ireland (vs. non-native) (aOR 1.49 95 %CI 1.12-1.96), unemployed (vs. employed) (aOR 1.80 95 %CI 1.02-3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95 %CI 1.14-2.63) (other illicit drugs, aOR 2.28 95 %CI 1.67-3.09), reported anxiety/depression (vs. none) (aOR 1.73 95 %CI 1.12-2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95 %CI 1.09-2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95 %CI 0.46-0.93). CONCLUSIONS The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.
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Affiliation(s)
- Fionn P Daly
- School of Medicine and Health, University College Cork, Cork, T12V821, Ireland; School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Kate O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, D01A4A3, Ireland
| | - Martin P Davoren
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland; Sexual Health Centre, Cork, T12DX73, Ireland
| | - Chris Noone
- School of Psychology, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene and Tropical Medicine, London, WC1E7HT, United Kingdom
| | | | - Bill Foley
- Gay Health Network, Dublin, D01R290, Ireland
| | - Derval Igoe
- HSE Health Protection Surveillance Centre, Dublin, D01A4A3, Ireland
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland; Department of Public Health HSE-South, St. Finbarr's Hospital, Cork, T12XH60, Ireland.
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Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS. Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e018494. [PMID: 33870708 PMCID: PMC8200761 DOI: 10.1161/jaha.120.018494] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Maternal chronic hypertension is associated with adverse pregnancy outcomes. Previous studies examined the association between either chronic hypertension or antihypertensive treatment and adverse pregnancy outcomes. We aimed to synthesize the evidence on the effect of chronic hypertension/antihypertensive treatment on adverse pregnancy outcomes. Methods and Results Medline/PubMed, EMBASE, and Web of Science were searched; we included observational studies and assessed the effect of race/ethnicity, where possible, following a registered protocol (CRD42019120088). Random-effects meta-analyses were used. A total of 81 studies were identified on chronic hypertension, and a total of 16 studies were identified on antihypertensive treatment. Chronic hypertension was associated with higher odds of preeclampsia (adjusted odd ratio [aOR], 5.43; 95% CI, 3.85-7.65); cesarean section (aOR, 1.87; 95% CI, 1.6-2.16); maternal mortality (aOR, 4.80; 95% CI, 3.04-7.58); preterm birth (aOR, 2.23; 95% CI, 1.96-2.53); stillbirth (aOR, 2.32; 95% CI, 2.22-2.42); and small for gestational age (SGA) (aOR, 1.96; 95% CI, 1.6-2.40). Subgroup analyses indicated that maternal race/ethnicity does not influence the observed associations. Women with chronic hypertension on antihypertensive treatment (versus untreated) had higher odds of SGA (aOR, 1.86; 95% CI, 1.38-2.50). Conclusions Chronic hypertension is associated with adverse pregnancy outcomes, and these associations appear to be independent of maternal race/ethnicity. In women with chronic hypertension, those on treatment had a higher risk of SGA, although the number of studies was limited. This could result from a direct effect of the treatment or because severe hypertension during pregnancy is a risk factor for SGA and women with severe hypertension are more likely to be treated. The effect of antihypertensive treatment on SGA needs to be further tested with large randomized controlled trials.
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Affiliation(s)
- Sukainah Y Al Khalaf
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
| | - Éilis J O'Reilly
- School of Public Health University College Cork Cork Ireland.,Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA
| | - Peter M Barrett
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
| | | | - Lauren C Pawley
- Department of Anatomy and Neuroscience University College Cork Cork Ireland
| | - Fergus P McCarthy
- INFANT Research Centre University College Cork Ireland.,Department of Obstetrics and Gynaecology University College Cork Cork Ireland
| | - Ali S Khashan
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
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Abstract
BACKGROUND It is recognized that healthcare workers (HCWs) are at high risk of contracting Covid-19. It is incumbent on occupational health staff to recognize potential symptoms of Covid-19 among HCWs. AIMS The aims of the study were to describe the presenting symptoms of HCWs who developed Covid-19 in Ireland, and to estimate the odds of specific symptoms being associated with a positive Covid-19 polymerase chain reaction (PCR) result. METHODS A retrospective chart review of all symptomatic HCWs who self-presented for Covid-19 testing in Cork from March to May 2020 was conducted. A sex-matched case-control study was carried out to compare presenting features among those who tested positive compared to those who tested negative. Univariate and multivariable-adjusted conditional logistic regression models were run using Stata 15.0 to identify the symptoms associated with positive Covid-19 swab results. RESULTS Three hundred and six HCWs were included in the study; 102 cases and 204 controls. Common presenting features among cases were fever/chills (55%), cough (44%) and headache (35%). The symptoms which were significantly associated with a positive Covid-19 swab result were loss of taste/smell (adjusted odds ratio [aOR] 12.15, 95% confidence interval [CI] 1.36-108.79), myalgia (aOR 2.36, 95% 1.27-4.38), fatigue (aOR 2.31, 95% CI 1.12-4.74), headache (aOR 2.11, 95% CI 1.19-3.74) and fever/chills (aOR 1.88, 95% CI 1.12-3.15). CONCLUSIONS Fever, fatigue, myalgia, loss of taste/smell and headache were associated with increased odds of a Covid-19 diagnosis among symptomatic self-referred HCWs compared with those had negative swab results. Testing criteria for HCWs should reflect the broad range of possible symptoms of Covid-19.
