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Carters-White LE, Patterson C, Nimegeer A, Hilton S, Chambers S. Newspaper framing of food and beverage corporations' sponsorship of sport: a content analysis. BMC Public Health 2022; 22:1753. [PMID: 36114474 PMCID: PMC9479402 DOI: 10.1186/s12889-022-14031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Unhealthy diets are a leading contributor to obesity, disability and death worldwide. One factor cited as contributing to rises in obesity rates is the pervasive and ubiquitous marketing of unhealthy foods and beverages (F&Bs) across a variety of mediums, such as sport sponsorship at both professional and amateur levels. Despite increased academic attention on the detrimental impacts of sport sponsorship within the obesogenic environment, this has not been matched by legislative action. One explanation may be the way that F&B corporations' sport sponsorship is framed within policy debates. Framing is the deliberate ways in which (often contested) issues are presented in communication. This paper examines how sport sponsorship by F&B corporations is framed through media reports. METHODS This study employed a mixed methods content and framing analysis. First, we conducted a quantitative newsprint content analysis (n = 234). This then informed and directed a thematic framing analysis of a sub-set of articles (n = 54) that specifically associated sport sponsorship by F&B corporations with obesity and childhood obesity. RESULTS The findings suggest that two competing frames are evident within newspaper coverage: 1) public health and 2) industry. The public health frame rejects the sponsorship of sport by High in Fat Sugar and Salt (HFSS) product corporations in particular, calling for such sponsorship to be restricted or banned. The industry frame characterises sponsorship of sport as a form of corporate social responsibility, positioning industry as good moral actors and part of the solution to childhood and adult obesity. These frames are evident across other Unhealthy Commodity Industries (UCIs) policy debates. However, the prominence of industry actors within the sample is potentially indicative of their discursive power within this space, particularly with their emphasis on the financial maintenance of sport as well as encouraging physical activity, contributing to the lack of regulatory development of sport sponsorship by F&B corporations. CONCLUSIONS The findings of this study are particularly useful for public health organisations who seek regulatory change, as it may provide further insight into countering industry framing practices, raising the salience of regulation of sport sponsorship and thus increasing the likelihood of regulatory development that seeks to improve population health.
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Affiliation(s)
- L E Carters-White
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, Berkeley Square, United Kingdom
- SPECTRUM Consortium, Usher Institute of Population Health Sciences and Informatics, Doorway 1, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom, EH8 9AG
| | - C Patterson
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, Berkeley Square, United Kingdom
| | - A Nimegeer
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, Berkeley Square, United Kingdom
| | - S Hilton
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, Berkeley Square, United Kingdom
| | - S Chambers
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, Berkeley Square, United Kingdom.
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom.
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Tollestrup K, Thomas T, Stone N, Chambers S, Sedillo P, Perry F, Forster-Cox S. The Development of a Team-Based, Hybrid Inter-university Graduate Certificate Program Focused on Maternal Child Health Professionals. Matern Child Health J 2022; 26:3-9. [PMID: 35904673 PMCID: PMC9482575 DOI: 10.1007/s10995-022-03455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
Introduction Pregnancy, childbirth, and child well-being are identified by Healthy People 2030 as priority topics for improving the health of all Americans. New Mexico is the fifth largest state geographically with most of the state’s 33 counties considered rural or frontier. Accessing health care services is challenging in this resource-poor environment. The need to provide maternal and child health (MCH) education in the state was the impetus for developing a graduate certificate in maternal and child public health. Methods The hybrid MCH graduate certificate engaged professionals in formal training that included a public health approach to addressing MCH issues in the state’s diverse communities. Grant funds paid for the tuition, books and travel for students providing an opportunity to individuals who otherwise could not have pursued graduate education and professional development. Results Over a 4-year period, two cohorts were recruited, educated, and evaluated. The evaluations reflected an increase in competency knowledge scores for all students. Discussion This model of MCH education was successful at delivering public health graduate education to MCH practitioners and increasing their knowledge and skills. Listening to students and communities as to what their MCH public health needs are and responding with a flexible educational model provided individuals with information and tools that could be used to improve maternal and child health and reduce health disparities in rural, tribal, and underserved communities.
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Affiliation(s)
- K Tollestrup
- College of Population Health, University of New Mexico, MSC 09-3070, Albuquerque, NM, 87131-0001, USA.
| | - T Thomas
- College of Population Health, University of New Mexico, MSC 09-3070, Albuquerque, NM, 87131-0001, USA
| | - N Stone
- College of Population Health, University of New Mexico, MSC 09-3070, Albuquerque, NM, 87131-0001, USA
| | - S Chambers
- College of Population Health, University of New Mexico, MSC 09-3070, Albuquerque, NM, 87131-0001, USA
| | - P Sedillo
- College of Population Health, University of New Mexico, MSC 09-3070, Albuquerque, NM, 87131-0001, USA
| | - F Perry
- College of Population Health, University of New Mexico, MSC 09-3070, Albuquerque, NM, 87131-0001, USA
| | - S Forster-Cox
- Department of Public Health Sciences, New Mexico State University, P.O. Box 30001, MSC 3HLS, Las Cruces, NM, 87131-0001, USA
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Holzhauser L, Norris M, Molina M, Chambers S, Gala K, Fallah T, Bittermann T, Atluri P, McLean R, Peyster E. A Transplant Center Experience with Basiliximab Induction Strategies - A Double Edged Sword? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Singh G, Bowers A, Ferguson C, Chambers S, Ivynian S, Hickman L. Hospital Service Use in the Last Year of Life for Individuals ≥60 Years of Age Who Died of Heart Failure in Queensland. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim D, Theberge V, Provencher S, Yassa M, Kong I, Perera F, Lavertu S, Rousseau P, Lee J, Karam I, Schneider K, Chambers S, Levine M, Parpia S, Whelan T. OPAR: A Multicenter Phase II Randomized Trial of Fractionation Schedules for Once-a-Day Accelerated Partial Breast Irradiation (APBI). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Carters-White L, Hilton S, Skivington K, Chambers S. Instrumental, structural & discursive power & the regulation of online advertising of unhealthy food. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.596] [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
Examinations of corporate power demonstrate how Unhealthy Commodity Industries (UCIs) exert influence on the public and policymakers. For example, the High in Fat Sugar and Salt (HFSS) product industry exploit online environments to market their products to young people as a form of discursive power, and regulating this marketing can limit the power of those industries and is recognised as an important policy response. Here we address the gap in consideration of stakeholders' views of regulation of online advertising of HFSS products to young people to limit industry power.
