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Polden M, Jones A, Essman M, Adams J, Bishop T, Burgoine T, Donohue A, Sharp S, White M, Smith R, Robinson E. Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021. BMJ Open 2024; 14:e080405. [PMID: 38604637 PMCID: PMC11015320 DOI: 10.1136/bmjopen-2023-080405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022. METHODS In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed. RESULTS There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way. CONCLUSION The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England. PREREGISTRATION Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).
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Affiliation(s)
- Megan Polden
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Lancaster University, Lancaster, UK
| | | | - Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tom Bishop
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- Institute of Health Research, University of Exeter Medical School, Exeter, Devon, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
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Heathcote LE, Pollard DJ, Brennan A, Davies MJ, Eborall H, Edwardson CL, Gillett M, Gray LJ, Griffin SJ, Hardeman W, Henson J, Khunti K, Sharp S, Sutton S, Yates T. Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial. BMJ Open Diabetes Res Care 2024; 12:e003516. [PMID: 38471669 DOI: 10.1136/bmjdrc-2023-003516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D. MATERIALS AND METHODS We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective. RESULTS Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years. CONCLUSIONS We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect. TRIAL REGISTRATION NUMBER ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
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Affiliation(s)
| | - Daniel J Pollard
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Melanie J Davies
- Diabetes Research Department, University of Leicester, Leicester, UK
| | - Helen Eborall
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Michael Gillett
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | | | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Department, University of Leicester, Leicester, UK
| | | | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Rogers NT, Pell D, Mytton OT, Penney TL, Briggs A, Cummins S, Jones C, Rayner M, Rutter H, Scarborough P, Sharp S, Smith R, White M, Adams J. Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: a controlled interrupted time series analysis. BMJ Open 2023; 13:e077059. [PMID: 38052470 PMCID: PMC10711915 DOI: 10.1136/bmjopen-2023-077059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To determine changes in household purchases of drinks 1 year after implementation of the UK soft drinks industry levy (SDIL). DESIGN Controlled interrupted time series. PARTICIPANTS Households reporting their purchasing to a market research company (average weekly n=22 091), March 2014 to March 2019. INTERVENTION A two-tiered tax levied on soft drinks manufacturers, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g sugar/100 mL (high tier) are taxed at £0.24/L, drinks with ≥5 to <8 g sugar/100 mL (low tier) are taxed at £0.18/L. MAIN OUTCOME MEASURES Absolute and relative differences in the volume of, and amount of sugar in, soft drinks categories, all soft drinks combined, alcohol and confectionery purchased per household per week 1 year after implementation. RESULTS In March 2019, compared with the counterfactual, purchased volume of high tier drinks decreased by 140.8 mL (95% CI 104.3 to 177.3 mL) per household per week, equivalent to 37.8% (28.0% to 47.6%), and sugar purchased in these drinks decreased by 16.2 g (13.5 to 18.8 g), or 42.6% (35.6% to 49.6%). Purchases of low tier drinks decreased by 170.5 mL (154.5 to 186.5 mL) or 85.8% (77.8% to 93.9%), with an 11.5 g (9.1 to 13.9 g) reduction in sugar in these drinks, equivalent to 87.8% (69.2% to 106.4%). When all soft drinks were combined irrespective of levy tier or eligibility, the volume of drinks purchased increased by 188.8 mL (30.7 to 346.9 mL) per household per week, or 2.6% (0.4% to 4.7%), but sugar decreased by 8.0 g (2.4 to 13.6 g), or 2.7% (0.8% to 4.5%). Purchases of confectionery and alcoholic drinks did not increase. CONCLUSIONS Compared with trends before the SDIL was announced, 1 year after implementation, volume of all soft drinks purchased combined increased by 189 mL, or 2.6% per household per week. The amount of sugar in those drinks was 8 g, or 2.7%, lower per household per week. Further studies should determine whether and how apparently small effect sizes translate into health outcomes. TRIAL REGISTRATION NUMBER ISRCTN18042742.
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Affiliation(s)
| | | | - Oliver T Mytton
- MRC Epidemiology Unit, Cambridge, UK
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Tarra L Penney
- York University - Keele Campus, Toronto, Ontario, Canada
| | - Adam Briggs
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute for Health Policy and Clinical Practice, University of Warwick Warwick Medical School, Coventry, UK
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Harry Rutter
- University of Bath Department of Social and Policy Sciences, Bath, UK
| | - Peter Scarborough
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention, Oxford, UK
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Birch JM, Mueller J, Sharp S, Logue J, Kelly MP, Griffin SJ, Ahern A. Are there inequalities in the attendance and effectiveness of behavioural weight management interventions for adults in the UK? Protocol for an individual participant data (IPD) meta-analysis. BMJ Open 2023; 13:e067607. [PMID: 36958788 PMCID: PMC10039995 DOI: 10.1136/bmjopen-2022-067607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION It is important to identify whether behavioural weight management interventions work well across different groups in the population so health inequalities in obesity are not widened. Previous systematic reviews of inequalities in the attendance and effectiveness of behavioural weight management interventions have been limited because few trials report relevant analyses and heterogeneity in the categorisation of inequality characteristics prevents meta-analysis. An individual participant data meta-analysis (IPD-MA) allows us to reanalyse all trials with available data in a uniform way. We aim to conduct an IPD meta-analysis of UK randomised controlled trials to examine whether there are inequalities in the attendance and effectiveness of behavioural weight interventions. METHODS AND ANALYSIS In a recently published systematic review, we identified 17 UK-based randomised controlled trials of primary care-relevant behavioural interventions, conducted in adults living with overweight or obesity and reporting weight outcomes at baseline and 1-year follow-up. The corresponding author of each trial will be invited to contribute data to the IPD-MA. The outcomes of interest are weight at 12-months and intervention attendance (number of sessions offered vs number of sessions attended). We will primarily consider whether there is an interaction between intervention group and characteristics where inequalities occur, such as by gender/sex, socioeconomic status or age. The IPD-MA will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses of IPD guidelines. ETHICS AND DISSEMINATION No further ethical approval was required as ethical approval for each individual study was obtained by the original trial investigators from appropriate ethics committees. The completed IPD-MA will be disseminated at conferences, in a peer-reviewed journal and contribute to the lead author's PhD thesis. Investigators of each individual study included in the final IPD-MA will be invited to collaborate on any publications that arise from the project.
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Affiliation(s)
- Jack M Birch
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Workman P, Clarke P, Te Poele R, Powers M, Box G, De Billy E, De Haven Brandon A, Hallsworth A, Hayes A, McCann H, Sharp S, Valenti M, Raynaud F, Eccles S, Cheeseman M, Jones K. Discovery and validation of biomarkers to support clinical development of NXP800: A first-in-class orally active, small-molecule HSF1 pathway inhibitor. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00893-0] [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]
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies M, Eborall H, Edwardson C, Gray L, Hardeman W, Heathcote L, Henson J, Morton K, Pollard D, Sharp S, Sutton S, Troughton J, Yates T. Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT. Health Technol Assess 2022; 25:1-190. [PMID: 34995176 DOI: 10.3310/hta25770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a leading cause of mortality globally and accounts for significant health resource expenditure. Increased physical activity can reduce the risk of diabetes. However, the longer-term clinical effectiveness and cost-effectiveness of physical activity interventions in those at high risk of type 2 diabetes is unknown. OBJECTIVES To investigate whether or not Walking Away from Diabetes (Walking Away) - a low-resource, 3-hour group-based behavioural intervention designed to promote physical activity through pedometer use in those with prediabetes - leads to sustained increases in physical activity when delivered with and without an integrated mobile health intervention compared with control. DESIGN Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with follow-up conducted at 12 and 48 months. SETTING Primary care and the community. PARTICIPANTS Adults whose primary care record included a prediabetic blood glucose measurement recorded within the past 5 years [HbA1c ≥ 42 mmol/mol (6.0%), < 48 mmol/mol (6.5%) mmol/mol; fasting glucose ≥ 5.5 mmol/l, < 7.0 mmol/l; or 2-hour post-challenge glucose ≥ 7.8 mmol/l, < 11.1 mmol/l] were recruited between December 2013 and February 2015. Data collection was completed in July 2019. INTERVENTIONS Participants were randomised (1 : 1 : 1) using a web-based tool to (1) control (information leaflet), (2) Walking Away with annual group-based support or (3) Walking Away Plus (comprising Walking Away, annual group-based support and a mobile health intervention that provided automated, individually tailored text messages to prompt pedometer use and goal-setting and provide feedback, in addition to biannual telephone calls). Participants and data collectors were not blinded; however, the staff who processed the accelerometer data were blinded to allocation. MAIN OUTCOME MEASURES The primary outcome was accelerometer-measured ambulatory activity (steps per day) at 48 months. Other objective and self-reported measures of physical activity were also assessed. RESULTS A total of 1366 individuals were randomised (median age 61 years, median body mass index 28.4 kg/m2, median ambulatory activity 6638 steps per day, women 49%, black and minority ethnicity 28%). Accelerometer data were available for 1017 (74%) and 993 (73%) individuals at 12 and 48 months, respectively. The primary outcome assessment at 48 months found no differences in ambulatory activity compared with control in either group (Walking Away Plus: 121 steps per day, 97.5% confidence interval -290 to 532 steps per day; Walking Away: 91 steps per day, 97.5% confidence interval -282 to 463). This was consistent across ethnic groups. At the intermediate 12-month assessment, the Walking Away Plus group had increased their ambulatory activity by 547 (97.5% confidence interval 211 to 882) steps per day compared with control and were 1.61 (97.5% confidence interval 1.05 to 2.45) times more likely to achieve 150 minutes per week of objectively assessed unbouted moderate to vigorous physical activity. In the Walking Away group, there were no differences compared with control at 12 months. Secondary anthropometric, biomechanical and mental health outcomes were unaltered in either intervention study arm compared with control at 12 or 48 months, with the exception of small, but sustained, reductions in body weight in the Walking Away study arm (≈ 1 kg) at the 12- and 48-month follow-ups. Lifetime cost-effectiveness modelling suggested that usual care had the highest probability of being cost-effective at a threshold of £20,000 per quality-adjusted life-year. Of 50 serious adverse events, only one (myocardial infarction) was deemed possibly related to the intervention and led to the withdrawal of the participant from the study. LIMITATIONS Loss to follow-up, although the results were unaltered when missing data were replaced using multiple imputation. CONCLUSIONS Combining a physical activity intervention with text messaging and telephone support resulted in modest, but clinically meaningful, changes in physical activity at 12 months, but the changes were not sustained at 48 months. FUTURE WORK Future research is needed to investigate which intervention types, components and features can help to maintain physical activity behaviour change over the longer term. TRIAL REGISTRATION Current Controlled Trials ISRCTN83465245. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 77. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration, East Midlands, UK
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration, East Midlands, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Helen Eborall
- Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Laura Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katie Morton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Innovia Technology Limited, Cambridge, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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Mba C, Koulman A, Sharp S, Forouhi N, Imamura F, Assah F, Mbanya JC, Wareham X. Associations of Serum Folate and Holotranscobalamin With Cardiometabolic Risk Factors in Rural and Urban Cameroon. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_051] [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
Objectives
Previous studies mostly in Western populations suggest that a low exposure to B-vitamins (folate and vitamin B12 in particular) are associated with increased cardiometabolic disease risk. This study aimed to examine the association of blood concentrations of folate and holotranscobalamin (holoTC) with cardiometabolic risk factors in adults in Cameroon.
Methods
We conducted a cross-sectional population-based study in 497 adults. We measured serum folate and holoTC by liquid chromatography tandem mass spectrometry and “sandwich” ELISA respectively. Total folate was calculated excluding the oxidation product 5-methyltetrahydrofolate. The outcomes were individual cardiometabolic risk factors and a continuous metabolic risk score. We fitted linear regression models to examine the association between B-vitamins and cardiometabolic risk factors and estimated β-coefficients and 95% confidence intervals per standard deviation (SD) difference in each B vitamin variable.
Results
Mean age was 38.2 (SD: 8.6) years and 63.5% of the participants were women. Mean serum folate was 15.9 (SD: 10.8) nmol/L and holoTC was 74.1 (SD: 33.7) pmol/L. Rural residents had higher concentrations of serum folate but lower holoTC than urban residents. There was a significant inverse association between serum folate and the metabolic risk score (−0.22 (−0.41 to −0.03)) in a multivariable model adjusted for age, sex, education level, smoking, alcohol intake, rural/urban site and BMI. This association was attenuated to the null after further adjustments for objectively measured physical activity (PAEE) and holoTC. HoloTC was positively associated with the metabolic risk score in unadjusted analysis (0.29 (0.08 to 0.51)) but attenuated to the null after adjusting for socio-demographic characteristics. For individual risk factors, an inverse association was observed between serum folate and diastolic blood pressure, which was unaffected by adjustment for confounders including PAEE and holoTC (−1.18 (−2.16 to − 0.20)).