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Affiliation(s)
- G O'Sullivan
- Occupational Health Department, Cork University Hospital, Cork, Ireland
| | - S Jacob
- Occupational Health Department, Cork University Hospital, Cork, Ireland
| | - P M Barrett
- School of Public Health, University College Cork, Cork, Ireland.,Department of Public Health HSE South, Cork, Ireland
| | - J Gallagher
- Occupational Health Department, Cork University Hospital, Cork, Ireland
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Barrett PM. Editorial: Adverse Pregnancy Outcomes-A Missed Opportunity to Prevent Chronic Disease? Int J Public Health 2021; 66:582810. [PMID: 34366764 PMCID: PMC8336677 DOI: 10.3389/ijph.2021.582810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter M Barrett
- 1School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Programme, University College Cork, Cork, Ireland
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12
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Barrett PM, Khashan AS, McCarthy FP, Kublickiene K. Adverse pregnancy outcomes and maternal health: Action needed for long-term benefit. Acta Obstet Gynecol Scand 2020; 99:1107-1109. [PMID: 32609893 DOI: 10.1111/aogs.13945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Peter M Barrett
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Center, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Program, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Center, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Center, University College Cork, Cork, Ireland.,Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Karolina Kublickiene
- Renal Medicine, Department of Clinical Intervention, Science & Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS, Kublickiene K. Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype.
Methods
Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded.
Results
The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD.
Conclusions
Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery.
Key messages
Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.
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Affiliation(s)
- P M Barrett
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
| | - F P McCarthy
- INFANT, University College Cork, Cork, Ireland
- Department of Obstetrics, University College Cork, Cork, Ireland
| | - M Evans
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - M Kublickas
- Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - P Stenvinkel
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - A S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT, University College Cork, Cork, Ireland
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS, Kublickiene K. Stillbirth is associated with increased risk of long-term maternal renal disease: a nationwide cohort study. Am J Obstet Gynecol 2020; 223:427.e1-427.e14. [PMID: 32112729 PMCID: PMC7479504 DOI: 10.1016/j.ajog.2020.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 01/30/2023]
Abstract
Background Stillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth. Objective To identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities. Study Design/Methods We conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately. Results There were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9–30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09–1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55–3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13–1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86–4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73–1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78–2.85). Conclusion Women who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS, Kublickiene K. Hypertensive disorders of pregnancy and the risk of chronic kidney disease: A Swedish registry-based cohort study. PLoS Med 2020; 17:e1003255. [PMID: 32797043 PMCID: PMC7428061 DOI: 10.1371/journal.pmed.1003255] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) (preeclampsia, gestational hypertension) are associated with an increased risk of end-stage kidney disease (ESKD). Evidence for associations between HDP and chronic kidney disease (CKD) is more limited and inconsistent. The underlying causes of CKD are wide-ranging, and HDP may have differential associations with various aetiologies of CKD. We aimed to measure associations between HDP and maternal CKD in women who have had at least one live birth and to identify whether the risk differs by CKD aetiology. METHODS AND FINDINGS Using data from the Swedish Medical Birth Register (MBR), singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register (SRR) and National Patient Register (NPR; up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. Gestational hypertension was also investigated as a secondary exposure. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulointerstitial, and other/nonspecific CKD. Cox proportional hazard regression models were used, adjusting for maternal age, country of origin, education level, antenatal BMI, smoking during pregnancy, gestational diabetes, and parity. Women with pre-pregnancy comorbidities were excluded. The final sample consisted of 1,924,409 women who had 3,726,554 singleton live births. The mean (±SD) age of women at first delivery was 27.0 (±5.1) years. Median follow-up was 20.7 (interquartile range [IQR] 9.9-30.0) years. A total of 90,917 women (4.7%) were diagnosed with preeclampsia, 43,964 (2.3%) had gestational hypertension, and 18,477 (0.9%) developed CKD. Preeclampsia was associated with a higher risk of developing CKD during follow-up (adjusted hazard ratio [aHR] 1.92, 95% CI 1.83-2.03, p < 0.001). This risk differed by CKD subtype and was higher for hypertensive CKD (aHR 3.72, 95% CI 3.05-4.53, p < 0.001), diabetic CKD (aHR 3.94, 95% CI 3.38-4.60, p < 0.001), and glomerular/proteinuric CKD (aHR 2.06, 95% CI 1.88-2.26, p < 0.001). More modest associations were observed between preeclampsia and tubulointerstitial CKD (aHR 1.44, 95% CI 1.24-1.68, p < 0.001) or other/nonspecific CKD (aHR 1.51, 95% CI 1.38-1.65, p < 0.001). The risk of CKD was increased after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who had gestational hypertension also had increased risk of developing CKD (aHR 1.49, 95% CI 1.38-1.61, p < 0.001). This association was strongest for hypertensive CKD (aHR 3.13, 95% CI 2.47-3.97, p < 0.001). Limitations of the study are the possibility that cases of CKD were underdiagnosed in the national registers, and some women may have been too young to have developed symptomatic CKD despite the long follow-up time. Underreporting of postpartum hypertension is also possible. CONCLUSIONS In this study, we found that HDP are associated with increased risk of maternal CKD, particularly hypertensive or diabetic forms of CKD. The risk is higher after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who experience HDP may benefit from future systematic renal monitoring.
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Affiliation(s)
- Peter M. Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
- Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Marius Kublickas
- Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ali S. Khashan
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Barrett PM, Mullen L, McCarthy T. Enduring psychological impact of childhood cancer on survivors and their families in Ireland: A national qualitative study. Eur J Cancer Care (Engl) 2020; 29:e13257. [PMID: 32537764 PMCID: PMC7988562 DOI: 10.1111/ecc.13257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/30/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
Objective To establish the major expressed psychological needs of adult survivors of childhood cancer living in Ireland. Methods Seven focus groups were conducted with adult survivors of childhood cancer and their parents in 2018. Survivors were invited to participate if they were diagnosed with cancer before age 18. Results Thirty‐three participants (15 survivors, 18 parents; 27 female, 6 male) were included. They had experienced a range of haematological and solid tumours. Five themes were generated: (a) Enduring psychological impact on survivors; many survivors experience delayed trauma and mental health crises in adulthood. (b) Enduring psychological impact on family members; parents and siblings have unmet psychological needs relating to the family's experience of cancer. (c) Enduring impact on family dynamics; survivors and parents expressed fear and guilt relating to cancer which impacted on family interactions. (d) Challenges accessing support; psychological support services are inadequate to meet expressed needs. (e) Desired model of care; no single service model appeals to all survivors, and flexibility is required in the delivery of psychological support. Conclusion Adult survivors of childhood cancer and their family members experience enduring psychological effects relating to their diagnosis and treatment. Psychological support services are inadequate to meet the expressed needs of this growing population.