Methods
We undertook primary analysis of 8 focus groups of parents, 11 stakeholder interviews and secondary analysis of 15 focus groups of young people (aged 12 and 15 years-of-age) in various community settings, with 5 individual interviews over the telephone. Focus group participants were recruited from a range of socioeconomic areas following the Scottish Index of Multiple Deprivation quintiles. Stakeholders were recruited from civil society organisations, government bodies and industry. Analysis employed Fuchs and Lederer's (2007) framework on instrumental, structural and discursive power.
Results
Stakeholders' views on the power of HFSS product industry appeared to predicate their views on regulation as an appropriate policy response. The majority of participants viewed regulation as a means to increase young people's and parents' autonomy over young people's diets by addressing the problematic power dynamic with industry at a policy level, yet concern remained about the adverse impact of regulation on individual autonomy.
Conclusions
Power is an important consideration when examining acceptability of To increase public support for regulation, it may be beneficial to emphasise the empowering effects of policy proposals. Advocates should shift their framing of regulation from focusing on restricting industry, to focusing on empowering the public.
Key messages
Views on power appear important when considering public acceptability of regulatory policy. Understanding views on power may improve public health messaging on policy interventions.
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Affiliation(s)
- L Carters-White
- SPECTRUM, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Hilton
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - K Skivington
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Chambers
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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Noiman A, Macalino G, Won SH, Byrne M, Deiss R, Haw NJ, Ganesan A, Okulicz JF, Schofield C, Lalani T, Maves RC, Wang X, Agan BK, Achatz E, Bradley W, Merritt S, Merritt T, Olsen C, Rhodes C, Sjoberg T, Baker C, Chambers S, Colombo R, Ferguson T, Kunz A, Powers J, Tramont E, Banks S, Illinik L, Kronmann K, Tant R, Cammarata S, Curry J, Kirkland N, Utz G, Price M, Aronson N, Burgess T, Chu X, Estupigan C, Hsieh, Parmelee E, Tribble D, Won S, Ake J, Crowell T, Peel S, Barahona I, Blaylock J, Decker C, Ressner R. Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell". AIDS Patient Care STDS 2020; 34:523-533. [PMID: 33296270 DOI: 10.1089/apc.2020.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.
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Affiliation(s)
- Adi Noiman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason F. Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Christina Schofield
- Division of Infectious Diseases, Madigan Army Medical Center, Joint Base Lewis McChord, Washington, District of Columbia, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California, USA
| | - Xun Wang
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
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Lazenby M, Chambers S, Chyun D, Davidson P, Dithole K, Norman I, Tlou S. Clinical nursing and midwifery education in the pandemic age. Int Nurs Rev 2020; 67:323-325. [PMID: 32578218 PMCID: PMC7361742 DOI: 10.1111/inr.12601] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
Abstract
The COVID‐19 pandemic has disrupted clinical nursing and midwifery education. This disruption has long‐term implications for the nursing and midwifery workforce and for future healthcare responses to pandemics. Solutions may include enhanced partnerships between schools of nursing and midwifery and health service providers and including schools of nursing and midwifery in preparedness planning. These suggestions notwithstanding, we call upon national and international nursing and midwifery bodies to study how to further the clinical education of nurses and midwives during pandemics and other times of crisis.
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Affiliation(s)
- M Lazenby
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - S Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - D Chyun
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - P Davidson
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - K Dithole
- University of Botswana School of Nursing, Gaborone, Botswana
| | - I Norman
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, UK
| | - S Tlou
- University of Botswana School of Nursing, Gaborone, Botswana
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Skafida V, Chambers S. Positive association between sugar consumption and dental decay prevalence independent of oral hygiene in pre-school children: a longitudinal prospective study. J Public Health (Oxf) 2019; 40:e275-e283. [PMID: 29301042 PMCID: PMC6166585 DOI: 10.1093/pubmed/fdx184] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background Few studies explore how the longitudinal cumulative and combined effects of dietary habits and oral hygiene habits relate to dental decay in very young children. Methods Using longitudinal survey data, logistic regression models were specified to predict dental decay by age 5. Predictor variables included questions on diet and oral hygiene from ages 2 to 5. Results Compared to mainly eating meals, children who snacked all day but had no real meals had a higher chance of dental decay (odds ratios (OR) = 2.32). There was an incremental association between a decreasing frequency of toothbrushing at age 2 and higher chances of dental decay at age 5 (OR range from 1.39 to 2.17). Among children eating sweets or chocolate more frequently (once/day or more), toothbrushing more often (once/day; twice/day or more) reduced the chance of decay (OR of 2.11–2.26 compared to OR 3.60 for the least frequent brushing group). Compared to mothers in managerial and professional occupations, those who had never worked had children with a much higher chance of decay (OR = 3.47). Conclusion This study has shown that toothbrushing can only in part attenuate the association between snacking and long term sugar consumption on dental decay outcomes in children under 5.
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Affiliation(s)
- V Skafida
- Social Policy, School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - S Chambers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Chambers S, Sussman J. Surgical attitudes toward preoperative breast magnetic resonance imaging in women with early-stage breast cancer. ACTA ACUST UNITED AC 2019; 26:e194-e201. [PMID: 31043827 DOI: 10.3747/co.26.4227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Preoperative breast magnetic resonance imaging (mri) is commonly requested by surgeons in the initial workup of women with breast cancer; however, its use is controversial. We performed a survey of breast cancer surgeons across Canada to investigate current knowledge about, attitudes to, and self-reported use of preoperative breast mri in a publicly funded health care system in light of the limited evidence to support it. Methods All identified general surgeons in Canada were mailed a survey instrument designed to probe current practice and knowledge of published trials. Results Of 403 responding surgeons, 233 (58%) indicated that they performed breast cancer surgery. Of those 233, 218 (94%) had access to breast mri and completed the entire survey. Overall, 54.6% of responding surgeons felt that breast mri was useful in surgical planning, and more than half (58.3%) indicated that their frequency of use was likely to increase over the next 5 years. Surgeons found preoperative mri most useful in detecting mammographically occult disease (71.5% of respondents) and in planning for breast-conserving surgery (57.3%). The main limitations reported were timely access to mri (51%) and false positives (36.7%). Responses suggest a knowledge gap in awareness of published trials in breast mri. Conclusions Our study found that, in early-stage breast cancer, self-reported use of mri by breast cancer surgeons in Canada varied widely. Reported indications did not align with published data, and significant gaps in self-reported knowledge of the data were evident. Our results would support the development and dissemination of guidelines to optimize use of mri.