Conclusions
In Cameroon, serum folate and holoTC were associated with the metabolic risk score in opposite directions, partly depending on potential demographic and socioeconomic characteristics. The inverse association between serum folate and the metabolic risk score was likely driven by the blood pressure component.
Funding Sources
None.
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Khunti K, Knighton P, Zaccardi F, Bakhai C, Barron E, Holman N, Kar P, Meace C, Sattar N, Sharp S, Wareham NJ, Weaver A, Woch E, Young B, Valabhji J. Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England. Lancet Diabetes Endocrinol 2021; 9:293-303. [PMID: 33798464 PMCID: PMC8009618 DOI: 10.1016/s2213-8587(21)00050-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND In patients with type 2 diabetes, hyperglycaemia is an independent risk factor for COVID-19-related mortality. Associations between pre-infection prescription for glucose-lowering drugs and COVID-19-related mortality in people with type 2 diabetes have been postulated but only investigated in small studies and limited to a few agents. We investigated whether there are associations between prescription of different classes of glucose-lowering drugs and risk of COVID-19-related mortality in people with type 2 diabetes. METHODS This was a nationwide observational cohort study done with data from the National Diabetes Audit for people with type 2 diabetes and registered with a general practice in England since 2003. Cox regression was used to estimate the hazard ratio (HR) of COVID-19-related mortality in people prescribed each class of glucose-lowering drug, with covariate adjustment with a propensity score to address confounding by demographic, socioeconomic, and clinical factors. FINDINGS Among the 2 851 465 people with type 2 diabetes included in our analyses, 13 479 (0·5%) COVID-19-related deaths occurred during the study period (Feb 16 to Aug 31, 2020), corresponding to a rate of 8·9 per 1000 person-years (95% CI 8·7-9·0). The adjusted HR associated with recorded versus no recorded prescription was 0·77 (95% CI 0·73-0·81) for metformin and 1·42 (1·35-1·49) for insulin. Adjusted HRs for prescription of other individual classes of glucose-lowering treatment were as follows: 0·75 (0·48-1·17) for meglitinides, 0·82 (0·74-0·91) for SGLT2 inhibitors, 0·94 (0·82-1·07) for thiazolidinediones, 0·94 (0·89-0·99) for sulfonylureas, 0·94 (0·83-1·07) for GLP-1 receptor agonists, 1·07 (1·01-1·13) for DPP-4 inhibitors, and 1·26 (0·76-2·09) for α-glucosidase inhibitors. INTERPRETATION Our results provide evidence of associations between prescription of some glucose-lowering drugs and COVID-19-related mortality, although the differences in risk are small and these findings are likely to be due to confounding by indication, in view of the use of different drug classes at different stages of type 2 diabetes disease progression. In the context of the COVID-19 pandemic, there is no clear indication to change prescribing of glucose-lowering drugs in people with type 2 diabetes. FUNDING None.
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Affiliation(s)
- Kamlesh Khunti
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
| | - Peter Knighton
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; NHS Digital, Leeds, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | | | | | - Naomi Holman
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; NHS Digital, Leeds, UK; NHS England and NHS Improvement, London, UK; Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Partha Kar
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; NHS England and NHS Improvement, London, UK; Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Claire Meace
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; NHS Digital, Leeds, UK
| | - Naveed Sattar
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Emilia Woch
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; NHS Digital, Leeds, UK
| | - Bob Young
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; Diabetes UK, London, UK
| | - Jonathan Valabhji
- National Diabetes Audit Programme, NHS England & Improvement, London, UK; NHS England and NHS Improvement, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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de Luca K, McDonald M, Montgomery L, Sharp S, Young A, Vella S, Holmes MM, Aspinall S, Brousseau D, Burrell C, Byfield D, Dane D, Dewhurst P, Downie A, Engel R, Gleberzon B, Hollandsworth D, Nielsen AM, O'Connor L, Starmer D, Tunning M, Wanlass P, D French S. COVID-19: how has a global pandemic changed manual therapy technique education in chiropractic programs around the world? Chiropr Man Therap 2021; 29:7. [PMID: 33522933 PMCID: PMC7849220 DOI: 10.1186/s12998-021-00364-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Manual therapy is a cornerstone of chiropractic education, whereby students work towards a level of skill and expertise that is regarded as competent to work within the field of chiropractic. Due to the COVID-19 pandemic, chiropractic programs in every region around the world had to make rapid changes to the delivery of manual therapy technique education, however what those changes looked like was unknown. Aims The aims of this study were to describe the immediate actions made by chiropractic programs to deliver education for manual therapy techniques and to summarise the experience of academics who teach manual therapy techniques during the initial outbreak of COVID-19 pandemic. Methods A qualitative descriptive approach was used to describe the immediate actions made by chiropractic programs to deliver manual therapy technique education during the COVID-19 pandemic. Chiropractic programs were identified from the webpages of the Councils on Chiropractic Education International and the Council on Chiropractic Education – USA. Between May and June 2020, a convenience sample of academics who lead or teach in manual therapy technique in those programs were invited via email to participate in an online survey with open-ended questions. Responses were entered into the NVivo software program and analysed using a reflexive thematic analysis by a qualitative researcher independent to the data collection. Results Data from 16 academics in 13 separate chiropractic programs revealed five, interconnected themes: Immediate response; Move to online delivery; Impact on learning and teaching; Additional challenges faced by educators; and Ongoing challenges post lockdown. Conclusion This study used a qualitative descriptive approach to describe how some chiropractic programs immediately responded to the initial outbreak of the COVID-19 pandemic in their teaching of manual therapy techniques. Chiropractic programs around the world provided their students with rapid, innovative learning strategies, in an attempt to maintain high standards of chiropractic education; however, challenges included maintaining student engagement in an online teaching environment, psychomotor skills acquisition and staff workload. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00364-7.
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Affiliation(s)
- Katie de Luca
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia.
| | - Marcus McDonald
- Discipline of Chiropractic, RMIT University, Melbourne, Australia
| | - Laura Montgomery
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Stephen Sharp
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Anika Young
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Simon Vella
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | | | - Sasha Aspinall
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Danica Brousseau
- Department of Chiropractic, Université du Québec à Trois-Rivieres, Trois-Rivières, Canada
| | - Chris Burrell
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, UK
| | - Dawn Dane
- Central Queensland University, Brisbane, Australia
| | - Philip Dewhurst
- School of Chiropractic, AECC University College, Bournemouth, UK
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Roger Engel
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Brian Gleberzon
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | | | - Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Laura O'Connor
- Department of Chiropracti, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - David Starmer
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Michael Tunning
- Associate Dean of Clinical Sciences, Palmer College of Chiropractic, Davenport, USA
| | - Paul Wanlass
- Interim Chair, Principles and Practice Department, Southern California University of Health Sciences, Los Angeles College of Chiropractic, Los Angeles, USA
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
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10
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Casey M, Raynor M, Jacob C, Sharp S, McFarlane E. Improving the precision of search strategies for guideline surveillance. Res Synth Methods 2020; 11:903-912. [PMID: 32985071 DOI: 10.1002/jrsm.1461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/13/2020] [Accepted: 09/25/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION AND AIM NICE guideline surveillance determines whether previously published guidelines need updating. The surveillance process must balance time constraints with methodological rigor. It includes a rapid review to identify new evidence to contradict, reinforce or clarify guideline recommendations. Despite this approach, the screening burden can still be high. Applying additional search techniques may increase the precision of the database searches. METHODS A retrospective analysis was conducted on five surveillance reviews with less than 2% of the studies included after screening. Modified searches were run in MEDLINE, Embase and PsycINFO (where appropriate) to test the impact of additional search techniques: focused subject headings, subheadings, frequency operators and title only searches. Modified searches were compared to original search results to determine: the retrieval of included studies, the precision of the search and the number needed to read. Studies not retrieved by the modified search were checked to determine if the surveillance decision would have been affected. RESULTS The additional search techniques tested indicated that a combination of focused subject headings and frequency operators could improve the precision of surveillance searches. The modified search retrieved all the original studies included in the surveillance review for three of the reviews tested. Some of the original included studies were not retrieved for two reviews but the missing studies would not have affected the surveillance decision. CONCLUSIONS Combining focused subject headings and frequency operators is a viable option for improving the precision of surveillance searches without compromising recall and without impacting the surveillance decision.
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Affiliation(s)
- Monica Casey
- Information Services, National Institute for Health and Care Excellence, London, UK
| | - Michael Raynor
- Centre for Guidelines, National Institute for Health and Care Excellence, London, UK
| | - Catherine Jacob
- Information Services, National Institute for Health and Care Excellence, London, UK
| | - Stephen Sharp
- Centre for Guidelines, National Institute for Health and Care Excellence, London, UK
| | - Emma McFarlane
- Centre for Guidelines, National Institute for Health and Care Excellence, London, UK
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11
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Sharp S, Mountziaris P, Logghe H, MacKenzie DG, Ong D, Ferrada P, Wexner SD. Social Media Use during the 2018 American College of Surgeons Clinical Congress. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.785] [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]
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12
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Imanishi J, Chan LWM, Broadhead ML, Pang G, Ngan SY, Slavin J, Sharp S, Choong PFM. Clinical Features of High-Grade Extremity and Trunk Sarcomas in Patients Aged 80 Years and Older: Why Are Outcomes Inferior? Front Surg 2019; 6:29. [PMID: 31214596 PMCID: PMC6554445 DOI: 10.3389/fsurg.2019.00029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The population of many countries is aging and a significant number of elderly patients with soft-tissue sarcoma are being seen at cancer centers. The unique therapeutic and prognostic implications of treating soft-tissue sarcoma in geriatric patients warrant further consideration in order to optimize outcomes. Patients and Methods: This is a single-institution retrospective study of consecutive non-metastatic primary extremity and trunk high-grade sarcomas surgically treated between 1996 and 2012, with at least 2 years of follow-up for survivors. Patient characteristics and oncological outcomes were compared between age groups (≥80 vs. <80 years), using Chi-square or Fisher-exact test and Log-Rank or Wilcoxon test, respectively. Deaths from other causes were censored for disease-specific survival estimation. A p< 0.05 was regarded as statistically significant. Results: A total of 333 cases were eligible for this study. Thirty-six patients (11%) were aged ≥80 years. Unplanned surgery incidence and surgical margin status were comparable between the age groups. Five-year local-recurrence-free, metastasis-free and disease-specific survivals were 72% (≥80 years) vs. 90% (<80 years) (p = 0.004), 59 vs. 70% (p = 0.07) and 55 vs. 80% (p < 0.001), respectively. A significantly earlier first metastasis after surgery (8.3 months vs. 20.5 months, mean) and poorer survival after first metastasis (p = 0.03) were observed. Cox analysis revealed "age ≥80 years" as an independent risk factor for local failure and disease-specific mortality, with hazard ratios of 2.41 (95% CI: 1.09-5.32) and 2.52 (1.33-4.13), respectively. A competing risks analysis also showed that "age ≥80 years" was significantly associated with the disease-specific mortality. Conclusions: Oncological outcomes were significantly worse in high-grade sarcoma patients aged ≥80 years. The findings of more frequent local failure regardless of a consistent primary treatment strategy, an earlier time to first metastasis after surgery, and poorer prognosis after first metastasis suggest that more aggressive tumor biology, in addition to multiple co-morbidity, may explain the inferiority.