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Affiliation(s)
- Peter M Barrett
- HSE National Cancer Control Programme, Dublin 1, Ireland.,School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Programme, University College Cork, Cork, Ireland
| | - Louise Mullen
- HSE National Cancer Control Programme, Dublin 1, Ireland
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Barrett PM, Bambury N, Kelly L, Condon R, Crompton J, Sheahan A. Measuring the effectiveness of an automated text messaging active surveillance system for COVID-19 in the south of Ireland, March to April 2020. Euro Surveill 2020; 25:2000972. [PMID: 32553064 PMCID: PMC7403640 DOI: 10.2807/1560-7917.es.2020.25.23.2000972] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report the effectiveness of automated text messaging for active surveillance of asymptomatic close contacts of coronavirus disease (COVID-19) cases in the Cork/Kerry region of Ireland. In the first 7 weeks of the COVID-19 outbreak, 1,336 close contacts received 12,421 automated texts. Overall, 120 contacts (9.0%) reported symptoms which required referral for testing and 35 (2.6%) tested positive for COVID-19. Non-response was high (n = 2,121; 17.1%) and this required substantial clinical and administrative resources for follow-up.
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Affiliation(s)
- Peter M Barrett
- Department of Public Health HSE-South (Cork and Kerry), St. Finbarr’s Hospital, Cork, Ireland,Wellcome Trust-HRB Irish Clinical Academic Training (ICAT) Programme, University College Cork, Cork, Ireland
| | - Niamh Bambury
- Department of Public Health HSE-South (Cork and Kerry), St. Finbarr’s Hospital, Cork, Ireland
| | | | - Rosalind Condon
- Department of Public Health HSE-South (Cork and Kerry), St. Finbarr’s Hospital, Cork, Ireland
| | - Janice Crompton
- Department of Public Health HSE-South (Cork and Kerry), St. Finbarr’s Hospital, Cork, Ireland
| | - Anne Sheahan
- Department of Public Health HSE-South (Cork and Kerry), St. Finbarr’s Hospital, Cork, Ireland
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Kublickiene K, Khashan AS. Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study. BMC Med 2020; 18:66. [PMID: 32234061 PMCID: PMC7110747 DOI: 10.1186/s12916-020-01534-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function. This study aimed to examine whether women who experience preterm delivery are at increased risk of subsequent chronic kidney disease (CKD) and end-stage kidney disease (ESKD). METHODS Using data from the Swedish Medical Birth Register, singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Gestational age at delivery was the main exposure and treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox proportional hazard regression models were used for analysis. RESULTS The dataset included 1,943,716 women who had 3,760,429 singleton live births. The median follow-up was 20.6 (interquartile range 9.9-30.0) years. Overall, 162,918 women (8.4%) delivered at least 1 preterm infant (< 37 weeks). Women who had any preterm delivery (< 37 weeks) were at increased risk of CKD (adjusted hazard ratio (aHR) 1.39, 95% CI 1.32-1.45) and ESKD (aHR 2.22, 95% CI 1.90-2.58) compared with women who only delivered at term (≥ 37 weeks). Women who delivered an extremely preterm infant (< 28 weeks) were at increased risk of CKD (aHR 1.84, 95% CI 1.52-2.22) and ESKD (aHR 3.61, 95% CI 2.03-6.39). The highest risk of CKD and ESKD was in women who experienced preterm delivery + preeclampsia (vs. non-preeclamptic term deliveries, for CKD, aHR 2.81, 95% CI 2.46-3.20; for ESKD, aHR 6.70, 95% CI 4.70-9.56). However, spontaneous preterm delivery was also associated with increased risk of CKD (aHR 1.32, 95% CI 1.25-1.39) and ESKD (aHR 1.99, 95% CI 1.67-2.38) independent of preeclampsia or small for gestational age (SGA). CONCLUSIONS Women with history of preterm delivery are at increased risk of CKD and ESKD. The risk is higher among women who had very preterm or extremely preterm deliveries, or whose preterm delivery was medically indicated. Women who experience spontaneous preterm delivery are at increased risk of long-term renal disease independent of preeclampsia or SGA. Preterm delivery may act as a risk marker for adverse maternal renal outcomes.