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Affiliation(s)
| | - N Hodgson
- Juravinski Cancer Centre, Hamilton, ON.,Juravinski Hospital, Hamilton, ON
| | | | | | | | - J Sussman
- Juravinski Cancer Centre, Hamilton, ON.,McMaster University, Hamilton, ON
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Macintyre AK, Marryat L, Chambers S. Exposure to liquid sweetness in early childhood: artificially-sweetened and sugar-sweetened beverage consumption at 4-5 years and risk of overweight and obesity at 7-8 years. Pediatr Obes 2018; 13:755-765. [PMID: 29624909 PMCID: PMC6492200 DOI: 10.1111/ijpo.12284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND A significant gap exists in longitudinal evidence on early exposure to artificially sweetened beverages (ASBs) and weight outcomes for paediatric populations. OBJECTIVE The objective of this study is to examine the relationship between ASB/sugar-sweetened beverage (SSB) consumption at 4-5 years and risk of overweight and obesity at 7-8 years. METHODS Data from a nationally representative cohort (n = 2986) in Scotland were analysed using logistic regression to evaluate the association between exposure to ASBs/SSBs at 4-5 years and risk of overweight and obesity at 7-8 years. RESULTS There were positive unadjusted associations between ASB consumption and risk of obesity, and following adjustment for confounders, ASB associations attenuated, and only the middle consumption category (1 to 6 times per week) remained significant (odds ratio 1.57, 95% confidence interval {CI} 1.05-2.36). For SSB consumption, there were no significant unadjusted associations, and following adjustment for confounders, only the middle consumption category was significant (odds ratio 1.65, 95% CI 1.12-2.44). There were no significant associations for risk of overweight. CONCLUSIONS Longitudinal analysis from 4-5 to 7-8 years demonstrated some evidence of associations between ASBs/SSB consumption and risk of obesity. However, non-linear patterns and wide CIs suggest cautious interpretation and need for future studies with long-term follow-up.
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Affiliation(s)
| | - L. Marryat
- Farr Institute Scottish Collaboration for Public Health Research and PolicyUniversity of EdinburghEdinburghUK
| | - S. Chambers
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
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Crawford-Williams F, March S, Ireland M, Rowe A, Goodwin B, Chambers S, Aitken J, Dunn J. Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.83400] [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: 11/20/2022] Open
Abstract
Background: Colorectal cancer (CRC) presents considerable health, economic, and societal burden, and Australia has one of the highest incidence rates of this disease. Over a third of the Australian population live in nonmetropolitan areas and research has shown that they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. One of the main contributors of poorer CRC outcomes in rural Australia may be limited access to treatment facilities and optimal care; however, the extent to which geographical disparities exist in CRC management has not been systematically explored. Aim: To understand the nature of geographical variations in the clinical management and treatment of CRC (including surgery, chemotherapy, and radiotherapy) in Australia, incorporating clinical reports as well as peer-reviewed literature. Methods: A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. PRISMA systematic review reporting methods were applied. Results: Only 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in nonmetropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. Conclusion: The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. Population-level data regarding clinical management and treatment of CRC needs to be routinely collected to better understand geographical variations and inform future guidelines and policy.
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Affiliation(s)
| | - S. March
- University of Southern Queensland, Springfield Central, Australia
| | - M. Ireland
- University of Southern Queensland, Springfield Central, Australia
| | - A. Rowe
- University of Southern Queensland, Springfield Central, Australia
| | - B. Goodwin
- University of Southern Queensland, Springfield Central, Australia
| | - S. Chambers
- Menzies Health Institute Queensland, Southport, Australia
| | - J. Aitken
- Cancer Council Queensland, Brisbane, Australia
| | - J. Dunn
- University of Southern Queensland, Springfield Central, Australia
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Ralph N, Chambers S, Pomery A, Dunn J. Developing a Nurse-Led Intervention for Men With Advanced Prostate Cancer: A Preimplementation Study. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.90300] [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: 11/20/2022] Open
Abstract
Background: Men with advanced prostate cancer can experience poor life quality and health outcomes compared with men with localized disease. Closely matching men's needs and identifying barriers and facilitators to implementation were critical first steps for ensuring the feasibility of our nurse-led telephone-based supportive care intervention for men with advanced prostate cancer. Aim: The aim of this study is to understand the context for implementing ProsCare from PCSNs, and in doing so, further develop the intervention and implementation strategy. Methods: A total of 30 Prostate Cancer Specialist Nurses (PCSNs) participated in 4 semistructured focus groups. Data were coded into the Consolidated Framework for Implementation Research (CFIR) to evaluate the ProsCare program content and guide the implementation and evaluation of this targeted program for men with advanced prostate cancer. Results: Participants validated ProsCare components of (1) decision support; (2) treatment education with self-management and skills training for symptom effects, including exercise prescription; (3) routine screening for psychological distress with referral; (4) psycho-education with tailored distress management strategies; and (5) communicating with health professionals. Data supported a revised treatment schedule and a comprehensive implementation plan including professional education and centralised administration. Conclusion: ProsCare is a valid supportive care nurse-led intervention. The CFIR framework is useful for the structured identification of implementation factors.
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Affiliation(s)
- N. Ralph
- University of Southern Queensland, Institute for Resilient Regions, Toowoomba, Australia
| | - S. Chambers
- Menzies Health Institute Queensland, Southport, Australia
| | - A. Pomery
- Prostate Cancer Foundation of Australia, Melbourne, Australia
| | - J. Dunn
- Institute for Resilient Regions, Springfield, Australia
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Crawford-Williams F, Goodwin B, March S, Ireland M, Chambers S, Aitken J, Dunn J. Challenges and Opportunities for Cancer Care in Regional Australia: The Health Professional´s Perspective. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.91700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cancer specialists working in rural and regional Australia may experience unique difficulties when compared with their metropolitan counterparts, as they often have higher workloads, spend longer hours in clinical practice, and experience professional and social isolation. Previous research has identified accessibility and distance from services, a shortage of workforce, limited availability of specialists and allied health providers, suboptimal chemotherapy administration, and reduced availability of radiotherapy services as predictors of poorer outcomes in regional areas. Yet to date, limited research has focused on the perspective of the regional healthcare professionals. Aim: This study aimed to identify the factors which health professionals believe influence clinical care and outcomes for people with cancer in regional areas of Australia, to confirm existing barriers and identify any new insights specific to the health professional perspective. Methods: Semistructured interviews were conducted with regional oncology health professionals of varying backgrounds. Interview questions explored health professional´s perspectives on barriers to cancer care for patients, factors which influence clinical care, and access to support in regional areas. Data were interpreted using an inductive thematic analysis approach. Results: Two global themes were identified: rural culture and the health system. Within these global themes, health professionals discussed barriers to cancer care in regional areas, predominantly associated with travel, limited workforce, and poor communication within the health system. Participants also noted many positive aspects of cancer care in regional areas, including more personalised care for the patients and faster career progression for professionals. Conclusion: Despite recent innovations aimed at improving rural cancer care, including innovative models of care and increased infrastructure, regional health professionals still perceive many barriers to cancer care in regional Australia. These are predominantly associated with patient demographics, travel difficulties, and inadequate governance. However, there are also many notable benefits to receiving care in regional areas which have been absent from previous literature. These positive factors should be incorporated in efforts to enhance regional cancer care through the recruitment of health professionals to regional areas and development of regional community support networks. An understanding of the experiences of health professionals working in oncology settings in regional areas is a key step toward improving care and providing recommendations to health services and policymakers, particularly regarding recruitment and retention.