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Affiliation(s)
- Jungo Imanishi
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Orthopedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Orthopaedic Surgery, Saitama Medical University Hospital, Moroyama, Japan
| | - Lester W M Chan
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Grant Pang
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Bone and Soft Tissue Tumour Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Samuel Y Ngan
- Bone and Soft Tissue Tumour Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - John Slavin
- Department of Pathology, St. Vincent's Hospital, Fitzroy, VIC, Australia
| | - Stephen Sharp
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Peter F M Choong
- Department of Orthopedics, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
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13
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Silarova B, Sharp S, Usher-Smith JA, Lucas J, Payne RA, Shefer G, Moore C, Girling C, Lawrence K, Tolkien Z, Walker M, Butterworth A, Di Angelantonio E, Danesh J, Griffin SJ. Effect of communicating phenotypic and genetic risk of coronary heart disease alongside web-based lifestyle advice: the INFORM Randomised Controlled Trial. Heart 2019; 105:982-989. [PMID: 30928969 PMCID: PMC6582721 DOI: 10.1136/heartjnl-2018-314211] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/21/2019] [Accepted: 01/25/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To determine whether provision of web-based lifestyle advice and coronary heart disease risk information either based on phenotypic characteristics or phenotypic plus genetic characteristics affects changes in objectively measured health behaviours. Methods A parallel-group, open randomised trial including 956 male and female blood donors with no history of cardiovascular disease (mean [SD] age=56.7 [8.8] years) randomised to four study groups: control group (no information provided); web-based lifestyle advice only (lifestyle group); lifestyle advice plus information on estimated 10-year coronary heart disease risk based on phenotypic characteristics (phenotypic risk estimate) (phenotypic group) and lifestyle advice plus information on estimated 10-year coronary heart disease risk based on phenotypic (phenotypic risk estimate) and genetic characteristics (genetic risk estimate) (genetic group). The primary outcome was change in physical activity from baseline to 12 weeks assessed by wrist-worn accelerometer. Results 928 (97.1%) participants completed the trial. There was no evidence of intervention effects on physical activity (difference in adjusted mean change from baseline): lifestyle group vs control group 0.09 milligravity (mg) (95% CI −1.15 to 1.33); genetic group vs phenotypic group −0.33 mg (95% CI −1.55 to 0.90); phenotypic group and genetic group vs control group −0.52 mg (95% CI −1.59 to 0.55) and vs lifestyle group −0.61 mg (95% CI −1.67 to 0.46). There was no evidence of intervention effects on secondary biological, emotional and health-related behavioural outcomes except self-reported fruit and vegetable intake. Conclusions Provision of risk information, whether based on phenotypic or genotypic characteristics, alongside web-based lifestyle advice did not importantly affect objectively measured levels of physical activity, other health-related behaviours, biological risk factors or emotional well-being. Trial registration number ISRCTN17721237; Pre-results.
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Affiliation(s)
- Barbora Silarova
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- Department of Public Health and Primary Care, The Primary Care Unit, Cambridge, UK
| | - Joanne Lucas
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK
| | - Rupert A Payne
- University of Bristol Centre for Academic Primary Care, Bristol, Bristol, UK.,Institute of Public Health, Cambridge Centre for Health Services Research, Cambridge, UK
| | - Guy Shefer
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Carmel Moore
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK.,Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | | | | | - Zoe Tolkien
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK
| | - Matthew Walker
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK.,Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Adam Butterworth
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK.,Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK.,Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - John Danesh
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, Cambridge, UK.,Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Public Health and Primary Care, The Primary Care Unit, Cambridge, UK
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14
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Kim Y, Sharp S, Hwang S, Jee SH. Exercise and incidence of myocardial infarction, stroke, hypertension, type 2 diabetes and site-specific cancers: prospective cohort study of 257 854 adults in South Korea. BMJ Open 2019; 9:e025590. [PMID: 30872551 PMCID: PMC6430026 DOI: 10.1136/bmjopen-2018-025590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/23/2018] [Revised: 12/05/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the longitudinal associations of exercise frequency with the incidence of myocardial infarction, stroke, hypertension, type 2 diabetes and 10 different cancer outcomes. DESIGN A prospective cohort study. SETTING Physical examination data linked with the entire South Korean population's health insurance system: from 2002 to 2015. PARTICIPANTS 257 854 South Korean adults who provided up to 7 repeat measures of exercise (defined as exercises causing sweat) and confounders. PRIMARY OUTCOME MEASURES Each disease incidence was defined using both fatal and non-fatal health records (a median follow-up period of 13 years). RESULTS Compared with no exercise category, the middle categories of exercise frequency (3-4 or 5-6 times/week) showed the lowest risk of myocardial infarction (HR 0.79; 95% CI 0.70 to 0.90), stroke (HR 0.80; 95% CI 0.73 to 0.89), hypertension (HR 0.86; 95% CI 0.85 to 0.88), type 2 diabetes (HR 0.87; 95% CI 0.84 to 0.89), stomach (HR 0.87; 95% CI 0.79 to 0.96), lung (HR 0.80; 95% CI 0.71 to 0.91), liver (HR 0.85; 95% CI 0.75 to 0.98) and head and neck cancers (HR 0.76; 95% CI 0.63 to 0.93; for 1-2 times/week), exhibiting J-shaped associations. There was, in general, little evidence of effect modification by body mass index, smoking, alcohol consumption, family history of disease and sex in these associations. CONCLUSIONS Moderate levels of sweat-inducing exercise showed the lowest risk of myocardial infarction, stroke, hypertension, type 2 diabetes, stomach, lung, liver and head and neck cancers. Public health and lifestyle interventions should, therefore, promote moderate levels of sweat-causing exercise as a behavioural prevention strategy for non-communicable diseases in a wider population of East Asians.
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Affiliation(s)
- Youngwon Kim
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Semi Hwang
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sun Ha Jee
- Epidemiology, Graduate School of Public Health, Yonsei University, Seoul, South Korea
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15
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Panter J, Mytton O, Sharp S, Brage S, Cummins S, Laverty AA, Wijndaele K, Ogilvie D. Using alternatives to the car and risk of all-cause, cardiovascular and cancer mortality. Heart 2018; 104:1749-1755. [PMID: 29785956 PMCID: PMC6241630 DOI: 10.1136/heartjnl-2017-312699] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/14/2018] [Accepted: 02/25/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate the associations between using alternatives to the car which are more active for commuting and non-commuting purposes, and morbidity and mortality. METHODS We conducted a prospective study using data from 3 58 799 participants, aged 37-73 years, from UK Biobank. Commute and non-commute travel were assessed at baseline in 2006-2010. We classified participants according to whether they relied exclusively on the car or used alternative modes of transport that were more active at least some of the time. The main outcome measures were incident cardiovascular disease (CVD) and cancer, and CVD, cancer and all-cause mortality. We excluded events in the first 2 years and conducted analyses separately for those who regularly commuted and those who did not. RESULTS In maximally adjusted models, regular commuters with more active patterns of travel on the commute had a lower risk of incident (HR 0.89, 95% CI 0.79 to 1.00) and fatal (HR 0.70, 95% CI 0.51 to 0.95) CVD. Those regular commuters who also had more active patterns of non-commute travel had an even lower risk of fatal CVD (HR 0.57, 95% CI 0.39 to 0.85). Among those who were not regular commuters, more active patterns of travel were associated with a lower risk of all-cause mortality (HR 0.92, 95% CI 0.86 to 0.99). CONCLUSIONS More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality in adults. This is an important message for clinicians advising people about how to be physically active and reduce their risk of disease.
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Affiliation(s)
- Jenna Panter
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Oliver Mytton
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | | | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
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16
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Thomson H, Oliver N, Godsland IF, Darzi A, Srivanichakorn W, Majeed A, Johnston DG, Nanditha A, Snehalatha C, Raghavan A, Susairaj P, Simon M, Satheesh K, Ramachandran A, Sharp S, Westgate K, Brage S, Wareham N. Protocol for a clinical trial of text messaging in addition to standard care versus standard care alone in prevention of type 2 diabetes through lifestyle modification in India and the UK. BMC Endocr Disord 2018; 18:63. [PMID: 30200935 PMCID: PMC6131868 DOI: 10.1186/s12902-018-0293-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/09/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a serious clinical problem in both India and the UK. Adoption of a healthy lifestyle through dietary and physical activity modification can help prevent type 2 diabetes. However, implementing lifestyle modification programmes to high risk groups is expensive and alternative cheaper methods are needed. We are using a short messaging service (SMS) programme in our study as a tool to provide healthy lifestyle advice and an aid to motivation. The aim of the study is to assess the efficacy and user acceptability of text messaging employed in this way for people with pre-diabetes (HbA1c 6.0% to ≤6.4%; 42-47 mmol/mol) in the UK and India. METHODS/DESIGN This is a randomised, controlled trial with participants followed up for 2 years. After being screened and receiving a structured education programme for prediabetes, participants are randomised to a control or intervention group. In the intervention group, text messages are delivered 2-3 times weekly and contain educational, motivational and supportive content on diet, physical activity, lifestyle and smoking. The control group undergoes monitoring only. In India, the trial involves 5 visits after screening (0, 6, 12, 18 and 24 months). In the UK there are 4 visits after screening (0, 6, 12 and 24 months). Questionnaires (EQ-5D, RPAQ, Transtheoretical Model of Behavioural Change, and food frequency (UK)/24 h dietary recall (India)) and physical activity monitors (Actigraph GT3X+ accelerometers) are assessed at baseline and all follow-up visits. The SMS acceptability questionnaires are evaluated in all follow-up visits. The primary outcome is progression to type 2 diabetes as defined by an HbA1c of 6.5% or over(India) and by any WHO criterion(UK). Secondary outcomes are the changes in body weight, body mass index, waist circumference, blood pressure, fasting plasma glucose; lipids; proportion of participants achieving HbA1c ≤6.0%; HOMA-IR; HOMA-β; acceptability of SMS; dietary parameters; physical activity and quality of life. DISCUSSION The study is designed to assess the efficacy of tailored text messaging in addition to standard lifestyle advice to reduce the progression from prediabetes to type 2 diabetes in the two different countries. TRIAL REGISTRATION ClinicalTrials.gov ; NCT01570946 , 4th April 2012 (India); NCT01795833 , 21st February 2013 (UK).
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Affiliation(s)
- Hazel Thomson
- Diabetes and Endocrinology, Imperial College London St Mary’s Hospital Campus, Norfolk Place, London, W2 1PG UK
| | - Nick Oliver
- Diabetes and Endocrinology, Imperial College London St Mary’s Hospital Campus, Norfolk Place, London, W2 1PG UK
| | - Ian F. Godsland
- Diabetes and Endocrinology, Imperial College London St Mary’s Hospital Campus, Norfolk Place, London, W2 1PG UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital Campus, Norfolk Place, London, W2 1PG UK
| | - Weerachai Srivanichakorn
- Diabetes and Endocrinology, Imperial College London St Mary’s Hospital Campus, Norfolk Place, London, W2 1PG UK
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700 Thailand
| | - Azeem Majeed
- Primary Care and Public Health, Imperial College London Charing Cross Hospital Campus, Reynolds Building, Hammersmith, London, w6 8RP UK
| | - Desmond G. Johnston
- Diabetes and Endocrinology, Imperial College London St Mary’s Hospital Campus, Norfolk Place, London, W2 1PG UK
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Mary Simon
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, 28 Marshalls Road, Egmore, Chennai, 600 008 India
| | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0SL UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0SL UK
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0SL UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0SL UK
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17
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Griffin SJ, Bethel MA, Holman RR, Khunti K, Wareham N, Brierley G, Davies M, Dymond A, Eichenberger R, Evans P, Gray A, Greaves C, Harrington K, Hitman G, Irving G, Lessels S, Millward A, Petrie JR, Rutter M, Sampson M, Sattar N, Sharp S. Metformin in non-diabetic hyperglycaemia: the GLINT feasibility RCT. Health Technol Assess 2018; 22:1-64. [PMID: 29652246 PMCID: PMC5925436 DOI: 10.3310/hta22180] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The treatment of people with diabetes with metformin can reduce cardiovascular disease (CVD) and may reduce the risk of cancer. However, it is unknown whether or not metformin can reduce the risk of these outcomes in people with elevated blood glucose levels below the threshold for diabetes [i.e. non-diabetic hyperglycaemia (NDH)]. OBJECTIVE To assess the feasibility of the Glucose Lowering In Non-diabetic hyperglycaemia Trial (GLINT) and to estimate the key parameters to inform the design of the full trial. These parameters include the recruitment strategy, randomisation, electronic data capture, postal drug distribution, retention, study medication adherence, safety monitoring and remote collection of outcome data. DESIGN A multicentre, individually randomised, double-blind, parallel-group, pragmatic, primary prevention trial. Participants were individually randomised on a 1 : 1 basis, blocked within each site. SETTING General practices and clinical research facilities in Cambridgeshire, Norfolk and Leicestershire. PARTICIPANTS Males and females aged ≥ 40 years with NDH who had a high risk of CVD. INTERVENTIONS Prolonged-release metformin (500 mg) (Glucophage® SR, Merck KGaA, Bedfont Cross, Middlesex, UK) or the matched placebo, up to three tablets per day, distributed by post. MAIN OUTCOME MEASURES Recruitment rates; adherence to study medication; laboratory results at baseline and 3 and 6 months; reliability and acceptability of study drug delivery; questionnaire return rates; and quality of life. RESULTS We sent 5251 invitations, with 511 individuals consenting to participate. Of these, 249 were eligible and were randomised between March and November 2015 (125 to the metformin group and 124 to the placebo group). Participants were followed up for 0.99 years [standard deviation (SD) 0.30 years]. The use of electronic medical records to identify potentially eligible individuals in individual practices was resource intensive. Participants were generally elderly [mean age 70 years (SD 6.7 years)], overweight [mean body mass index 30.1 kg/m2 (SD 4.5 kg/m2)] and male (88%), and the mean modelled 10-year CVD risk was 28.8% (SD 8.5%). Randomisation, postal delivery of the study drug and outcome assessment using registers/medical records were feasible and acceptable to participants. Most participants were able to take three tablets per day, but premature discontinuation of the study drug was common (≈30% of participants by 6 months), although there were no differences between the groups. All randomised participants returned questionnaires at baseline and 67% of participants returned questionnaires by the end of the study. There was no between-group difference in Short Form questionnaire-8 items or EuroQol-5 Dimensions scores. Compared with placebo, metformin was associated with small improvements in the mean glycated haemoglobin level [-0.82 mmol/mol, 95% confidence interval (CI) -1.39 to -0.24 mmol/mol], mean estimated glomerular filtration rate (2.31 ml/minute/1.73 m2, 95% CI -0.2 to 4.81 ml/minute/1.73 m2) and mean low-density lipoprotein cholesterol level (-0.11 mmol/l, 95% CI -0.25 to 0.02 mmol/l) and a reduction in mean plasma vitamin B12 level (-16.4 ng/l, 95% CI -32.9 to -0.01 ng/l). There were 35 serious adverse events (13 in the placebo group, 22 in the metformin group), with none deemed to be treatment related. LIMITATIONS Changes to sponsorship reduced the study duration, the limited availability of information in medical records reduced recruitment efficiency and discontinuation of study medication exceeded forecasts. CONCLUSIONS A large, pragmatic trial comparing the effects of prolonged-release metformin and placebo on the risk of CVD events is potentially feasible. However, changes to the study design and conduct are recommended to enable an efficient scaling up of the trial. Recommendations include changing the inclusion criteria to recruit people with pre-existing CVD to increase the recruitment and event rates, using large primary/secondary care databases to increase recruitment rates, conducting follow-up remotely to improve efficiency and including a run-in period prior to randomisation to optimise trial adherence. TRIAL REGISTRATION Current Controlled Trials ISRCTN34875079. FUNDING The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 18. See the NIHR Journals Library website for further project information. Merck KGaA provided metformin and matching placebo.