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Affiliation(s)
- Peter M Barrett
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland. .,Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
| | - Fergus P McCarthy
- Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marius Kublickas
- Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan J Perry
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
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Barrett PM, McCarthy FP, Kublickiene K, Cormican S, Judge C, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS. Adverse Pregnancy Outcomes and Long-term Maternal Kidney Disease: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e1920964. [PMID: 32049292 DOI: 10.1001/jamanetworkopen.2019.20964] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Adverse pregnancy outcomes, such as hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery, are associated with increased risk of maternal cardiovascular disease. Little is known about whether adverse pregnancy outcomes are associated with increased risk of maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD). OBJECTIVE To review and synthesize the published literature on adverse pregnancy outcomes (hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery) and subsequent maternal CKD and ESKD. DATA SOURCES PubMed, Embase, and Web of Science were searched from inception to July 31, 2019, for cohort and case-control studies of adverse pregnancy outcomes and maternal CKD and ESKD. STUDY SELECTION Selected studies included the following: a population of pregnant women, exposure to an adverse pregnancy outcome of interest, and at least 1 primary outcome (CKD or ESKD) or secondary outcome (hospitalization or death due to kidney disease). Adverse pregnancy outcomes included exposure to hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, or chronic hypertension), preterm delivery (<37 weeks), and gestational diabetes. Three reviewers were involved in study selection. Of 5656 studies retrieved, 23 were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed throughout. Three reviewers extracted data and appraised study quality. Random-effects meta-analyses were used to calculate overall pooled estimates using the generic inverse variance method. MAIN OUTCOMES AND MEASURES Primary outcomes included CKD and ESKD diagnosis, defined using established clinical criteria (estimated glomerular filtration rate or albuminuria values) or hospital records. The protocol for this systematic review was registered on PROSPERO (CRD42018110891). RESULTS Of 23 studies included (5 769 891 participants), 5 studies reported effect estimates for more than 1 adverse pregnancy outcome. Preeclampsia was associated with significantly increased risk of CKD (pooled adjusted risk ratio [aRR], 2.11; 95% CI, 1.72-2.59), ESKD (aRR, 4.90; 95% CI, 3.56-6.74), and kidney-related hospitalization (aRR, 2.65; 95% CI, 1.03-6.77). Gestational hypertension was associated with increased risk of CKD (aRR, 1.49; 95% CI, 1.11-2.01) and ESKD (aRR, 3.64; 95% CI, 2.34-5.66). Preterm preeclampsia was associated with increased risk of ESKD (aRR, 5.66; 95% CI, 3.06-10.48); this association with ESKD persisted for women who had preterm deliveries without preeclampsia (aRR, 2.09; 95% CI, 1.64-2.66). Gestational diabetes was associated with increased risk of CKD among black women (aRR, 1.78; 95% CI, 1.18-2.70), but not white women (aRR, 0.81; 95% CI, 0.58-1.13). CONCLUSIONS AND RELEVANCE In this meta-analysis, exposure to adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery, was associated with higher risk of long-term kidney disease. The risk of ESKD was highest among women who experienced preeclampsia. A systematic approach may be warranted to identify women at increased risk of kidney disease, particularly after hypertensive disorders of pregnancy, and to optimize their long-term follow-up.
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Affiliation(s)
- Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
- Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Cormican
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - Conor Judge
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marius Kublickas
- Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
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Barrett PM, McCarthy FP, Kublickiene K, Evans M, Cormican S, Judge C, Perry IJ, Kublickas M, Stenvinkel P, Khashan AS. Adverse pregnancy outcomes and long-term risk of maternal renal disease: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e027180. [PMID: 31061049 PMCID: PMC6502020 DOI: 10.1136/bmjopen-2018-027180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM) and preterm birth have been linked to maternal cardiovascular disease in later life. Pre-eclampsia (PE) is associated with an increased risk of postpartum microalbuminuria, but there is no clear consensus on whether HDP increases the risk of maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Similarly, it is uncertain whether GDM, preterm birth and delivery of low birth-weight infants independently predict the risk of maternal renal disease in later life. The aims of this proposed systematic review and meta-analysis are to summarise the available evidence examining the association between adverse outcomes of pregnancy (HDP, GDM, preterm birth, delivery of low birth-weight infant) and later maternal renal disease and to synthesise the results of relevant studies. METHODS AND ANALYSIS A systematic search of PubMed, EMBASE and Web of Science will be undertaken using a detailed prespecified search strategy. Two authors will independently review the titles and abstracts of all studies, perform data extraction and appraise the quality of included studies using a bias classification tool. Original case-control and cohort studies published in English will be considered for inclusion. Primary outcomes of interest will be CKD and ESKD; secondary outcomes will be hospitalisation for renal disease and deaths from renal disease. Meta-analyses will be performed to calculate the overall pooled estimates using the generic inverse variance method. The systematic review will follow the Meta-analyses Of Observational Studies in Epidemiology guidelines. ETHICS AND DISSEMINATION This systematic review and meta-analysis will be based on published data, and thus there is no requirement for ethics approval. The results will be shared through publication in a peer reviewed journal and through presentations at academic conferences. PROSPERO REGISTRATION NUMBER CRD42018110891.
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Affiliation(s)
- Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Karolina Kublickiene
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Marie Evans
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Sarah Cormican
- Department of Nephrology, Galway University Hospital, Galway, Ireland
| | - Conor Judge
- Department of Nephrology, Galway University Hospital, Galway, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Marius Kublickas
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
- Department of Obstetrics & Gynaecology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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Barrett PM, Hull EA, King CE, Burkart K, Ott KA, Ryan JN, Gawel JE, Neumann RB. Increased exposure of plankton to arsenic in contaminated weakly-stratified lakes. Sci Total Environ 2018; 625:1606-1614. [PMID: 29996457 PMCID: PMC6044462 DOI: 10.1016/j.scitotenv.2017.12.336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 05/05/2023]
Abstract
Arsenic, a priority Superfund contaminant and carcinogen, is a legacy pollutant impacting aquatic ecosystems in urban lakes downwind of the former ASARCO copper smelter in Ruston, WA, now a Superfund site. We examined the mobility of arsenic from contaminated sediments and arsenic bioaccumulation in phytoplankton and zooplankton in lakes with varying mixing regimes. In lakes with strong seasonal thermal stratification, high aqueous arsenic concentrations were limited to anoxic bottom waters that formed during summer stratification, and arsenic concentrations were low in oxic surface waters. However, in weakly-stratified lakes, the entire water column, including the fully oxic surface waters, had elevated concentrations of arsenic (up to 30μgL-1) during the summer. We found enhanced trophic transfer of arsenic through the base of the aquatic food web in weakly-stratified lakes; plankton in these lakes accumulated up to an order of magnitude more arsenic on multiple sampling days than plankton in stratified lakes with similar levels of contamination. We posit that greater bioaccumulation in weakly-stratified lakes was due to elevated arsenic in oxic waters. Aquatic life primarily inhabits oxic waters and in the oxic water column of weakly-stratified lakes arsenic was speciated as arsenate, which is readily taken up by phytoplankton because of its structural similarities to phosphate. Our study indicates that mobilization of arsenic from lake sediments into overlying oxic water columns in weakly-stratified lakes leads to increased arsenic exposure and uptake at the base of the aquatic food web.