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Affiliation(s)
| | - B. Goodwin
- University of Southern Queensland, Springfield Central, Australia
| | - S. March
- University of Southern Queensland, Springfield Central, Australia
| | - M. Ireland
- University of Southern Queensland, Springfield Central, Australia
| | - S. Chambers
- Menzies Health Institute Queensland, Southport, Australia
| | - J. Aitken
- Cancer Council Queensland, Brisbane, Australia
| | - J. Dunn
- University of Southern Queensland, Springfield Central, Australia
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Goodwin B, Ireland M, March S, Myers L, Crawford-Williams F, Chambers S, Aitken J, Dunn J. Strategies for Increasing Participation in Mail-out Colorectal Cancer Screening Programs. A Systematic Review and Meta-Analysis. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.74700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Population mail-out bowel screening programs are a convenient, cost-effective and sensitive method of detecting colorectal cancer (CRC). Despite increased survival rates associated with early detection of CRC, in many countries 50% or more of eligible individuals do not participate in such programs, resulting in a substantial amount of cancers progressing undetected and wasted public health resources. Aim: The current study aimed to systematically review all of the interventions that have been applied internationally to increase fecal occult blood test (FOBT) kit return, specifically in population mail-out programs, to make recommendations to policy makers and program organizers as to the most effective methods of increasing uptake. Method: Six electronic databases (PubMed, PsycINFO, Scopus, InformIT, CINAHL, and ProQuest Dissertations and Theses) were searched for articles published in English before 10th of March 2018. Studies were included if they reported the results of an intervention designed to increase the return of FOBT kits that had been mailed to individuals' homes. Results: PRISMA systematic review reporting methods were applied and each study was assessed using Cochrane's risk of bias tool. The quality of evidence was assessed using GRADE guidelines. The review identified 53 interventions from 30 published studies. Nine distinct intervention strategy types were identified and pooled risk ratios and confidence intervals were estimated for each intervention type. Four key effective intervention strategies were identified including telephone contact, GP endorsement, simplified test procedures, and advance notification with small to moderate effect sizes. Conclusions: Interventions that combine program-level changes incorporating the issue of advance notification and alternative screening tools with the involvement of primary health professionals through endorsement letters and telephone contact should lead to increases in kit return in mail-out CRC screening programs. Future research should examine the benefit of combining intervention strategies and tailoring to specific populations.
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Affiliation(s)
- B. Goodwin
- University of Southern Queensland, Springfield, Australia
| | - M. Ireland
- Institute for Resilient Regions, Springfield, Australia
| | - S. March
- University of Southern Queensland, Springfield, Australia
| | - L. Myers
- University of Southern Queensland, Springfield, Australia
| | | | - S. Chambers
- Cancer Council Queensland, Research Centre, Brisbane, Australia
- Menzies Health Institute Queensland, Southport, Australia
- Prostate Cancer Foundation of Australia, St. Leonards, Australia
| | - J. Aitken
- Cancer Council Queensland, Research Centre, Brisbane, Australia
- Queensland University of Technology, School of Public Health and Social Work, Brisbane, Australia
- Menzies Health Institute Queensland, Brisbane, Australia
| | - J. Dunn
- Cancer Council Queensland, Research Centre, Brisbane, Australia
- University of Southern Queensland, Institute for Resilient Regions, Springfield, Australia
- University of Queensland, School of Social Science, Brisbane, Australia
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Lo J, Bester C, Collins A, Newbold C, Hampson A, Chambers S, Eastwood H, O'Leary S. Intraoperative force and electrocochleography measurements in an animal model of cochlear implantation. Hear Res 2018; 358:50-58. [DOI: 10.1016/j.heares.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/07/2017] [Accepted: 11/06/2017] [Indexed: 12/15/2022]
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Chambers S, Griffin E, Jenkins L, Ayaani S, Al-Omishy H, Robertson S, Sreenivas M, Tomlins A, McEvoy K. Is Surgical Clip Placement Necessary in all Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy, and Could This Have Financial Implications for Local Trusts? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phipps R, White L, Hilton S, Chambers S. Young people's views on non-broadcast advertising of foods high in fat, sugar and salt. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Phipps
- University of Glasgow, Glasgow, UK
| | - L White
- University of Glasgow, Glasgow, UK
| | - S Hilton
- University of Glasgow, Glasgow, UK
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Moore K, Cadoo K, Chambers S, Ghamande S, Konecny G, Oza A, Chen LM, Konstantinopoulos P, Lea J, Spitz D, Uyar D, Mugundu G, Laing N, Strickland D, Jones S, Burris H, Spigel D, Hamilton E. A multicentre phase II study of AZD1775 plus chemotherapy in patients with platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Bermudez C, Molina M, Goldberg L, Chambers S, Atluri P, Forde-Mclean R, Gentile J, Wald J, Rame E, Jessup M, Birati E, Acker M. Incidence and Implications of Primary Graft Dysfunction in Heart Transplantation Using the ISHLT Consensus Criteria. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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Sprowson AP, Jensen C, Chambers S, Parsons NR, Aradhyula NM, Carluke I, Inman D, Reed MR. The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip: The Fractured Hip Infection trial. Bone Joint J 2017; 98-B:1534-1541. [PMID: 27803231 PMCID: PMC5102031 DOI: 10.1302/0301-620x.98b11.34693] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 07/01/2014] [Accepted: 07/06/2016] [Indexed: 12/27/2022]
Abstract
Aims A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. Patients and Methods A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery. Results The rate of deep SSI was 3.5% in the control group and 1.1% in
the intervention group
(p = 0.041; logistic regression adjusting for age and gender). The
overall rate of non-infective surgical complications did not differ
between the two groups (unadjusted chi-squared test; p > 0.999). Conclusion The use of high dose dual-antibiotic impregnated cement in these
patients significantly reduces the rate of SSI compared with standard
low dose single antibiotic loaded bone cement. Cite this article: Bone Joint J 2016;98-B:1534–1541.