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Affiliation(s)
- Simon J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Rury R Holman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nicholas Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Gwen Brierley
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Andrew Dymond
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rose Eichenberger
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Kyla Harrington
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Graham Hitman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Greg Irving
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Sarah Lessels
- Diabetes Trials Unit, University of Oxford, Oxford, UK
| | | | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martin Rutter
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Mike Sampson
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Diabetes, Endocrinology and General Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stephen Sharp
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
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Sharp S, Lee J, Chawla S. CT colonography practice at a university teaching hospital: improving standards. Colorectal Dis 2017; 19:693. [PMID: 28586145 DOI: 10.1111/codi.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 02/08/2023]
Affiliation(s)
- S Sharp
- Department of Radiology, University Hospital Aintree, Liverpool, UK
| | - J Lee
- Department of Radiology, University Hospital Aintree, Liverpool, UK
| | - S Chawla
- Department of Radiology, University Hospital Aintree, Liverpool, UK
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Urquhart CJ, Massiter CA, Thomas RE, Sharp S, Smith J. Integrating information services with vocational training: the GIVTS project experience. Health Informatics J 2016. [DOI: 10.1177/146045829900500409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The GIVTS project (Getting Information to Vocational Trainees: an evaluative study) was a two-year study (January 1997-January 1999) of the effectiveness of providing tailored information services to vocational trainees throughout their three-year training period to become general (family) practitioners (GPs). This paper focuses on the problems of collaborative working between the information services and vocational training to ensure that trainees obtain the support they need for evidence-based practice.
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Affiliation(s)
- C. J. Urquhart
- Department of Information and Library Studies, University of Wales, Aberystwyth Llanbadarn Campus, Aberystwyth, SY23 3AS, UK,
| | | | | | - S. Sharp
- University of Wales, Aberystwith
| | - J. Smith
- University of Wales, Aberystwith
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20
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West TA, Sharp S. Neuroendocrine dysfunction following mild TBI: when to screen for it. J Fam Pract 2014; 63:11-16. [PMID: 24475461] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Therese A West
- CCSi contracting support for Defense and Veterans Brain Injury Center, The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Silver Spring, MD, USA.
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Goodman A, Panter J, Sharp S, Ogilvie D. OP22 Effectiveness and Equity Impact of Town-Wide Cycling Investment in England: A Longitudinal, Controlled Natural Experimental Study. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Pfister R, Michels G, Sharp S, Luben R, Wareham N, Khaw KT. Urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2478] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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den Hoed M, Eijgelsheim M, Esko T, Brundel BJJM, Peal DS, Evans DM, Nolte IM, Segrè AV, Holm H, Handsaker RE, Westra HJ, Johnson T, Isaacs A, Yang J, Lundby A, Zhao JH, Kim YJ, Go MJ, Almgren P, Bochud M, Boucher G, Cornelis MC, Gudbjartsson D, Hadley D, van der Harst P, Hayward C, den Heijer M, Igl W, Jackson AU, Kutalik Z, Luan J, Kemp JP, Kristiansson K, Ladenvall C, Lorentzon M, Montasser ME, Njajou OT, O'Reilly PF, Padmanabhan S, St Pourcain B, Rankinen T, Salo P, Tanaka T, Timpson NJ, Vitart V, Waite L, Wheeler W, Zhang W, Draisma HHM, Feitosa MF, Kerr KF, Lind PA, Mihailov E, Onland-Moret NC, Song C, Weedon MN, Xie W, Yengo L, Absher D, Albert CM, Alonso A, Arking DE, de Bakker PIW, Balkau B, Barlassina C, Benaglio P, Bis JC, Bouatia-Naji N, Brage S, Chanock SJ, Chines PS, Chung M, Darbar D, Dina C, Dörr M, Elliott P, Felix SB, Fischer K, Fuchsberger C, de Geus EJC, Goyette P, Gudnason V, Harris TB, Hartikainen AL, Havulinna AS, Heckbert SR, Hicks AA, Hofman A, Holewijn S, Hoogstra-Berends F, Hottenga JJ, Jensen MK, Johansson A, Junttila J, Kääb S, Kanon B, Ketkar S, Khaw KT, Knowles JW, Kooner AS, Kors JA, Kumari M, Milani L, Laiho P, Lakatta EG, Langenberg C, Leusink M, Liu Y, Luben RN, Lunetta KL, Lynch SN, Markus MRP, Marques-Vidal P, Mateo Leach I, McArdle WL, McCarroll SA, Medland SE, Miller KA, Montgomery GW, Morrison AC, Müller-Nurasyid M, Navarro P, Nelis M, O'Connell JR, O'Donnell CJ, Ong KK, Newman AB, Peters A, Polasek O, Pouta A, Pramstaller PP, Psaty BM, Rao DC, Ring SM, Rossin EJ, Rudan D, Sanna S, Scott RA, Sehmi JS, Sharp S, Shin JT, Singleton AB, Smith AV, Soranzo N, Spector TD, Stewart C, Stringham HM, Tarasov KV, Uitterlinden AG, Vandenput L, Hwang SJ, Whitfield JB, Wijmenga C, Wild SH, Willemsen G, Wilson JF, Witteman JCM, Wong A, Wong Q, Jamshidi Y, Zitting P, Boer JMA, Boomsma DI, Borecki IB, van Duijn CM, Ekelund U, Forouhi NG, Froguel P, Hingorani A, Ingelsson E, Kivimaki M, Kronmal RA, Kuh D, Lind L, Martin NG, Oostra BA, Pedersen NL, Quertermous T, Rotter JI, van der Schouw YT, Verschuren WMM, Walker M, Albanes D, Arnar DO, Assimes TL, Bandinelli S, Boehnke M, de Boer RA, Bouchard C, Caulfield WLM, Chambers JC, Curhan G, Cusi D, Eriksson J, Ferrucci L, van Gilst WH, Glorioso N, de Graaf J, Groop L, Gyllensten U, Hsueh WC, Hu FB, Huikuri HV, Hunter DJ, Iribarren C, Isomaa B, Jarvelin MR, Jula A, Kähönen M, Kiemeney LA, van der Klauw MM, Kooner JS, Kraft P, Iacoviello L, Lehtimäki T, Lokki MLL, Mitchell BD, Navis G, Nieminen MS, Ohlsson C, Poulter NR, Qi L, Raitakari OT, Rimm EB, Rioux JD, Rizzi F, Rudan I, Salomaa V, Sever PS, Shields DC, Shuldiner AR, Sinisalo J, Stanton AV, Stolk RP, Strachan DP, Tardif JC, Thorsteinsdottir U, Tuomilehto J, van Veldhuisen DJ, Virtamo J, Viikari J, Vollenweider P, Waeber G, Widen E, Cho YS, Olsen JV, Visscher PM, Willer C, Franke L, Erdmann J, Thompson JR, Pfeufer A, Sotoodehnia N, Newton-Cheh C, Ellinor PT, Stricker BHC, Metspalu A, Perola M, Beckmann JS, Smith GD, Stefansson K, Wareham NJ, Munroe PB, Sibon OCM, Milan DJ, Snieder H, Samani NJ, Loos RJF. Identification of heart rate-associated loci and their effects on cardiac conduction and rhythm disorders. Nat Genet 2013; 45:621-31. [PMID: 23583979 DOI: 10.1038/ng.2610] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/21/2013] [Indexed: 12/16/2022]
Abstract
Elevated resting heart rate is associated with greater risk of cardiovascular disease and mortality. In a 2-stage meta-analysis of genome-wide association studies in up to 181,171 individuals, we identified 14 new loci associated with heart rate and confirmed associations with all 7 previously established loci. Experimental downregulation of gene expression in Drosophila melanogaster and Danio rerio identified 20 genes at 11 loci that are relevant for heart rate regulation and highlight a role for genes involved in signal transmission, embryonic cardiac development and the pathophysiology of dilated cardiomyopathy, congenital heart failure and/or sudden cardiac death. In addition, genetic susceptibility to increased heart rate is associated with altered cardiac conduction and reduced risk of sick sinus syndrome, and both heart rate-increasing and heart rate-decreasing variants associate with risk of atrial fibrillation. Our findings provide fresh insights into the mechanisms regulating heart rate and identify new therapeutic targets.
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Affiliation(s)
- Marcel den Hoed
- Medical Research Council MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
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Affiliation(s)
- C. H. Sheth
- Department of Nutrition & Dietetics; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - S. Sharp
- Department of Nutrition & Dietetics; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - E. R. Walters
- Department of Nutrition & Dietetics; University Hospital Southampton NHS Foundation Trust; Southampton UK
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Corder K, Sharp S, Griffin S, Jones A, Ekelund U, van Sluijs E. Change in objectively measured physical activity during the transition to adolescence: Targets for intervention. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.612] [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: 10/27/2022]
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Beulens JWJ, van der Schouw YT, Bergmann MM, Rohrmann S, Schulze MB, Buijsse B, Grobbee DE, Arriola L, Cauchi S, Tormo MJ, Allen NE, van der A DL, Balkau B, Boeing H, Clavel-Chapelon F, de Lauzon-Guillan B, Franks P, Froguel P, Gonzales C, Halkjaer J, Huerta JM, Kaaks R, Key TJ, Khaw KT, Krogh V, Molina-Montes E, Nilsson P, Overvad K, Palli D, Panico S, Ramón Quirós J, Rolandsson O, Romieu I, Romaguera D, Sacerdote C, Sánchez MJ, Spijkerman AMW, Teucher B, Tjonneland A, Tumino R, Sharp S, Forouhi NG, Langenberg C, Feskens EJM, Riboli E, Wareham NJ. Alcohol consumption and risk of type 2 diabetes in European men and women: influence of beverage type and body size The EPIC-InterAct study. J Intern Med 2012; 272:358-70. [PMID: 22353562 DOI: 10.1111/j.1365-2796.2012.02532.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association between alcohol consumption and type 2 diabetes, and determine whether this is modified by sex, body mass index (BMI) and beverage type. DESIGN Multicentre prospective case-cohort study. SETTING Eight countries from the European Prospective Investigation into Cancer and Nutrition cohort. SUBJECTS A representative baseline sample of 16 154 participants and 12 403 incident cases of type 2 diabetes. INTERVENTIONS Alcohol consumption assessed using validated dietary questionnaires. MAIN OUTCOME MEASURES Occurrence of type 2 diabetes based on multiple sources (mainly self-reports), verified against medical information. RESULTS Amongst men, moderate alcohol consumption was nonsignificantly associated with a lower incidence of diabetes with a hazard ratio (HR) of 0.90 (95% CI: 0.78-1.05) for 6.1-12.0 versus 0.1-6.0 g day(-1) , adjusted for dietary and diabetes risk factors. However, the lowest risk was observed at higher intakes of 24.1-96.0 g day(-1) with an HR of 0.86 (95% CI: 0.75-0.98). Amongst women, moderate alcohol consumption was associated with a lower incidence of diabetes with a hazard ratio of 0.82 (95% CI: 0.72-0.92) for 6.1-12.0 g day(-1) (P interaction gender <0.01). The inverse association between alcohol consumption and diabetes was more pronounced amongst overweight (BMI ≥ 25 kg m(-2) ) than normal-weight men and women (P interaction < 0.05). Adjusting for waist and hip circumference did not alter the results for men, but attenuated the association for women (HR=0.90, 95% CI: 0.79-1.03 for 6.1-12.0 g day(-1) ). Wine consumption for men and fortified wine consumption for women were most strongly associated with a reduced risk of diabetes. CONCLUSIONS The results of this study show that moderate alcohol consumption is associated with a lower risk of type 2 diabetes amongst women only. However, this risk reduction is in part explained by fat distribution. The relation between alcohol consumption and type 2 diabetes was stronger for overweight than normal-weight women and men.