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Affiliation(s)
- P M Barrett
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA 98195, United States.
| | - E A Hull
- Environmental Science and Studies, School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA 98402, United States
| | - C E King
- Environmental Science and Studies, School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA 98402, United States
| | - K Burkart
- Environmental Science and Studies, School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA 98402, United States
| | - K A Ott
- Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, CO 80309, United States
| | - J N Ryan
- Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, CO 80309, United States
| | - J E Gawel
- Environmental Science and Studies, School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA 98402, United States
| | - R B Neumann
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA 98195, United States
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22
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Abstract
The technologies of cardiovascular connected health stand to dramatically alter the management and prevention of cardiovascular disease, a worldwide leading cause of death. The American Heart Association has outlined seven key health metrics including physical activity, adequate blood pressure control, weight and a healthy diet, which lie at the core of cardiovascular disease management. Controlling these metrics has been demonstrated to result in substantial reductions in cardiovascular mortality. These metrics are ideally suited to a connected health management strategy involving enhanced patient empowerment and augmented physician engagement. As more patients and healthcare providers adopt technologies that allow for self-monitoring and point-of-care diagnostics, the physician has access to a greater depth of data concerning their patient's health and how best to influence it.
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Affiliation(s)
- A Ansary
- Address correspondence to Dr P.M. Barrett.
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23
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Butler RJ, Barrett PM, Kenrick P, Penn MG. Diversity patterns amongst herbivorous dinosaurs and plants during the Cretaceous: implications for hypotheses of dinosaur/angiosperm co-evolution. J Evol Biol 2009; 22:446-59. [PMID: 19210589 DOI: 10.1111/j.1420-9101.2008.01680.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Palaeobiologists frequently attempt to identify examples of co-evolutionary interactions over extended geological timescales. These hypotheses are often intuitively appealing, as co-evolution is so prevalent in extant ecosystems, and are easy to formulate; however, they are much more difficult to test than their modern analogues. Among the more intriguing deep time co-evolutionary scenarios are those that relate changes in Cretaceous dinosaur faunas to the primary radiation of flowering plants. Demonstration of temporal congruence between the diversifications of co-evolving groups is necessary to establish whether co-evolution could have occurred in such cases, but is insufficient to prove whether it actually did take place. Diversity patterns do, however, provide a means for falsifying such hypotheses. We have compiled a new database of Cretaceous dinosaur and plant distributions from information in the primary literature. This is used as the basis for plotting taxonomic diversity and occurrence curves for herbivorous dinosaurs (Sauropodomorpha, Stegosauria, Ankylosauria, Ornithopoda, Ceratopsia, Pachycephalosauria and herbivorous theropods) and major groups of plants (angiosperms, Bennettitales, cycads, cycadophytes, conifers, Filicales and Ginkgoales) that co-occur in dinosaur-bearing formations. Pairwise statistical comparisons were made between various floral and faunal groups to test for any significant similarities in the shapes of their diversity curves through time. We show that, with one possible exception, diversity patterns for major groups of herbivorous dinosaurs are not positively correlated with angiosperm diversity. In other words, at the level of major clades, there is no support for any diffuse co-evolutionary relationship between herbivorous dinosaurs and flowering plants. The diversification of Late Cretaceous pachycephalosaurs (excluding the problematic taxon Stenopelix) shows a positive correlation, but this might be spuriously related to poor sampling in the Turonian-Santonian interval. Stegosauria shows a significant negative correlation with flowering plants and a significant positive correlation with the nonflowering cycadophytes (cycads, Bennettitales). This interesting pattern is worthy of further investigation, and it reflects the decline of both stegosaurs and cycadophytes during the Early Cretaceous.
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Affiliation(s)
- R J Butler
- Department of Palaeontology, The Natural History Museum, London, UK.
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24
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Hatzaras I, Tranquilli M, Coady M, Barrett PM, Bible J, Elefteriades JA. Weight Lifting and Aortic Dissection: More Evidence for a Connection. Cardiology 2006; 107:103-6. [PMID: 16847387 DOI: 10.1159/000094530] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS In 2003, we reported on a small number of patients in whom acute aortic dissection appeared to be causally related to intense weight lifting. If additional cases could be identified, the phenomenon of weight lifting induced aortic dissection would be further substantiated. We now report a substantially larger number of cases in which aortic dissection is associated with intense physical exertion. METHODS Additional cases of acute aortic dissection occurring at the time of intense physical exertion were accumulated and analyzed. Cases were culled from retrospective review of a large university data base and from reports forwarded to our attention from around the country. We determined type of activity bringing on symptoms, age and sex of the patients, location of the dissection (ascending or descending aorta), aortic size, therapy, and survival. RESULTS We identified 31 patients in whom acute aortic dissection occurred in the context of severe physical exertion, predominantly weight lifting or similar activities. All patients except one were males. Mean age was 47.3 (range = 19-76). All except four dissections were in the ascending aorta. Only three patients (9.7%) had a family history of aortic disease. Mean aortic diameter on the initial imaging study was 4.63 cm. Twenty-six of the 31 cases were diagnosed ante-mortem and 5 post-mortem. Overall, 10 of the 31 patients (32.2%) died. Of 24 patients reaching surgical therapy, 20 (83.3%) survived. CONCLUSION Weight lifting related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event. Moderate aortic dilatation confers vulnerability to exertion-related aortic dissection. Individuals with known aortic dilatation should be cautioned to refrain from weight lifting or strenuous exertion. Routine echocardiographic screening of individuals engaging in heavy strength training should be considered, in order to prevent this tragic loss of life.