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Affiliation(s)
| | - C Jensen
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - S Chambers
- Northern Deanery Training Programme, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle-upon-Tyne, NE15 8NY, UK
| | - N R Parsons
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - N M Aradhyula
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - I Carluke
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - D Inman
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - M R Reed
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
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Chen H, Peelukhana S, Berwick Z, Kratzberg J, Krieger J, Roeder B, Chambers S, Kassab G. Fluid–Structure Interaction Simulations of Aortic Dissection with Bench Validation. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chambers S, Manickam D, Wright J, Wooldridge E, White E, Abolghasemi-Malekabadi K, Robinson S, Perry A. Potential financial savings for the local health economy in type 2 diabetic care, following bariatric surgery. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chen H, Peelukhana S, Berwick Z, Kratzberg J, Krieger J, Roeder B, Chambers S, Kassab G. Editor's Choice – Fluid–Structure Interaction Simulations of Aortic Dissection with Bench Validation. Eur J Vasc Endovasc Surg 2016; 52:589-595. [DOI: 10.1016/j.ejvs.2016.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
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26
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Chambers S, Ford A, Boydell N, Moore L, Stead M, Eadie D. Universal free school meals in Scotland: A process evaluation of implementation and uptake. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Freedman MS, Wolinsky JS, Truffinet P, Comi G, Kappos L, Miller AE, Olsson TP, Benamor M, Chambers S, O'Connor PW. A randomized trial of teriflunomide added to glatiramer acetate in relapsing multiple sclerosis. Mult Scler J Exp Transl Clin 2015; 1:2055217315618687. [PMID: 28607708 PMCID: PMC5433345 DOI: 10.1177/2055217315618687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Teriflunomide is a once-daily oral immunomodulator for the treatment of relapsing−remitting MS. Objective To evaluate the safety and tolerability of teriflunomide as add-on therapy to a stable dose of glatiramer acetate (GA) in patients with relapsing forms of MS (RMS). Methods Phase II, randomized, double-blind, add-on, placebo-controlled study. The primary objective was to assess safety and tolerability; secondary objectives were to evaluate effects of treatment on disease activity assessed by MRI and relapse. Results Patients with RMS on GA (N = 123) were randomized 1:1:1 to receive teriflunomide 14 mg (n = 40), 7 mg (n = 42), or placebo (n = 41) for 24 weeks; 96 patients entered the 24-week extension, remaining on original treatment allocation. Teriflunomide was well tolerated over 48 weeks. The frequency of adverse events (AEs) was low across all groups; 5 (12.2%), 3 (7.1%), and 2 (5.0%) patients in the 14 mg, 7 mg, and placebo groups, respectively, discontinued treatment due to AEs. Teriflunomide reduced the number of T1-Gd lesions vs placebo (14 mg: 46.6% relative reduction, p = 0.1931; 7 mg: 64.0%: relative reduction, p = 0.0306). Conclusions Teriflunomide added to stable-dose GA had acceptable safety and tolerability, and reduced some MRI markers of disease activity compared with GA alone. NCT00475865 (core study); NCT00811395 (extension).
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Affiliation(s)
- M S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - J S Wolinsky
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - P Truffinet
- Genzyme, a Sanofi company, Chilly-Mazarin, France
| | - G Comi
- University Vita-Salute San Raffaele, Milan, Italy
| | - L Kappos
- University Hospital Basel, Basel, Switzerland
| | - A E Miller
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - S Chambers
- Fishawack Communications Ltd, Abingdon, UK
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Mainman H, Chambers S, Curtis HJ. M22 Does a Nurse-Led Non Invasive Ventilation (NIV) Service improve patient outcomes?: Abstract M22 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McFarlane M, Chambers S, Dhaliwal A, Patel A, Nwokolo C, Arasaradnam R. Six month clinical outcomes in patients with intermediate raised faecal calprotectin levels. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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VanderMeer R, Chambers S, Van Dam A, Cutz JC, Goffin JR, Ellis PM. Diagnosing lung cancer in the 21st century: are we ready to meet the challenge of individualized care? ACTA ACUST UNITED AC 2015; 22:272-8. [PMID: 26300665 DOI: 10.3747/co.22.2526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Histologic and molecular subtyping have become increasingly important as predictors of treatment benefit in lung cancer. The objective of the present study was to determine whether current diagnostic approaches provide adequate tissue to allow for individualized treatment decisions. METHODS Our retrospective cohort study of new lung cancer patients seen at an academic centre between July 2007 and June 2008 collected baseline demographic and diagnostic information, including mode of diagnosis, type of diagnostic material, and pathology diagnosis. RESULTS Of the 431 study patients, 20% had stage i or ii non-small-cell lung cancer (nsclc), 24% stage iii disease, and 39% stage iv nsclc. Three quarters of the small-cell lung cancer (sclc) cases were extensive stage. Diagnostically, 18% of patients had sclc; 30%, adenocarcinoma; 27%, squamous-cell cancer; 2%, large-cell carcinoma; 1%, bronchoalveolar carcinoma; 1%, mixed histology; 18%, nsclc not otherwise specified; 4%, other; and 2%, no pathology diagnosis. Surgical pathology material was available in 80% of cases, and cytology material alone in 20%. Surgical pathology material was more common in patients with early-stage than with advanced disease (89% for stages i and ii vs. 74% for stages iii and iv, p < 0.0001). The pathology report included ambiguous terms in 24% of cases: "consistent" (12%), "suspicious" (3%), "favour" (2%), "suggestive" (2%), "likely" (1%), "compatible" with malignancy (1%), "at least" (1%), "atypical" (0.5%), and "no pathology" (1.5%). CONCLUSIONS Current diagnostic approaches in most lung cancer patients appear adequate, but complete histopathologic identification is missing in nearly 20% of cases, and some uncertainty as to the final diagnosis is expressed in 24% of pathology reports. Some improvement in diagnostic sampling and pathology reporting are required to allow for implementation of current treatment approaches.