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Sacerdote C, Ricceri F, Rolandsson O, Baldi I, Chirlaque MD, Feskens E, Bendinelli B, Ardanaz E, Arriola L, Balkau B, Bergmann M, Beulens JWJ, Boeing H, Clavel-Chapelon F, Crowe F, de Lauzon-Guillain B, Forouhi N, Franks PW, Gallo V, Gonzalez C, Halkjær J, Illner AK, Kaaks R, Key T, Khaw KT, Navarro C, Nilsson PM, Dal Ton SO, Overvad K, Pala V, Palli D, Panico S, Polidoro S, Quirós JR, Romieu I, Sánchez MJ, Slimani N, Sluijs I, Spijkerman A, Teucher B, Tjønneland A, Tumino R, van der A D, Vergnaud AC, Wennberg P, Sharp S, Langenberg C, Riboli E, Vineis P, Wareham N. Lower educational level is a predictor of incident type 2 diabetes in European countries: the EPIC-InterAct study. Int J Epidemiol 2012; 41:1162-73. [PMID: 22736421 DOI: 10.1093/ije/dys091] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship. Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340, 234, 3.99 million person-years of follow-up). A random sub-cohort of 16,835 individuals and a total of 12,403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed. RESULTS Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women). CONCLUSION This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.
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Marks C, Sharp S, Chetty K, Warde C, Seddon P. 243 “My child tastes salty”: children's and parents’ understanding of salt losses in cystic fibrosis. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60412-3] [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: 10/28/2022]
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Mortellaro V, Fike F, Sharp S, St. Peter S. Operative Findings in Antenatal Abdominal Masses of Unknown Etiology in Females. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.940] [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: 11/24/2022]
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Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD, Ekelund U, Lévy-Marchal C, Jarvelin MR, Kuh D, Ong KK. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol 2012; 26:19-26. [PMID: 22150704 DOI: 10.1111/j.1365-3016.2011.01213.x] [Citation(s) in RCA: 296] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To assess the predictive ability of infant weight gain on subsequent obesity we performed a meta-analysis of individual-level data on 47,661 participants from 10 cohort studies from the UK, France, Finland, Sweden, the US and Seychelles. For each individual, weight SD scores at birth and age 1 year were calculated using the same external reference (British 1990). Childhood obesity was defined by International Obesity Task Force criteria. Each +1 unit increase in weight SD scores between 0 and 1 year conferred a twofold higher risk of childhood obesity (odds ratio = 1.97 [95% confidence interval (CI) 1.83, 2.12]), and a 23% higher risk of adult obesity (odds ratio = 1.23 [1.16, 1.30]), adjusted for sex, age and birthweight. There was little heterogeneity between studies. A risk score for childhood obesity comprising weight gain 0-1 year, mother's body mass index, birthweight and sex was generated in a random 50% selection of individuals from general population cohorts with available information (n = 8236); this score showed moderate predictive ability in the remaining 50% sample (area under receiving operating curve = 77% [95% CI 74, 80%]). A separate risk score for childhood overweight showed similar predictive ability (area under receiving operating curve = 76% [73, 79%]). In conclusion, infant weight gain showed a consistent positive association with subsequent obesity. A risk score combining birthweight and infant weight gain (or simply infant weight), together with mother's body mass index and sex may allow early stratification of infants at risk of childhood obesity.
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Affiliation(s)
- Céline Druet
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
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Abstract
Bubbles in supersaturated tissues and blood occur in beaked whales stranded near sonar exercises, and post-mortem in dolphins bycaught at depth and then hauled to the surface. To evaluate live dolphins for bubbles, liver, kidneys, eyes and blubber-muscle interface of live-stranded and capture-release dolphins were scanned with B-mode ultrasound. Gas was identified in kidneys of 21 of 22 live-stranded dolphins and in the hepatic portal vasculature of 2 of 22. Nine then died or were euthanized and bubble presence corroborated by computer tomography and necropsy, 13 were released of which all but two did not re-strand. Bubbles were not detected in 20 live wild dolphins examined during health assessments in shallow water. Off-gassing of supersaturated blood and tissues was the most probable origin for the gas bubbles. In contrast to marine mammals repeatedly diving in the wild, stranded animals are unable to recompress by diving, and thus may retain bubbles. Since the majority of beached dolphins released did not re-strand it also suggests that minor bubble formation is tolerated and will not lead to clinically significant decompression sickness.
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Affiliation(s)
- S Dennison
- Department of Biology, Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA
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Pfister R, Sharp S, Luben R, Welsh P, Barroso I, Salomaa V, Meirhaeghe A, Khaw KT, Sattar N, Langenberg C, Wareham NJ. Mendelian randomization study of B-type natriuretic peptide and type 2 diabetes: evidence of causal association from population studies. PLoS Med 2011; 8:e1001112. [PMID: 22039354 PMCID: PMC3201934 DOI: 10.1371/journal.pmed.1001112] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [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: 03/13/2011] [Accepted: 09/15/2011] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Genetic and epidemiological evidence suggests an inverse association between B-type natriuretic peptide (BNP) levels in blood and risk of type 2 diabetes (T2D), but the prospective association of BNP with T2D is uncertain, and it is unclear whether the association is confounded. METHODS AND FINDINGS We analysed the association between levels of the N-terminal fragment of pro-BNP (NT-pro-BNP) in blood and risk of incident T2D in a prospective case-cohort study and genotyped the variant rs198389 within the BNP locus in three T2D case-control studies. We combined our results with existing data in a meta-analysis of 11 case-control studies. Using a Mendelian randomization approach, we compared the observed association between rs198389 and T2D to that expected from the NT-pro-BNP level to T2D association and the NT-pro-BNP difference per C allele of rs198389. In participants of our case-cohort study who were free of T2D and cardiovascular disease at baseline, we observed a 21% (95% CI 3%-36%) decreased risk of incident T2D per one standard deviation (SD) higher log-transformed NT-pro-BNP levels in analysis adjusted for age, sex, body mass index, systolic blood pressure, smoking, family history of T2D, history of hypertension, and levels of triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The association between rs198389 and T2D observed in case-control studies (odds ratio = 0.94 per C allele, 95% CI 0.91-0.97) was similar to that expected (0.96, 0.93-0.98) based on the pooled estimate for the log-NT-pro-BNP level to T2D association derived from a meta-analysis of our study and published data (hazard ratio = 0.82 per SD, 0.74-0.90) and the difference in NT-pro-BNP levels (0.22 SD, 0.15-0.29) per C allele of rs198389. No significant associations were observed between the rs198389 genotype and potential confounders. CONCLUSIONS Our results provide evidence for a potential causal role of the BNP system in the aetiology of T2D. Further studies are needed to investigate the mechanisms underlying this association and possibilities for preventive interventions. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Roman Pfister
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.
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Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N, Ekelund U, Barroso I, Panico S, Tormo MJ, Spranger J, Griffin S, van der Schouw YT, Amiano P, Ardanaz E, Arriola L, Balkau B, Barricarte A, Beulens JWJ, Boeing H, Bueno-de-Mesquita HB, Buijsse B, Chirlaque Lopez MD, Clavel-Chapelon F, Crowe FL, de Lauzon-Guillan B, Deloukas P, Dorronsoro M, Drogan D, Froguel P, Gonzalez C, Grioni S, Groop L, Groves C, Hainaut P, Halkjaer J, Hallmans G, Hansen T, Huerta Castaño JM, Kaaks R, Key TJ, Khaw KT, Koulman A, Mattiello A, Navarro C, Nilsson P, Norat T, Overvad K, Palla L, Palli D, Pedersen O, Peeters PH, Quirós JR, Ramachandran A, Rodriguez-Suarez L, Rolandsson O, Romaguera D, Romieu I, Sacerdote C, Sánchez MJ, Sandbaek A, Slimani N, Sluijs I, Spijkerman AMW, Teucher B, Tjonneland A, Tumino R, van der A DL, Verschuren WMM, Tuomilehto J, Feskens E, McCarthy M, Riboli E, Wareham NJ. Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia 2011; 54:2272-82. [PMID: 21717116 PMCID: PMC4222062 DOI: 10.1007/s00125-011-2182-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS Studying gene-lifestyle interaction may help to identify lifestyle factors that modify genetic susceptibility and uncover genetic loci exerting important subgroup effects. Adequately powered studies with prospective, unbiased, standardised assessment of key behavioural factors for gene-lifestyle studies are lacking. This case-cohort study aims to investigate how genetic and potentially modifiable lifestyle and behavioural factors, particularly diet and physical activity, interact in their influence on the risk of developing type 2 diabetes. METHODS Incident cases of type 2 diabetes occurring in European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts between 1991 and 2007 from eight of the ten EPIC countries were ascertained and verified. Prentice-weighted Cox regression and random-effects meta-analyses were used to investigate differences in diabetes incidence by age and sex. RESULTS A total of 12,403 verified incident cases of type 2 diabetes occurred during 3.99 million person-years of follow-up of 340,234 EPIC participants eligible for InterAct. We defined a centre-stratified subcohort of 16,154 individuals for comparative analyses. Individuals with incident diabetes who were randomly selected into the subcohort (n = 778) were included as cases in the analyses. All prevalent diabetes cases were excluded from the study. InterAct cases were followed-up for an average of 6.9 years; 49.7% were men. Mean baseline age and age at diagnosis were 55.6 and 62.5 years, mean BMI and waist circumference values were 29.4 kg/m(2) and 102.7 cm in men, and 30.1 kg/m(2) and 92.8 cm in women, respectively. Risk of type 2 diabetes increased linearly with age, with an overall HR of 1.56 (95% CI 1.48-1.64) for a 10 year age difference, adjusted for sex. A male excess in the risk of incident diabetes was consistently observed across all countries, with a pooled HR of 1.51 (95% CI 1.39-1.64), adjusted for age. CONCLUSIONS/INTERPRETATION InterAct is a large, well-powered, prospective study that will inform our understanding of the interplay between genes and lifestyle factors on the risk of type 2 diabetes development.