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Affiliation(s)
- I Hatzaras
- Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
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25
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Abstract
The effectiveness of a 14-week cognitive-behavioral family treatment protocol for childhood obsessive-compulsive disorder (OCD) was piloted using a volunteer sample of seven children aged 10-14 years. The primary outcome measures were diagnostic status, symptom severity, and global functioning which were assessed at pre- and post-treatment, and at three-month follow-up. A series of self-report measures assessing obsessive-compulsive symptomatology, depression, and family factors were also completed at pre- and post-treatment. The results indicated that six participants no longer met criteria for OCD at post-treatment, with a mean reduction of 60% in symptom severity. Self-reported obsessive-compulsive symptomatology and family involvement in the disorder also significantly decreased across time. The findings support the efficacy of cognitive-behavioral treatment with a structured family component for childhood OCD. Further research investigating the comparative efficacy of treatment with and without family involvement is warranted.
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Affiliation(s)
- T L Waters
- School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, 4122, Australia
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26
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Abstract
Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect-Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.
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Affiliation(s)
- A L Shortt
- School of Applied Psychology, Faculty of Health Science, Griffith University, Nathan, Queensland, Australia
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27
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Shortt AL, Barrett PM, Fox TL. Evaluating the FRIENDS program: a cognitive-behavioral group treatment for anxious children and their parents. J Clin Child Psychol 2001; 30:525-35. [PMID: 11708240 DOI: 10.1207/s15374424jccp3004_09] [Citation(s) in RCA: 238] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Conducted the 1st randomized clinical trial evaluating the efficacy of the FRIENDS program, a family-based group cognitive-behavioral treatment (FGCBT) for anxious children. Children (n = 71) ranging from 6 to 10 years of age who fulfilled diagnostic criteria for separation anxiety (SAD), generalized anxiety disorder (GAD), or social phobia (SOP) were randomly allocated to FRIENDS or to a 10-week wait-list control group. The effectiveness of the intervention was evaluated at posttreatment and 12-month follow-up. Results indicated that 69% of children who completed FGCBT were diagnosis-free, compared to 6% of children completing the wait-list condition. At 12-month follow-up, 68% of children were diagnosis-free. Beneficial treatment effects were also evident on the self-report measures completed by the children and their mothers. Parents and children reported high treatment satisfaction. Results suggest that FRIENDS is an effective treatment for clinically anxious children. Limitations of this study and directions for future research are discussed.
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Affiliation(s)
- A L Shortt
- Department of Applied Psychology, Griffith University, Brisbane, Australia
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28
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Abstract
Many anxiety problems begin in childhood and are a common form of psychological problem that can be highly distressing and associated with a range of social impairments. Thus, skills for conceptualising, assessing, and treating childhood anxiety problems should be in the repertoire of all child mental health specialists. This paper reviews psychosocial treatments for the most common anxiety disorders in children and adolescents. Developmental models of anxiety disorders emphasise maximum risk in children with shy or inhibited temperaments who are exposed to high family anxiety and avoidance, and/or acutely distressing experiences. As children mature these temperamental and environmental experiences are internalised to low self-competence and high threat expectancy. Both individual or group-based interventions utilising cognitive-behavioural strategies to address multiple risk factors are highly efficacious and family involvement can contribute to positive outcomes. Guidelines for assessment and treatment are presented, and suggestions are made for effectively managing clinical process.
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Affiliation(s)
- M R Dadds
- School of Applied Psychology, Griffith University, Brisbane, Australia.
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29
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Abstract
Angiosperms first appeared in northern Gondwana during the Early Cretaceous, approximately 135 million years ago. Several authors have hypothesised that the origin of angiosperms, and the tempo and pattern of their subsequent radiation, was mediated by changes in the browsing behaviour of large herbivorous dinosaurs (sauropods and ornithischians). Moreover, the taxonomic and ecological radiation of angiosperms has been associated with the evolution of complex jaw mechanisms among ornithischian dinosaurs. Here, we review critically the evidence for dinosaur-angiosperm interactions during the Cretaceous Period, providing explicit spatiotemporal comparisons between evolutionary and palaeoecological events in both the dinosaur and angiosperm fossil records and an assessment of the direct and indirect evidence for dinosaur diets. We conclude that there are no strong spatiotemporal correlations in support of the hypothesis that dinosaurs were causative agents in the origin of angiosperms; however, dinosaur-angiosperm interactions in the Late Cretaceous may have resulted in some coevolutionary interactions, although direct evidence of such interactions is scanty at present. It is likely that other animal groups (insects, arboreal mammals) had a greater impact on angiosperm diversity during the Cretaceous than herbivorous dinosaurs. Elevated levels of atmospheric CO2 might have played a critical role in the initial stages of the angiosperm radiation.
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Affiliation(s)
- P M Barrett
- Department of Zoology, University of Oxford, UK.
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30
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Barrett PM, Duffy AL, Dadds MR, Rapee RM. Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up. J Consult Clin Psychol 2001; 69:135-41. [PMID: 11302272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Authors evaluated the long-term effectiveness of cognitive-behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders.
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Affiliation(s)
- P M Barrett
- School of Applied Psychology, Griffith University, Gold Coast, Southport, Queensland, Australia.
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31
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Abstract
While obsessive-compulsive disorder is widely recognized to have a strong genetic component, psychosocial factors are also acknowledged to be important. The primary focus of this paper is on familial factors associated with OCD in children and adolescents. It explores the family context as a possible risk factor in the development and maintenance of the disorder, including parental modeling, expressed emotion, parenting style, and family accommodation of the child's symptoms. The involvement of the family in the treatment of the disorder is also reviewed. Finally, future directions for research investigating familial factors in childhood OCD are presented.