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Affiliation(s)
- R VanderMeer
- Medical Oncology Department, Walker Family Cancer Centre, St. Catharines, ON
| | - S Chambers
- Department of Oncology, McMaster University, Hamilton, ON
| | - A Van Dam
- Department of Oncology, McMaster University, Hamilton, ON
| | - J C Cutz
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, ON
| | - J R Goffin
- Department of Oncology, McMaster University, Hamilton, ON; ; Medical Oncology Department, Juravinski Cancer Centre, Hamilton, ON
| | - P M Ellis
- Department of Oncology, McMaster University, Hamilton, ON; ; Medical Oncology Department, Juravinski Cancer Centre, Hamilton, ON
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31
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Skafida V, Chambers S. Dental decay in preschool children in Scotland – associations with diet and oral hygiene practices. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nanjappa S, Chambers S, Marcenes W, Richards D, Freeman R. A theory led narrative review of one-to-one health interventions: the influence of attachment style and client-provider relationship on client adherence. Health Educ Res 2014; 29:740-754. [PMID: 24895356 DOI: 10.1093/her/cyu029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A theory-led narrative approach was used to unpack the complexities of the factors that enable successful client adherence following one-to-one health interventions. Understanding this could prepare the provider to anticipate different adherence behaviours by clients, allowing them to tailor their interventions to increase the likelihood of adherence. The review was done in two stages. A theoretical formulation was proposed to explore factors which influence the effectiveness of one-to-one interventions to result in client adherence. The second stage tested this theory using a narrative synthesis approach. Eleven studies across the health care arena were included in the synthesis and explored the interplay between client attachment style, client-provider interaction and client adherence with health interventions. It emerged that adherence results substantially because of the relationship that the client has with the provider, which is amplified or diminished by the client's own attachment style. This occurs because the client's attachment style shapes how they perceive and behave in relationships with the health-care providers, who become the 'secure base' from which the client accepts, assimilates and adheres with the recommended health intervention. The pathway from one-to-one interventions to adherence is explained using moderated mediation and mediated moderation models.
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Affiliation(s)
- S Nanjappa
- Oral Health and Health Research Programme, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK, Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Queen Mary University of London, London E1 2AD, UK and Centre for Evidence-based Dentistry, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK.
| | - S Chambers
- Oral Health and Health Research Programme, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK, Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Queen Mary University of London, London E1 2AD, UK and Centre for Evidence-based Dentistry, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK
| | - W Marcenes
- Oral Health and Health Research Programme, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK, Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Queen Mary University of London, London E1 2AD, UK and Centre for Evidence-based Dentistry, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK
| | - D Richards
- Oral Health and Health Research Programme, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK, Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Queen Mary University of London, London E1 2AD, UK and Centre for Evidence-based Dentistry, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK
| | - R Freeman
- Oral Health and Health Research Programme, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK, Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Queen Mary University of London, London E1 2AD, UK and Centre for Evidence-based Dentistry, Dental Health Services Research Unit, Dundee Dental School, University of Dundee, Dundee DD1 4HN, UK
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Kim WH, Ko HJ, Hu CG, Lee H, Lee C, Chambers S, Williams A, Kang CH. Background Level of Atmospheric Radon-222 Concentrations at Gosan Station, Jeju Island, Korea in 2011. B KOREAN CHEM SOC 2014. [DOI: 10.5012/bkcs.2014.35.4.1149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bane AL, Whelan TJ, Pond GR, Parpia S, Gohla G, Fyles AW, Pignol JP, Pritchard KI, Chambers S, Levine MN. Tumor factors predictive of response to hypofractionated radiotherapy in a randomized trial following breast conserving therapy. Ann Oncol 2014; 25:992-8. [PMID: 24562444 DOI: 10.1093/annonc/mdu090] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To determine whether tumor grade, molecular subtype and hypoxia predict response to hypofractionated versus standard radiotherapy (RT) following breast-conserving surgery (BCS) for node-negative breast cancer in a randomized controlled trial (RCT). PATIENTS AND METHODS Formalin-fixed paraffin-embedded (FFPE) tumor blocks were available on 989 of 1234 patients enrolled in the Hypofractionation Whole Breast Irradiation (HWBI) Trial. A central pathology review and assessment of tumor grade using the Nottingham grading system was carried out. Tumors were classified by molecular subtype as luminal A, luminal B, HER2 enriched, basal-like or unclassified using a six-biomarker panel; ER, PR, HER-2, Ki67, CK5/6 and EGFR. Tumors were also classified as hypoxic based on the expression of HIF1α, CAIX or GLUT-1. The primary end point was local recurrence (LR). RESULTS Median follow-up was 12 years. In the multivariable Cox model, molecular subtype was the only factor predictive of LR, the 10-year cumulative incidence was 4.5% for luminal A and basal-like, 7.9% for luminal B and 16.9% for HER-2 enriched tumors (P < 0.01). Tumor grade, molecular subtype or hypoxia did not predict response to hypofractionation. CONCLUSIONS In women enrolled in the HWBI trial following BCS tumor molecular subtype predicted LR. However tumor grade, molecular subtype and hypoxia did not predict response to hypofractionation suggesting that patients with node-negative breast tumors of all grades and molecular subtypes may be safely treated with hypofractionated RT regimens.
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Affiliation(s)
- A L Bane
- Department of Pathology and Molecular Medicine
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Tien W, Chen H, Berwick Z, Krieger J, Chambers S, Dabiri D, Kassab G. Characterization of a Bioprosthetic Bicuspid Venous Valve Hemodynamics and Implications for Mechanism of Valve Dynamics. J Vasc Surg Venous Lymphat Disord 2014; 2:119. [DOI: 10.1016/j.jvsv.2013.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chambers S, Cooney A, Caplan N, Dowen D, Kader D. The accuracy of magnetic resonance imaging (MRI) in detecting meniscal pathology. J R Nav Med Serv 2014; 100:157-160. [PMID: 25335310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS The purpose of this study was to determine the accuracy of Magnetic Resonance Imaging (MRI) scanning in the detection of meniscal pathology in a district general hospital. METHODS We retrospectively analysed a single-surgeon series of 240 knee arthroscopic investigations for all indications. The arthroscopic reports included an outline diagram of the meniscus upon which the surgeon could record his operative findings. 112 of these patients had also had a recent MRI scan. We compared the MRI findings with the arthroscopy findings. RESULTS 66 patients had a positive MRI scan. 64 of these were found to have a meniscal tear at surgery. 37 MRI scans were reported as "no tear", of which four were found to have a meniscal tear at surgery. Nine MRI scans were descriptive, e.g. "signal change, possible tear", or "tear cannot be ruled out." These tended to correspond with equivocal arthroscopic findings of "degeneration" or "fibrillation". In our series of 112 patients with meniscal pathology, MRI scanning was 90.5% sensitive, 89.5% specific and 90.1% accurate. CONCLUSIONS False positive MRI scans may lead to unnecessary surgery. Patients with negative MRI scans had a mean delay to surgery of 33 weeks compared to 18 weeks for patients with positive MRI scans. Patients with false negative MRI results may wait longer for their surgery. Two of the false negative MRI scan reports clearly showed meniscus tears, which were not identified by the reporting radiologist. In our series, the MRI scan itself was more accurate than the reporting. It is important to have an experienced musculoskeletal radiologist to minimise the number of missed meniscal tears. It is also important for the surgeon to review the MRI scan itself, as well as the report.