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Affiliation(s)
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- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Box 285, Cambridge CB2 0QQ, UK e-mail:
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Thompson S, Ekelund U, Jebb S, Lindroos AK, Mander A, Sharp S, Turner R, Wilks D. A proposed method of bias adjustment for meta-analyses of published observational studies. Int J Epidemiol 2011; 40:765-77. [PMID: 21186183 PMCID: PMC3147067 DOI: 10.1093/ije/dyq248] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [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] [Accepted: 11/24/2010] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Interpretation of meta-analyses of published observational studies is problematic because of numerous sources of bias. We develop bias assessment, elicitation and adjustment methods, and apply them to a systematic review of longitudinal observational studies of the relationship between objectively measured physical activity and subsequent change in adiposity in children. METHODS We separated internal biases that reflect study quality from external biases that reflect generalizability to a target setting. Since published results were presented in different formats, these were all converted to correlation coefficients. Biases were considered as additive or proportional on the correlation scale. Opinions about the extent of each bias in each study, together with its uncertainty, were elicited in a formal process from quantitatively trained assessors for the internal biases and subject-matter specialists for the external biases. Bias-adjusted results for each study were combined across assessors using median pooling, and results combined across studies by random-effects meta-analysis. RESULTS Before adjusting for bias, the pooled correlation is difficult to interpret because the studies varied substantially in quality and design, and there was considerable heterogeneity. After adjusting for both the internal and external biases, the pooled correlation provides a meaningful quantitative summary of all available evidence, and the confidence interval incorporates the elicited uncertainties about the extent of the biases. In the adjusted meta-analysis, there was no apparent heterogeneity. CONCLUSION This approach provides a viable method of bias adjustment for meta-analyses of observational studies, allowing the quantitative synthesis of evidence from otherwise incompatible studies. From the meta-analysis of longitudinal observational studies, we conclude that there is no evidence that physical activity is associated with gain in body fat.
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de Silva-Sanigorski A, Elea D, Bell C, Kremer P, Carpenter L, Nichols M, Smith M, Sharp S, Boak R, Swinburn B. Obesity prevention in the family day care setting: impact of the Romp & Chomp intervention on opportunities for children's physical activity and healthy eating. Child Care Health Dev 2011; 37:385-93. [PMID: 21276039 DOI: 10.1111/j.1365-2214.2010.01205.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Romp & Chomp intervention reduced the prevalence of overweight/obesity in pre-school children in Geelong, Victoria, Australia through an intervention promoting healthy eating and active play in early childhood settings. This study aims to determine if the intervention successfully created more health promoting family day care (FDC) environments. METHODS The evaluation had a cross-sectional, quasi-experimental design with the intervention FDC service in Geelong and a comparison sample from 17 FDC services across Victoria. A 45-item questionnaire capturing nutrition- and physical activity-related aspects of the policy, socio-cultural and physical environments of the FDC service was completed by FDC care providers (in 2008) in the intervention (n= 28) and comparison (n= 223) samples. RESULTS Select results showed intervention children spent less time in screen-based activities (P= 0.03), organized active play (P < 0.001) and free inside play (P= 0.03) than comparison children. There were more rules related to healthy eating (P < 0.001), more care provider practices that supported children's positive meal experiences (P < 0.001), fewer unhealthy food items allowed (P= 0.05), higher odds of staff being trained in nutrition (P= 0.04) and physical activity (P < 0.001), lower odds of having set minimum times for outside (P < 0.001) and organized (P= 0.01) active play, and of rewarding children with food (P < 0.001). CONCLUSIONS Romp & Chomp improved the FDC service to one that discourages sedentary behaviours and promotes opportunities for children to eat nutritious foods. Ongoing investment to increase children's physical activity within the setting and improving the capacity and health literacy of care providers is required to extend and sustain the improvements.
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Affiliation(s)
- A de Silva-Sanigorski
- WHO Collaborating Centre for Obesity Prevention, Deakin University and McCaughey Centre and Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic. Australia.
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Kilfedder C, Power K, Karatzias T, McCafferty A, Niven K, Chouliara Z, Galloway L, Sharp S. A randomized trial of face-to-face counselling versus telephone counselling versus bibliotherapy for occupational stress. Psychol Psychother 2010; 83:223-42. [PMID: 19843354 DOI: 10.1348/147608309x476348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the effectiveness and acceptability of three interventions for occupational stress. METHODS/DESIGN A total of 90 National Health Service employees were randomized to face-to-face counselling or telephone counselling or bibliotherapy. Outcomes were assessed at post-intervention and 4-month follow-up. Clinical Outcomes in Routine Evaluation (CORE), General Health Questionnaire (GHQ-12), and Perceived Stress Scale (PSS-10) were used to evaluate intervention outcomes. An intention-to-treat analyses was performed. RESULTS Repeated measures analysis revealed significant time effects on all measures with the exception of CORE Risk. No significant group effects were detected on all outcome measures. No time by group significant interaction effects were detected on any of the outcome measures with the exception of CORE Functioning and GHQ total. With regard to acceptability of interventions, participants expressed a preference for face-to-face counselling over the other two modalities. CONCLUSIONS Overall, it was concluded that the three intervention groups are equally effective. Given that bibliotherapy is the least costly of the three, results from the present study might be considered in relation to a stepped care approach to occupational stress management with bibliotherapy as the first line of intervention, followed by telephone and face-to-face counselling as required.
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Schuchardt M, Toelle M, Huang T, Wiedon A, Van Der Giet M, Mill C, George S, Jeremy J, Santulli G, Illario M, Cipolletta E, Sorriento D, Del Giudice C, Anastasio A, Trimarco B, Iaccarino G, Jobs A, Wagner C, Kurtz A, De Wit C, Koller A, Suvorava T, Weber M, Dao V, Kojda G, Tsaousi A, Lyon C, Williams H, George S, Barth N, Loot A, Fleming I, Keul P, Lucke S, Graeler M, Heusch G, Levkau B, Biessen E, De Jager S, Bermudez-Pulgarin B, Bot I, Abia R, Van Berkel T, Renger A, Noack C, Zafiriou M, Dietz R, Bergmann M, Zelarayan L, Hammond J, Hamelet J, Van Assche T, Belge C, Vanderper A, Langin D, Herijgers P, Balligand J, Perrot A, Neubert M, Dietz R, Posch M, Oezcelik C, Posch M, Waldmuller S, Perrot A, Berger F, Scheffold T, Bouvagnet P, Ozcelik C, Lebreiro A, Martins E, Lourenco P, Cruz C, Martins M, Bettencourt P, Maciel M, Abreu-Lima C, Pilichou K, Bauce B, Rampazzo A, Carturan E, Corrado D, Thiene G, Basso C, Piccini I, Fortmueller L, Kuhlmann M, Schaefers M, Carmeliet P, Kirchhof P, Fabritz L, Sanchez J, Rodriguez-Sinovas A, Agullo E, Garcia-Dorado D, Lymperopoulos A, Rengo G, Gao E, Zincarelli C, Koch W, Fontes-Sousa A, Silva S, Gomes M, Ferreira P, Leite-Moreira A, Capuano V, Ferron L, Ruchon Y, Ben Mohamed F, Renaud JF, Morgan P, Falcao-Pires I, Goncalves N, Gavina C, Pinho S, Moura C, Amorim M, Pinho P, Leite-Moreira A, Christ T, Molenaar P, Diez A, Ravens U, Kaumann A, Kletsiou E, Giannakopoulou M, Bozas E, Iliodromitis E, Anastasiou-Nana M, Papathanassoglou E, Chottova Dvorakova M, Mistrova E, Perez N, Slavikova J, Hynie S, Sida P, Klenerova V, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Cingolani H, Zakrzewicz A, Hoffmann C, Hohberg M, Chlench S, Maroski J, Drab M, Siegel G, Pries A, Farrell K, Holt C, Zahradnikova A, Schrot G, Ibatov A, Wilck N, Fechner M, Arias A, Meiners S, Baumann G, Stangl V, Stangl K, Ludwig A, Polakova E, Christ A, Eijgelaar W, Daemen M, Li X, Penfold M, Schall T, Weber C, Schober A, Hintenberger R, Kaun C, Zahradnik I, Pfaffenberger S, Maurer G, Huber K, Wojta J, Demyanets S, Titov V, Nazari-Jahantigh M, Weber C, Schober A, Chin-Dusting J, Zahradnikova A, Vaisman B, Khong S, Remaley A, Andrews K, Hoeper A, Khalid A, Fuglested B, Aasum E, Larsen T, Titov V, Fluschnik N, Carluccio M, Scoditti E, Massaro M, Storelli C, Distante A, De Caterina R, Diebold I, Petry A, Djordjevic T, Belaiba R, Sossalla S, Fratz S, Hess J, Kietzmann T, Goerlach A, O'shea K, Chess D, Khairallah R, Walsh K, Stanley W, Falcao-Pires I, Ort K, Goncalves N, Van Der Velden J, Moreira-Goncalves D, Paulus W, Niessen H, Perlini S, Leite-Moreira A, Azibani F, Tournoux F, Fazal L, Neef S, Polidano E, Merval R, Chatziantoniou C, Samuel J, Delcayre C, Azibani F, Tournoux F, Fazal L, Polidano E, Merval R, Hasenfuss G, Chatziantoniou C, Samuel J, Delcayre C, Mgandela P, Brooksbank R, Maswanganyi T, Woodiwiss A, Norton G, Makaula S, Sartiani L, Maier L, Bucciantini M, Spinelli V, Coppini R, Russo E, Mugelli A, Cerbai E, Stefani M, Sukumaran V, Watanabe K, Ma M, Weinert S, Thandavarayan R, Azrozal W, Sari F, Shimazaki H, Kobayashi Y, Roleder T, Golba K, Deja M, Malinowski M, Wos S, Poitz D, Stieger P, Grebe M, Tillmanns H, Preissner K, Sedding D, Ercan E, Guven A, Asgun F, Ickin M, Ercan F, Herold J, Kaplan A, Yavuz O, Bagla S, Yang Y, Ma Y, Liu F, Li X, Huang Y, Kuka J, Vilskersts R, Schmeisser A, Vavers E, Liepins E, Dambrova M, Mariero L, Rutkovskiy A, Stenslokken K, Vaage J, Duerr G, Suchan G, Heuft T, Strasser J, Klaas T, Zimmer A, Welz A, Fleischmann B, Dewald O, Voelkl J, Haubner B, Kremser C, Mayr A, Klug G, Braun-Dullaeus R, Reiner M, Pachinger O, Metzler B, Pisarenko O, Shulzhenko V, Pelogeykina Y, Khatri D, Studneva I, Barnucz E, Loganathan S, Nazari-Jahantigh M, Hirschberg K, Korkmaz S, Merkely B, Karck M, Szabo G, Bencsik P, Gorbe A, Kocsis G, Csonka C, Csont T, Weber C, Shamloo M, Woodburn K, Ferdinandy P, Szucs G, Kupai K, Csonka C, Csont C, Ferdinandy P, Kocsisne Fodor G, Bencsik P, Schober A, Fekete V, Varga Z, Monostori P, Turi S, Ferdinandy P, Csont T, Leuner A, Eichhorn B, Ravens U, Morawietz H, Babes E, Babes V, Popescu M, Ardelean A, Rus M, Bustea C, Gwozdz P, Csanyi G, Luzak B, Gajda M, Mateuszuk L, Chmura-Skirlinska A, Watala C, Chlopicki S, Kierzkowska I, Sulicka J, Kwater A, Strach M, Surdacki A, Siedlar M, Grodzicki T, Olieslagers S, Pardali L, Tchaikovski V, Ten Dijke P, Waltenberger J, Renner M, Redwan B, Winter M, Panzenboeck A, Jakowitsch J, Sadushi-Kolici R, Bonderman D, Lang I, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Oliviero C, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Casprini P, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Amato M, Bellandi F, Molins B, Pena E, Badimon L, Ferreiro Gutierrez J, Ueno M, Alissa R, Dharmashankar K, Capodanno D, Desai B, Bass T, Angiolillo D, Chabielska E, Gromotowicz