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32
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Abstract
This review focuses on research on the cognitive-behavioral treatment of childhood anxiety disorders. Early forms of therapy for childhood anxiety were borrowed from adult treatment models. More recently, there has been a recognition of the need to design treatment from a child-based perspective. Consequently, several cognitive-behavioral programs designed specifically for children and youth have been both developed and evaluated. The importance of parental involvement has also been recognised in these treatment innovations. However, a number of developmental factors have yet to be given adequate consideration in both the research and practice of childhood anxiety treatment. The article highlights some of these factors including issues of individual, family and cultural variation.
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Affiliation(s)
- P M Barrett
- School of Applied Psychology, Griffith University, Queensland, Australia.
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33
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Affiliation(s)
- M Manabe
- Department of Geology, National Science Museum, Tokyo, Japan
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34
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Abstract
The Yixian Formation of northeastern China has yielded important new fossils that are fuelling debates on the origin of angiosperms, on the early radiation of birds and of mammals, and on the origin of feathers. Although these fossils provide a wealth of detailed anatomical information, knowledge of the absolute age of the Yixian Formation is crucial if we are to understand their true evolutionary significance. The age of the Yixian Formation has been disputed, but recent evidence provides strong support for an Early Cretaceous rather than a Late Jurassic age.
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35
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Dadds MR, Holland DE, Laurens KR, Mullins M, Barrett PM, Spence SH. Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up. J Consult Clin Psychol 1999. [PMID: 10028219 DOI: 10.1037//0022-006x.67.1.145] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.
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Affiliation(s)
- M R Dadds
- School of Applied Psychology, Griffith University, Nathan, Queensland, Australia.
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36
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Dadds MR, Holland DE, Laurens KR, Mullins M, Barrett PM, Spence SH. Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up. J Consult Clin Psychol 1999; 67:145-50. [PMID: 10028219 DOI: 10.1037/0022-006x.67.1.145] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.
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Affiliation(s)
- M R Dadds
- School of Applied Psychology, Griffith University, Nathan, Queensland, Australia.
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37
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Abstract
Undertook an evaluation of a cognitive-behavioral group family-based intervention for childhood anxiety disorders in Brisbane, Australia. The treatment aimed to provide children and their families with skills in the management of anxiety and avoidance, problem solving, and mutual family support. Children (n = 60) ranging from 7 to 14 years old who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: group cognitive-behavioral therapy (GROUP-CBT), group cognitive-behavioral therapy plus family management (GROUP-FAM), and wait list (WL). The effectiveness of the interventions was evaluated at posttreatment and 12-month follow-up. Results indicated that across treatment conditions, 64.8% of children no longer fulfilled diagnostic criteria for an anxiety disorder in comparison with 25.2% of children on the wait list. At 12-month FU, 64.5% of children in the GROUP-CBT group and 84.8% of children in the GROUP-FAM group were diagnosis free. Comparisons of children receiving GROUP-CBT with those receiving GROUP-FAM on self-report measures and clinician ratings indicated marginal added benefits from GROUP-FAM treatment. Results show that CBT interventions for childhood anxiety disorders can be effectively administered in a group format.
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Affiliation(s)
- P M Barrett
- School of Applied Psychology, Griffith University, Australia
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38
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Barrett PM, Carpenter K, Sues HD. On the proposed designation of Iguanodon bernissartensis Boulenger in Beneden, 1881 as the type species of Iguanodon Mantell, 1825, and proposed designation of a lectotype. ACTA ACUST UNITED AC 1998. [DOI: 10.5962/bhl.part.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Dadds MR, Spence SH, Holland DE, Barrett PM, Laurens KR. Prevention and early intervention for anxiety disorders: a controlled trial. J Consult Clin Psychol 1997. [PMID: 9256564 DOI: 10.1037//0022-006x.65.4.627] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Queensland Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of anxiety problems in children. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After recruitment and diagnostic interviews, 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group. Both groups showed improvements immediately postintervention. At 6 months follow-up, the improvement maintained in the intervention group only, reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. Overall, the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program.
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Affiliation(s)
- M R Dadds
- School of Applied Psychology, Faculty of Health and Behavioural Sciences, Griffith University, Nathan, Queensland, Australia.
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40
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Abstract
The Queensland Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of anxiety problems in children. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After recruitment and diagnostic interviews, 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group. Both groups showed improvements immediately postintervention. At 6 months follow-up, the improvement maintained in the intervention group only, reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. Overall, the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program.
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Affiliation(s)
- M R Dadds
- School of Applied Psychology, Faculty of Health and Behavioural Sciences, Griffith University, Nathan, Queensland, Australia.
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41
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Abstract
A family-based treatment for childhood anxiety was evaluated. Children (n = 79) aged 7 to 14 who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: cognitive-behavioral therapy (CBT), CBT plus family management (CBT + FAM), and waiting list. The effectiveness of the interventions was evaluated at posttreatment and at 6 and 12 months follow-up. The results indicated that across treatment conditions, 69.8% of the children no longer fulfilled diagnostic criteria for an anxiety disorder, compared with 26% of the waiting-list children. At the 12-month follow-up, 70.3% of the children in the CBT group and 95.6% of the children in the CBT + FAM group did not meet criteria. Comparisons of children receiving CBT with those receiving CBT + FAM on self-report measures and clinician ratings indicated added benefits from CBT + FAM treatment. Age and gender interacted with treatment condition, with younger children and female participants responding better to the CBT + FAM condition.