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Tien W, Chen H, Berwick Z, Krieger J, Chambers S, Dabiri D, Kassab G. Hemodynamic Role of Sinus on Venous Valve Performance. J Vasc Surg Venous Lymphat Disord 2014; 2:117. [DOI: 10.1016/j.jvsv.2013.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schluter PJ, Spittlehouse JK, Cameron VA, Chambers S, Gearry R, Jamieson HA, Kennedy M, Lacey CJ, Murdoch DR, Pearson J, Porter R, Richards M, Skidmore PML, Troughton R, Vierck E, Joyce PR. Canterbury Health, Ageing and Life Course (CHALICE) study: rationale, design and methodology. N Z Med J 2013; 126:71-85. [PMID: 23824026] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS New Zealand's ageing population threatens the financial sustainability of our current model of health service delivery. The Canterbury Health, Ageing and Life Course (CHALICE) study aims to develop a comprehensive and flexible database of important determinants of health to inform new models. This paper describes the design, methodology, and first 300 participants of CHALICE. METHODS Commencing August 2010, CHALICE is a multidisciplinary prospective random cohort study and biobank of 1,000 Canterbury adults aged 49-51 years at inception, stratified by self-identified Maori (n=200) and non-Maori (n=800) ethnicity. Assessment covers sociodemographic, physical, cognition, mental health, clinical history, family and social, cardiovascular, and lifestyle domains. Detailed follow-up assessment occurs every 5 years, with a brief postal follow-up assessment undertaken annually. RESULTS For the first 300 participants (44 Maori, 256 non-Maori), the participation rate is 63.7%. Overall, 53.3% of participants are female, 75.3% are living in married or de facto relationships, and 19.0% have university degrees. These sociodemographic profiles are comparable with the 2006 Census, Canterbury region, 50-54 years age group percentages (50.7%, 77.2%, and 14.3%, respectively). CONCLUSIONS CHALICE has been designed to provide quality data that will inform policy development and programme implementation across a broad spectrum of health indicators.
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Affiliation(s)
- P J Schluter
- School of Health Sciences, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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O'Connell D, Carmichael L, Smith D, Gattellari M, Chambers S, Pinnock C, Slevin T, Ward J. P2-225 Prostate-specific antigen testing awareness and participation in New South Wales, Australia: demographic, lifestyle and health-related factors. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ellis PM, VanderMeer R, Cutz J, Chambers S, Hasler A, Goffin JR. Individualized patient care: Are we ready to meet the challenges for patients with lung cancer? J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chambers S, Chadda S, Plumb JM. How much does international normalized ratio monitoring cost during oral anticoagulation with a vitamin K antagonist? A systematic review. Int J Lab Hematol 2009; 32:427-42. [PMID: 19930411 DOI: 10.1111/j.1751-553x.2009.01205.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Next-generation oral anticoagulants offer the potential for effective prevention and treatment of thrombosis without the need for repeated monitoring of the international normalized ratio (INR). This systematic review evaluated the costs associated with INR monitoring tests performed as part of the standard management of oral anticoagulation with vitamin K antagonists. Studies published in or after 1990 reporting the costs of INR monitoring were identified from bibliographic databases and manual searches of reference lists. Cost data were extracted and inflated to the year 2006 before purchasing power parity conversion to US dollars. A total of 29 studies reported the cost of one INR test, which was shown to range from $6.19 to $145.70. Cost estimates were based on various combinations of direct medical costs, such as healthcare contacts, equipment, laboratory tests, clerical costs (postage and stationery), telephone calls, quality control, training/education and patient transportation, and indirect costs, such as time lost from work. In conclusion, the cost of INR monitoring varied substantially between studies depending on the monitoring modality and setting, and the cost categories included. When selecting a published estimate, healthcare decision makers should ensure that the chosen estimate reflects local service provision as closely as possible.
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Affiliation(s)
- S Chambers
- Rx Communications Ltd., Nercwys, Mold, Flintshire, UK
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Goldblatt F, Chambers S, Rahman A, Isenberg DA. Serious infections in British patients with systemic lupus erythematosus: hospitalisations and mortality. Lupus 2009; 18:682-9. [DOI: 10.1177/0961203308101019] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This retrospective study determined the prevalence and nature of hospitalisations secondary to infection, and examined the mortality from infection in our large British cohort of patients with systemic lupus erythematosus (SLE). Casenote and database information of 104 consecutive patients attending the UCLH specialised SLE clinic were reviewed for the number of hospitalisations due to infection and the clinical and serological features of affected patients. Cohort mortality data were examined to identify deaths secondary to infectious diseases. Infection serious enough to result in hospitalisation occurred in 15% of the patients in the selected sample of our whole cohort. Six patients had more than one admission due to infection, with pneumonia being the most frequent. Typical bacterial pathogens were most commonly identified. A significant association between admissions for infection and nephritis ( P < 0.05 by Chi-square) was identified; however, the use of high dose prednisolone or other immunosuppressants did not increase the risk for infection requiring hospitalisation ( P > 0.5 by Chi-square) in our study. Between 1978 and 2007, 17 of 67 (25%) deaths in our SLE cohort of 470 patients were because of infection. Patients who died from infectious causes were more likely to have existing or previous renal disease than those who died from non-infectious causes ( P < 0.01 by Chi-square). The majority who died from infection were on high dose prednisolone plus at least one other immunosuppressive agent and had serologically active disease. The study highlights the significant problem of infection in British patients with SLE. Early recognition and treatment of infectious diseases in these patients together with considered use of immunosuppressant medications and vaccinations may help to reduce the impact of these complications.