A, Szemraj J, Stankiewicz A, Zakrzeska A, Mohammed S, Molla F, Soldo A, Russo I, Germano G, Balconi G, Staszewsky L, Latini R, Lynch F, Austin C, Prendergast B, Keenan D, Malik R, Izzard A, Heagerty A, Czikora A, Lizanecz E, Rutkai I, Boczan J, Porszasz R, Papp Z, Edes I, Toth A, Colantuoni A, Vagnani S, Lapi D, Maroz-Vadalazhskaya N, Koslov I, Shumavetz V, Glibovskaya T, Ostrovskiy Y, Koutsiaris A, Tachmitzi S, Kotoula M, Giannoukas A, Tsironi E, Rutkai I, Czikora A, Darago A, Orosz P, Megyesi Z, Edes I, Papp Z, Toth A, Eichhorn B, Schudeja S, Matschke K, Deussen A, Ravens U, Castro M, Cena J, Walsh M, Schulz R, Poddar K, Rha S, Ramasamy S, Park J, Choi C, Seo H, Park C, Oh D, Lebreiro A, Martins E, Almeida J, Pimenta S, Bernardes J, Machado J, Abreu-Lima C, Sabatasso S, Laissue J, Hlushchuk R, Brauer-Krisch E, Bravin A, Blattmann H, Michaud K, Djonov V, Hirschberg K, Tarcea V, Pali S, Korkmaz S, Loganathan S, Merkely B, Karck M, Szabo G, Pagliani L, Faggin E, Rattazzi M, Puato M, Presta M, Grego F, Deriu G, Pauletto P, Kaiser R, Albrecht K, Schgoer W, Theurl M, Beer A, Wiedemann D, Steger C, Bonaros N, Kirchmair R, Kharlamov A, Cabaravdic M, Breuss J, Uhrin P, Binder B, Fiordaliso F, Balconi G, Mohammed S, Maggioni M, Biondi A, Masson S, Cervo L, Latini R, Francke A, Herold J, Soenke W, Strasser R, Braun-Dullaeus R, Hecht N, Vajkoczy P, Woitzik J, Hackbusch D, Gatzke N, Duelsner A, Tsuprykov O, Slavic S, Buschmann I, Kappert K, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Barandi L, Harmati G, Simko J, Horvath B, Szentandrassy N, Banyasz T, Magyar J, Nanasi P, Kaya A, Uzunhasan I, Yildiz A, Yigit Z, Turkoglu C, Doisne N, Zannad N, Hivert B, Cosnay P, Maupoil V, Findlay I, Virag L, Kristof A, Koncz I, Szel T, Jost N, Biliczki P, Papp J, Varro A, Bukowska A, Skopp K, Hammwoehner M, Huth C, Bode-Boeger S, Goette A, Workman A, Dempster J, Marshall G, Rankin A, Revnic C, Ginghina C, Revnic F, Yakushev S, Petrushanko I, Makhro A, Segato Komniski M, Mitkevich V, Makarov A, Gassmann M, Bogdanova A, Rutkovskiy A, Mariero L, Stenslokken K, Valen G, Vaage J, Dizayee S, Kaestner S, Kuck F, Piekorz R, Hein P, Matthes J, Nurnberg B, Herzig S, Hertel F, Switalski A, Bender K, Kienitz MC, Pott L, Fornai L, Angelini A, Erika Amstalden Van Hove E, Fedrigo M, Thiene G, Heeren R, Kruse M, Pongs O, Lehmann H, Martens-Lobenhoffer J, Hammwoehner M, Roehl F, Bukowska A, Bode-Boeger S, Goette A, Radicke S, Cotella C, Sblattero D, Schaefer M, Ravens U, Wettwer E, Santoro C, Seyler C, Kulzer M, Zitron E, Scholz E, Welke F, Thomas D, Karle C, Schmidt K, Radicke S, Dobrev D, Ravens U, Wettwer E, Houshmand N, Menesi D, Ravens U, Wettwer E, Cotella D, Papp J, Varro A, Szuts V, Szuts V, Houshmand N, Puskas L, Jost N, Virag L, Kiss I, Deak F, Varro A, Tereshchenko S, Gladyshev M, Kalachova G, Syshchik N, Gogolashvili N, Dedok E, Evert L, Wenzel J, Brandenburger M, Bogdan R, Richardt D, Reppel M, Hescheler J, Dendorfer A, Terlau H, Wiegerinck R, Galvez-Monton C, Jorge E, Martinez R, Ricart E, Cinca J, Bagavananthem Andavan G, Lemmens Gruber R, Brack K, Coote J, Ng G, Daimi H, Haj Khelil A, Neji A, Ben Hamda K, Maaoui S, Aranega A, Chibani J, Franco Jaime D, Tanko AS, Brack K, Coote J, Ng G, Doisne N, Hivert B, Cosnay P, Findlay I, Maupoil V, Daniel JM, Bielenberg W, Stieger P, Tillmanns H, Sedding D, Fortini C, Toffoletto B, Fucili A, Beltrami A, Fiorelli V, Francolini G, Ferrari R, Beltrami C, Castellani C, Ravara B, Tavano R, Thiene G, Vettor R, De Coppi P, Papini E, Angelini A, Molla F, Soldo A, Biondi A, Staszewsky L, Russo I, Gunetti M, Fagioli F, Latini R, Suffredini S, Sartiani L, Stillitano F, Mugelli A, Cerbai E, Krausgrill B, Halbach M, Soemantri S, Schenk K, Lange N, Hescheler J, Saric T, Muller-Ehmsen J, Kavanagh D, Zhao Y, Yemm A, Kalia N, Wright E, Farrell K, Wallrapp C, Geigle P, Lewis A, Stratford P, Malik N, Holt C, Krausgrill B, Raths M, Halbach M, Schenk K, Hescheler J, Muller-Ehmsen J, Zagallo M, Luni C, Serena E, Cimetta E, Zatti S, Giobbe G, Elvassore N, Serena E, Cimetta E, Zaglia T, Zatti S, Zambon A, Gordon K, Elvassore N, Mioulane M, Foldes G, Ali N, Harding S, Gorbe A, Szunyog A, Varga Z, Pirity M, Rungaruniert S, Dinnyes A, Csont T, Ferdinandy P, Foldes G, Mioulane M, Iqbal A, Schneider MD, Ali N, Harding S, Babes E, Babes V, Khodjaeva E, Ibadov R, Khalikulov K, Mansurov A, Astvatsatryan A, Senan M, Astvatsatryan A, Senan M, Nemeth A, Lenkey Z, Ajtay Z, Cziraki A, Sulyok E, Horvath I, Lobenhoffer J, Bode-Boger S, Li J, He Y, Yang X, Wang F, Xu H, Li X, Zhao X, Lin Y, Juszynski M, Ciszek B, Jablonska A, Stachurska E, Ratajska A, Atkinson A, Inada S, Li J, Sleiman R, Zhang H, Boyett M, Dobrzynski H, Fedorenko O, Hao G, Atkinson A, Yanni J, Buckley D, Anderson R, Boyett M, Dobrzynski H, Ma Y, Ma X, Hu Y, Yang Y, Huang D, Liu F, Huang Y, Liu C, Jedrzejczyk T, Balwicki L, Wierucki L, Zdrojewski T, Makhro A, Agarkova I, Vogel J, Gassmann M, Bogdanova A, Korybalska K, Pyda M, Witowski J, Ibatov A, Sozmen N, Seymen A, Tuncay E, Turan B, Huang Y, Ma Y, Yang Y, Liu F, Chen B, Li X, Houston-Feenstra L, Chiong JR, Jutzy K, Furundzija V, Kaufmann J, Kappert K, Meyborg H, Fleck E, Stawowy P, Ksiezycka-Majczynska E, Lubiszewska B, Kruk M, Kurjata P, Ruzyllo W, Ibatov A, Driesen R, Coenen T, Fagard R, Sipido K, Petrov V, Aksentijevic D, Lygate C, Makinen K, Sebag-Montefiore L, Medway D, Schneider J, Neubauer S, Gasser R, Holzwart E, Rainer P, Von Lewinski D, Maechler H, Gasser S, Roessl U, Pieske B, Krueger J, Kintscher U, Kappert K, Podramagi T, Paju K, Piirsoo A, Roosimaa M, Kadaja L, Orlova E, Ruusalepp A, Seppet E, Auquier J, Ginion A, Hue L, Horman S, Beauloye C, Vanoverschelde J, Bertrand L, Fekete V, Zvara A, Pipis J, Konya C, Csonka C, Puskas L, Csont T, Ferdinandy P, Gasser S, Rainer P, Holzwart E, Roessl U, Kraigher-Krainer E, Von Lewinksi D, Pieske B, Gasser R, Gonzalez-Loyola A, Barba I, Rodriguez-Sinovas A, Fernandez-Sanz C, Agullo E, Ruiz-Meana M, Garcia-Dorado D, Forteza M, Bodi Peris V, Monleon D, Mainar L, Morales J, Moratal D, Trapero I, Chorro F, Leszek P, Sochanowicz B, Szperl M, Kolsut P, Piotrowski W, Rywik T, Danko B, Kruszewski M, Stanley W, Khairallah R, Khanna N, O'shea K, Kristian T, Hecker P, Des Rosiers R, Fiskum G, Fernandez-Alfonso M, Guzman-Ruiz R, Somoza B, Gil-Ortega M, Attane C, Castan-Laurell I, Valet P, Ruiz-Gayo M, Maroz-Vadalazhskaya N, Denissevich T, Shumavetz V, Ostrovskiy Y, Schrepper A, Schwarzer M, Amorim P, Schoepe M, Mohr F, Doenst T, Chiellini G, Ghelardoni S, Saba A, Marchini M, Frascarelli S, Raffaelli A, Scanlan T, Zucchi R, Van Den Akker N, Molin D, Kolk F, Jeukens F, Olde Engberink R, Waltenberger J, Post M, Van Den Akker N, Molin D, Verbruggen S, Schulten H, Post M, Waltenberger J, Rochais F, Kelly R, Aberg M, Johnell M, Wickstrom M, Siegbahn A, Dimitrakis P, Groppalli V, Ott D, Seifriz F, Suter T, Zuppinger C, Kashcheyeu Y, Mueller R, Wiesen M, Saric T, Gruendemann D, Hescheler J, Herzig S, Falcao-Pires I, Fontes-Sousa A, Lopes-Conceicao L, Bras-Silva C, Leite-Moreira A, Bukauskas F, Palacios-Prado N, Norheim F, Raastad T, Thiede B, Drevon C, Haugen F, Lindner D, Westermann D, Zietsch C, Schultheiss HP, Tschoepe C, Horn M, Graham H, Hall M, Richards M, Clarke J, Dibb K, Trafford A, Cheng CF, Lin H, Eigeldiger-Berthou S, Buntschu P, Frobert A, Flueck M, Tevaearai H, Kadner A, Mikhailov A, Torrado M, Centeno A, Lopez E, Lourido L, Castro Beiras A, Popov T, Srdanovic I, Petrovic M, Canji T, Kovacevic M, Jovelic A, Sladojevic M, Panic G, Kararigas G, Fliegner D, Regitz-Zagrosek V, De La Rosa Sanchez A, Dominguez J, Sedmera D, Franco D, Aranega A, Medunjanin S, Burgbacher F, Schmeisser A, Strasser R, Braun-Dullaeus R, Li X, Ma Y, Yang Y, Liu F, Han W, Chen B, Zhang J, Gao X, Bayliss C, Song W, Stuckey D, Dyer E, Leung MC, Monserrat L, Marston S, Sorriento D, Santulli G, Fusco A, Trimarco B, Iaccarino G, Revnic C, Ginghina C, Revnic F, Paillard M, Liang J, Strub G, Gomez L, Hait N, Allegood J, Lesnefsky E, Spiegel S, Zuchi C, Coiro S, Bettini M, Ciliberti G, Mancini I, Tritto I, Becker L, Ambrosio G, Adam T, Sharp S, Opie L, Lecour S, Khaliulin I, Parker J, Halestrap A, Kandasamy A, Schulz R, Schoepe M, Schwarzer M, Schrepper A, Osterholt M, Amorim P, Mohr F, Doenst T, Fernandez-Sanz C, Ruiz-Meana M, Miro-Casas E, Agullo E, Boengler K, Schulz R, Garcia-Dorado D, Menazza S, Canton M, Sheeran F, Di Lisa F, Pepe S, Borchi E, Manni M, Bargelli V, Giordano C, D'amati G, Cerbai E, Nediani C, Raimondi L, Micova P, Balkova P, Kolar F, Neckar J, Novak F, Novakova O, Schuchardt M, Toelle M, Pruefer N, Pruefer J, Jankowski V, Jankowski J, Van Der Giet M, Han W, Su Y, Zervou S, Aksentijevic D, Lygate C, Neubauer S, Seidel B, Korkmaz S, Radovits T, Hirschberg K, Loganathan S, Barnucz E, Karck M, Szabo G, Aggeli I, Kefaloyianni E, Beis I, Gaitanaki C, Lacerda L, Somers S, Opie L, Lecour S, Brack K, Coote J, Ng G, Paur H, Nikolaev V, Lyon A, Harding S, Bras-Silva C. Sunday, 18 July 2010. Cardiovasc Res 2010. [DOI: 10.1093/cvr/cvq176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dash S, Langenberg C, Fawcett KA, Semple RK, Romeo S, Sharp S, Sano H, Lienhard GE, Rochford JJ, Howlett T, Massoud AF, Hindmarsh P, Howell SJ, Wilkinson RJ, Lyssenko V, Groop L, Baroni MG, Barroso I, Wareham NJ, O’ Rahilly S, Savage DB. Analysis of TBC1D4 in patients with severe insulin resistance. Diabetologia 2010; 53:1239-42. [PMID: 20349035 PMCID: PMC2860565 DOI: 10.1007/s00125-010-1724-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 02/18/2010] [Indexed: 11/30/2022]
Affiliation(s)
- S. Dash
- University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital Box 289, Hills Road, Cambridge, CB2 0QQ UK
| | - C. Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Sciences, Addenbrooke’s Hospital, Cambridge, UK
| | - K. A. Fawcett
- Metabolic Disease Group, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, UK
| | - R. K. Semple
- University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital Box 289, Hills Road, Cambridge, CB2 0QQ UK
| | - S. Romeo
- University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital Box 289, Hills Road, Cambridge, CB2 0QQ UK
| | - S. Sharp
- MRC Epidemiology Unit, Institute of Metabolic Sciences, Addenbrooke’s Hospital, Cambridge, UK
| | - H. Sano
- Department of Biochemistry, Dartmouth Medical School, Hanover, NH USA
| | - G. E. Lienhard
- Department of Biochemistry, Dartmouth Medical School, Hanover, NH USA
| | - J. J. Rochford
- University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital Box 289, Hills Road, Cambridge, CB2 0QQ UK
| | - T. Howlett
- Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, UK
| | - A. F. Massoud
- Children’s Services, Northwick Park Hospital, Harrow, Middlesex, UK
| | - P. Hindmarsh
- London Centre for Paediatric Endocrinology and Metabolism, Cobbold Laboratories, Middlesex Hospital, London, UK
| | - S. J. Howell
- Department of Diabetes and Endocrinology, Royal Preston Hospital, Preston, UK
| | | | - V. Lyssenko
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - L. Groop
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - M. G. Baroni
- Department of Medical Sciences, Endocrinology and Metabolism, University of Cagliari, Cagliari, Sardinia Italy
| | - I. Barroso
- Metabolic Disease Group, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, UK
| | - N. J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Sciences, Addenbrooke’s Hospital, Cambridge, UK
| | - S. O’ Rahilly
- University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital Box 289, Hills Road, Cambridge, CB2 0QQ UK
| | - D. B. Savage
- University of Cambridge Metabolic Research Laboratories, Level 4, Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital Box 289, Hills Road, Cambridge, CB2 0QQ UK