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Affiliation(s)
- P M Barrett
- School of Applied Psychology, Griffith University, Nathan, Australia
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42
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Abstract
Barrett, Rapee, Dadds, and Ryan (1996) described a phenomenon whereby family discussions magnified the style of children's problem solving in a way characteristic of their particular clinical diagnosis. That is, anxious children became more avoidant, aggressive children more aggressive, and nonclinic children more prosocial, after discussing ambiguous hypothetical situations with their parents. This study examined specific sequences of communications exchanged between parents and children hypothesized to underlie this family exacerbation of child cognitive style. Family discussions were videotaped and categorized for groups of anxious, aggressive, and nonclinic children and their parents. Results revealed differences between groups of parents in frequency of agreeing with and listening to their child and the frequency of pointing out positive consequences. Conditional probability analyses showed that parents of anxious children were more likely to reciprocate avoidance, while parents of nonclinic children were more likely to agree with and listen to prosocial plans from their child. Differences in parent behaviors observed during the family discussions were reliably associated with the child's response to the ambiguous situation proposed after the family discussion. Results support a model of developmental anxiety and aggression that emphasizes the interaction of family processes and social-cognitive development in the child.
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Affiliation(s)
- M R Dadds
- School of Applied Psychology, Griffith University, Brisbane, Australia
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43
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Abstract
A family-based treatment for childhood anxiety was evaluated. Children (n = 79) aged 7 to 14 who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: cognitive-behavioral therapy (CBT), CBT plus family management (CBT + FAM), and waiting list. The effectiveness of the interventions was evaluated at posttreatment and at 6 and 12 months follow-up. The results indicated that across treatment conditions, 69.8% of the children no longer fulfilled diagnostic criteria for an anxiety disorder, compared with 26% of the waiting-list children. At the 12-month follow-up, 70.3% of the children in the CBT group and 95.6% of the children in the CBT + FAM group did not meet criteria. Comparisons of children receiving CBT with those receiving CBT + FAM on self-report measures and clinician ratings indicated added benefits from CBT + FAM treatment. Age and gender interacted with treatment condition, with younger children and female participants responding better to the CBT + FAM condition.
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Affiliation(s)
- P M Barrett
- School of Applied Psychology, Griffith University, Nathan, Australia
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44
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Abstract
Previous research has shown that anxious adults provide more threat interpretations of ambiguous stimuli than other clinic and nonclinic persons. We were interested in investigating if the same bias occurs in anxious children and how family processes impact on these children's interpretations of ambiguity. Anxious, oppositional, and nonclinical children and their parents were asked separately to interpret and provide plans of action to ambiguous scenarios. Afterwards, each family was asked to discuss two of these situations as a family and for the child to provide a final response. The results showed that anxious and oppositional children were both more likely to interpret ambiguous scenarios in a threatening manner. However, the two clinic groups differed in that the anxious children predominantly chose avoidant solutions whereas the oppositional children chose aggressive solutions. After family discussions, both the anxious children's avoidant plans of action and the oppositional children's aggressive plans increased. Thus, this study provides the first evidence of family enhancement of avoidant and aggressive responses in children. These results support a model of anxiety that emphasizes the development of an anxious cognitive style in the context of anxiety-supporting family processes.
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Affiliation(s)
- P M Barrett
- University of Queensland, Brisbane, Australia
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45
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Abstract
A 12-year-old, castrated male, domestic shorthair cat with a previous penetrating trauma to the left globe which progressed to a phthisical eye presented for acute blindness. Ophthalmic examination and electroretinography of the right eye were found to be normal. Following euthanasia, gross and microscopic examinations were completed. A left intraocular, posttraumatic fibrosarcoma with extension to the optic nerve and chiasm and induced right optic nerve fiber degeneration at the optic chiasm with necrosis leading to central amaurosis were diagnosed.
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Affiliation(s)
- P M Barrett
- Eye Clinic for Animals, Salt Lake City, Utah 84121, USA
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Rapee RM, Barrett PM, Dadds MR, Evans L. Reliability of the DSM-III-R childhood anxiety disorders using structured interview: interrater and parent-child agreement. J Am Acad Child Adolesc Psychiatry 1994; 33:984-92. [PMID: 7961354 DOI: 10.1097/00004583-199409000-00008] [Citation(s) in RCA: 206] [Impact Index Per Article: 6.9] [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: 01/28/2023]
Abstract
OBJECTIVE The aim of the study was to examine the interrater and parent-child agreement for the major child anxiety disorders. METHOD One hundred sixty-one children and their parents underwent a semistructured interview (Anxiety Disorders Interview Schedule for Children). To increase external validity, clinicians did not receive specific, extensive training in diagnosing anxiety disorders apart from their standard qualifications. The design of the study allowed for calculation of agreement between raters based on information obtained from the parents alone, from the child alone, or through combined information from both the parents and child, and for calculation of agreement between information obtained from the parents and information obtained from the child. RESULTS Levels of interrater agreement either as principal or additional diagnoses were moderate to strong for all of the major childhood anxiety disorders (kappa values .59 to .82). In contrast, parent-child agreement was poor for most diagnostic categories (kappa values .11 to .44). CONCLUSIONS The data indicate that, despite the fact that parents and their children do not demonstrate strong agreement, the DSM-III-R childhood anxiety disorders can be reliably diagnosed by pairs of general clinicians using structured interviews.
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Affiliation(s)
- R M Rapee
- School of Behavioural Sciences, Macquarie University, Sydney, Australia
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Vijayakumar S, McCarthy WA, Schroy CB, Thomas FJ, Thompson P, Higgins PD, Lanzieri CF, Barrett PM, Murray M. A technique using electrons and photons in the radiotherapy of orbital neoplasms. Acta Oncol 1987; 26:492-3. [PMID: 3128312 DOI: 10.3109/02841868709113725] [Citation(s) in RCA: 3] [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: 01/04/2023]
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