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Affiliation(s)
- F Goldblatt
- Centre for Rheumatology, Department of Medicine, University College London Hospital, United Kingdom
| | - S Chambers
- Centre for Rheumatology, Department of Medicine, University College London Hospital, United Kingdom
| | - A Rahman
- Centre for Rheumatology, Department of Medicine, University College London Hospital, United Kingdom
| | - DA Isenberg
- Centre for Rheumatology, Department of Medicine, University College London Hospital, United Kingdom
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Affiliation(s)
- M. Khashram
- Christchurch School of Medicine, University of Otago, New Zealand
| | - P. Huggan
- Department of Infectious Diseases, Christchurch Hospital, New Zealand
| | - R. Ikram
- Medlab South, Christchurch, New Zealand
| | - S. Chambers
- Christchurch School of Medicine, University of Otago, New Zealand
- Department of Infectious Diseases, Christchurch Hospital, New Zealand
| | - J.A. Roake
- Christchurch School of Medicine, University of Otago, New Zealand
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, New Zealand
| | - D.R. Lewis
- Christchurch School of Medicine, University of Otago, New Zealand
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, New Zealand
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Morris R, Woo Y, Hagan K, Chambers S, Jessup M, Acker M. 712: Transplant in the Elderly vs. Destination Therapy: Beginning of a Paradigm Shift? J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cortes S, Chambers S, Jerónimo A, Isenberg D. Diabetes mellitus complicating systemic lupus erythematosus – analysis of the UCL lupus cohort and review of the literature. Lupus 2008; 17:977-80. [DOI: 10.1177/0961203308091539] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) often coexists with other diseases. Diabetes mellitus (DM) is an example and patients with overlap SLE-DM can present with clinical features common to both disorders. In this review, we describe the patients with overlap SLE-DM, focussing on the clinical features common to both diseases that these patients can present, and on the challenges of managing such complications. A detailed review of the patients’ notes ( n = 485) was performed. At every outpatient appointment the patients’ urine was tested for glucose, protein and blood. Patients with persistent glycosuria were investigated with fasting blood glucose and a glucose tolerance test to help make the diagnosis of DM. Particular note was made of those patients whose symptoms could be due to SLE, DM or both. Nine patients with DM were identified. Three had type 1 DM, four had type 2 DM and two were considered to have steroid-induced DM. Among these patients, three had renal involvement (two with WHO class IV lupus nephritis); two had peripheral neuropathy (one had a mixed sensory and motor neuropathy, one had a sensory peripheral neuropathy); two patients had retinopathy and cataracts and one had angina. The combination of SLE and DM is uncommon but the predisposition to renal, peripheral neuropathy and retinal disease means that great care must be taken when deciding which clinical feature is due to which disease, because active SLE requires additional immunosuppression whereas DM requires optimization of the metabolic control. Interestingly, although in theory patients with SLE and DM are in double-jeopardy of developing atherosclerosis, to date, only one of our overlap patients has developed angina.
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Affiliation(s)
- S Cortes
- Department of Rheumatology, Portuguese Institute of Rheumatology, Lisbon, Portugal
| | - S Chambers
- Division of Medicine, Centre for Rheumatology Research, University College London, London, UK
| | - A Jerónimo
- Division of Internal Medicine, Pedro Hispano Hospital, Matosinhos, Portugal
| | - D Isenberg
- Division of Medicine, Centre for Rheumatology Research, University College London, London, UK
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Donehower L, Gatza C, Hinkal G, Moore L, Parikh N, Chambers S, Kittrell F, Xu J, Lee A, Medina D, Goodell M. Insights into stem cells and aging provided by a P53 mutant mouse. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chambers S, Raine R, Rahman A, Hagley K, De Ceulaer K, Isenberg D. Factors influencing adherence to medications in a group of patients with systemic lupus erythematosus in Jamaica. Lupus 2008; 17:761-9. [DOI: 10.1177/0961203308089404] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to examine the factors influencing adherence to medications in a group of patients with systemic lupus erythematosus (SLE) in Jamaica. A qualitative study was designed using a screening questionnaire and semi-structured interviews. The study was conducted in the rheumatology clinic at the University Hospital of the West Indies, Kingston, Jamaica. 75 patients with SLE including 20 interviewees, who had SLE for at least 1 year participated in the study. The main outcome measures were: (i) level of self-reported adherence in a sample of the clinic attendees and (ii) interviewees explanations of the reasons for taking or not taking drugs as prescribed by their physician. 56% of the 75 study participants reported taking their medications more than 85% of the time. High cost and poor availability of medications were the main reasons for poor adherence, but some patients chose not to take their medications because of side effects, perceived mild severity of their disease and/or a preference to take drugs only when symptomatic. Patients used herbal medicines to counteract side effects of Western medicines, to ‘purge the blood’ and to manage lupus symptoms when they had no medications. Religious beliefs were used as a coping strategy. Traditional use of herbal medicines is common particularly in patients from rural Jamaica, and may explain the observed use of herbal medicines in those who have emigrated to developed countries. Socio-economic constraints and poor drug availability are particularly important influences on poor adherence in Jamaican patients with SLE. Religious beliefs and use of herbal remedies do not seem to affect adherence adversely but are used when drugs cannot be obtained.
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Affiliation(s)
- S Chambers
- Department of Medicine, The Centre for Rheumatology, University College London, London, UK,
| | - R Raine
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Rahman
- Department of Medicine, The Centre for Rheumatology, University College London, London, UK
| | - K Hagley
- Department of Medicine, University of the West Indies, Kingston, Jamaica
| | - K De Ceulaer
- Department of Medicine, University of the West Indies, Kingston, Jamaica
| | - D Isenberg
- Department of Medicine, The Centre for Rheumatology, University College London, London, UK
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Sanders J, Pithie A, Ganly P, Surgenor L, Wilson R, Merriman E, Loudon G, Judkins R, Chambers S. A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. J Antimicrob Chemother 2008; 62:809-15. [DOI: 10.1093/jac/dkn284] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Abstract
This essay explores the link in Gerard Manley Hopkins's imagination between sensations of the body and the changing textures of intensity that characterize experiences of the mind. I argue that one of the first functions of Hopkins's stylistic experiments in The Wreck of the Deutschland and later poems is to call attention to the ways in which our experiences of knowing, reasoning, and believing have parallels in bodily sensations. Hopkins's manipulations of the kinesthetic properties of language - especially the capacity of syntax to evoke sensations of pressure, balance, momentum, and tension - are directed toward a mimesis of consciousness, in which the poet strives to represent the feeling in the mind as it cranes toward an insight or relishes the renewal of conviction.
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Abstract
Long-term backyard smelting of lead in a district known as Mona Commons, Kingston, Jamaica, has produced lead burdens as high as 30 000 mg/kg in soils near to the smelter, and indoor dust loadings of 373 microg/f2 in the residents' home. The blood lead levels (BPb) of 107 children from the district were in the range 2.2-202 microg/dL. Fifty-nine per cent of these had BPb levels above 10 microg/dL and the population mean was an unacceptably high 25.1 microg/dL. The highest levels were observed for five siblings, two of whom presented with lead encephalopathy. This severe chronic exposure to lead was exacerbated by a significant history of pica, and chronic nutritional anaemia. Chelation therapy significantly reduced the BPb levels but due to lead storage in other organs, the values after several months were still higher than desirable. This study emphasizes the importance of reducing the exposure of children to lead.
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Affiliation(s)
- G C Lalor
- International Centre for Environmental and Nuclear Sciences, The University of the West Indies, Kingston 7, Kingston, Jamaica.
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