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Ingelsson E, Langenberg C, Hivert MF, Prokopenko I, Lyssenko V, Dupuis J, Mägi R, Sharp S, Jackson AU, Assimes TL, Shrader P, Knowles JW, Zethelius B, Abbasi FA, Bergman RN, Bergmann A, Berne C, Boehnke M, Bonnycastle LL, Bornstein SR, Buchanan TA, Bumpstead SJ, Böttcher Y, Chines P, Collins FS, Cooper CC, Dennison EM, Erdos MR, Ferrannini E, Fox CS, Graessler J, Hao K, Isomaa B, Jameson KA, Kovacs P, Kuusisto J, Laakso M, Ladenvall C, Mohlke KL, Morken MA, Narisu N, Nathan DM, Pascoe L, Payne F, Petrie JR, Sayer AA, Schwarz PEH, Scott LJ, Stringham HM, Stumvoll M, Swift AJ, Syvänen AC, Tuomi T, Tuomilehto J, Tönjes A, Valle TT, Williams GH, Lind L, Barroso I, Quertermous T, Walker M, Wareham NJ, Meigs JB, McCarthy MI, Groop L, Watanabe RM, Florez JC. Detailed physiologic characterization reveals diverse mechanisms for novel genetic Loci regulating glucose and insulin metabolism in humans. Diabetes 2010; 59:1266-75. [PMID: 20185807 PMCID: PMC2857908 DOI: 10.2337/db09-1568] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Recent genome-wide association studies have revealed loci associated with glucose and insulin-related traits. We aimed to characterize 19 such loci using detailed measures of insulin processing, secretion, and sensitivity to help elucidate their role in regulation of glucose control, insulin secretion and/or action. RESEARCH DESIGN AND METHODS We investigated associations of loci identified by the Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC) with circulating proinsulin, measures of insulin secretion and sensitivity from oral glucose tolerance tests (OGTTs), euglycemic clamps, insulin suppression tests, or frequently sampled intravenous glucose tolerance tests in nondiabetic humans (n = 29,084). RESULTS The glucose-raising allele in MADD was associated with abnormal insulin processing (a dramatic effect on higher proinsulin levels, but no association with insulinogenic index) at extremely persuasive levels of statistical significance (P = 2.1 x 10(-71)). Defects in insulin processing and insulin secretion were seen in glucose-raising allele carriers at TCF7L2, SCL30A8, GIPR, and C2CD4B. Abnormalities in early insulin secretion were suggested in glucose-raising allele carriers at MTNR1B, GCK, FADS1, DGKB, and PROX1 (lower insulinogenic index; no association with proinsulin or insulin sensitivity). Two loci previously associated with fasting insulin (GCKR and IGF1) were associated with OGTT-derived insulin sensitivity indices in a consistent direction. CONCLUSIONS Genetic loci identified through their effect on hyperglycemia and/or hyperinsulinemia demonstrate considerable heterogeneity in associations with measures of insulin processing, secretion, and sensitivity. Our findings emphasize the importance of detailed physiological characterization of such loci for improved understanding of pathways associated with alterations in glucose homeostasis and eventually type 2 diabetes.
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Affiliation(s)
- Erik Ingelsson
- Corresponding authors: Erik Ingelsson, ; Leif Groop, ; Richard M. Watanabe, ; Jose C. Florez,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leif Groop
- Corresponding authors: Erik Ingelsson, ; Leif Groop, ; Richard M. Watanabe, ; Jose C. Florez,
| | - Richard M. Watanabe
- Corresponding authors: Erik Ingelsson, ; Leif Groop, ; Richard M. Watanabe, ; Jose C. Florez,
| | - Jose C. Florez
- Corresponding authors: Erik Ingelsson, ; Leif Groop, ; Richard M. Watanabe, ; Jose C. Florez,
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Ridgway CL, Ong KK, Tammelin TH, Sharp S, Ekelund U, Jarvelin MR. Infant motor development predicts sports participation at age 14 years: northern Finland birth cohort of 1966. PLoS One 2009; 4:e6837. [PMID: 19718258 PMCID: PMC2729394 DOI: 10.1371/journal.pone.0006837] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 07/28/2009] [Indexed: 11/18/2022] Open
Abstract
Background Motor proficiency is positively associated with physical activity levels. The aim of this study is to investigate associations between the timing of infant motor development and subsequent sports participation during adolescence. Methods Prospective observational study. The study population consisted of 9,009 individuals from the Northern Finland Birth Cohort 1966. Motor development was assessed by parental report at age 1 year, using age at walking with support and age at standing unaided. At follow up aged 14 years, data were collected on the school grade awarded for physical education (PE). Self report was used to collect information on the frequency of sports participation and number of different sports reported. Principal Findings Earlier infant motor development was associated with improved school PE grade, for age at walking supported (p<0.001) and standing unaided (p = <0.001). Earlier infant motor development, in terms of age at walking supported, was positively associated with the number of different sports reported (p = 0.003) and with a greater frequency of sports participation (p = 0.043). These associations were independent of gestational age and birth weight, as well as father's social class and body mass index at age 14 years. Conclusions Earlier infant motor development may predict higher levels of physical activity as indicated by higher school PE grade, participation in a greater number of different types of sports and increased frequency of sports participation. Identification of young children with slower motor development may allow early targeted interventions to improve motor skills and thereby increase physical activity in later life.
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Affiliation(s)
- Charlotte L. Ridgway
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, United Kingdom
- * E-mail:
| | - Ken K. Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, United Kingdom
| | | | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Ulf Ekelund
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Marjo-Riitta Jarvelin
- Imperial College London, London, United Kingdom
- Institute of Health Sciences, University of Oulu, Oulu, Finland
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Thangaratinam S, Ismail K, Sharp S, Coomarasamy A, O'Mahony F, Khan KS, O'Brien S. Prioritisation of Tests for the Prediction of Preeclampsia Complications: A Delphi Survey. Hypertens Pregnancy 2009; 26:131-8. [PMID: 17454225 DOI: 10.1080/10641950601148000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 10/23/2022]
Abstract
BACKGROUND Preeclampsia is associated with several maternal and fetal complications. Numerous tests - including patient history, physical examination findings, and laboratory investigations - are used to predict such complications in women with preeclampsia. At present, there are no robust systematic reviews or large studies examining the accuracy of tests that could predict complications in women with preeclampsia. OBJECTIVE To identify the tests (which include items of history, examination, and investigations) that are clinically relevant in predicting maternal and fetal complications in women with preeclampsia. METHODS A two-generational Delphi method was used to prioritize the clinically relevant tests that are considered helpful in predicting the maternal and fetal complications of preeclampsia. RESULTS Blood pressure was rated as the best predictor of complications with mean score (+/- SD) of 4.7 (+/- 0.47), followed by proteinuria 4.6 (+/- 0.5) and liver function tests 4.5 (+/- 0.52). CONCLUSION The list of tests that have been identified and prioritized will form the basis for future systematic reviews of the literature in this field.
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Affiliation(s)
- S Thangaratinam
- Academic Unit of Obstetrics and Gynaecology, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
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Buijsse B, Feskens EJM, Schulze MB, Forouhi NG, Wareham NJ, Sharp S, Palli D, Tognon G, Halkjaer J, Tjønneland A, Jakobsen MU, Overvad K, van der A DL, Du H, Sørensen TIA, Boeing H. Fruit and vegetable intakes and subsequent changes in body weight in European populations: results from the project on Diet, Obesity, and Genes (DiOGenes). Am J Clin Nutr 2009; 90:202-9. [PMID: 19458016 DOI: 10.3945/ajcn.2008.27394] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High fruit and vegetable intakes may limit weight gain, particularly in susceptible persons, such as those who stop smoking. OBJECTIVE The objective was to assess the association of fruit and vegetable intake with subsequent weight change in a large-scale prospective study. DESIGN The data used were from 89,432 men and women from 5 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). The association between fruit and vegetable intake and weight change after a mean follow-up of 6.5 y was assessed by linear regression. Polytomous logistic regression was used to evaluate whether fruit and vegetable intake relates to weight gain, weight loss, or both. RESULTS Per 100-g intake of fruit and vegetables, weight change was -14 g/y (95% CI: -19, -9 g/y). In those who stopped smoking during follow-up, this value was -37 g/y (95% CI: -58, -15 g/y; P for interaction < 0.0001). When weight gain and loss were analyzed separately per 100-g intake of fruit and vegetables in a combined model, the odds ratios (95% CIs) were 0.97 (0.95, 0.98) for weight gain > or =0.5 and <1 kg/y, 0.94 (0.92, 0.96) for weight gain > or =1 kg/y, and 0.97 (0.95, 0.99) for weight loss > or =0.5 kg/y. In those who stopped smoking during follow-up, the odds ratios (95% CIs) were 0.93 (0.88, 0.99), 0.87 (0.81, 0.92), and 0.97 (0.88, 1.07), respectively (P for interaction < 0.0001). CONCLUSIONS Fruit and vegetable intake relates significantly, albeit weakly inversely, to weight change. For persons who stop smoking, high fruit and vegetable intakes may be recommended to reduce the risk of weight gain.
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Affiliation(s)
- Brian Buijsse
- German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Epidemiology, Nuthetal, Germany.
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Wijndaele K, Lynch BM, Owen N, Dunstan DW, Sharp S, Aitken JF. Television viewing time and weight gain in colorectal cancer survivors: a prospective population-based study. Cancer Causes Control 2009; 20:1355-62. [DOI: 10.1007/s10552-009-9356-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 04/23/2009] [Indexed: 11/24/2022]
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Dunn S, Sharp S, Burgess S. The photochemical growth of silver nanoparticles on semiconductor surfaces--initial nucleation stage. Nanotechnology 2009; 20:115604. [PMID: 19420444 DOI: 10.1088/0957-4484/20/11/115604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Questions surrounding the nucleation mechanism for nanostructures that are grown on semiconductors, such as lead zirconate titanate, using photochemical techniques have ranged from 'What is the nucleation process?' to 'Is it possible to produce homogeneous nanoscale patterns?' Here we demonstrate that nucleation occurs at discrete locations on the surface of the substrate that are indicative of a disruption of the local Stern layer due to a local defect or electric field in the substrate. The band diagram for the system is such that when a cluster forms it is possible for electrons to migrate into the silver metal and so replace the surface positive charge, associated with the positive domain of the ferroelectric, with a local negative charge. Once the initial cluster starts to form, the rate of growth of an individual cluster increases due to a restructuring of the Stern layer and increased probability of reaction of an electron with the cations in solution. We show that the nucleation density does not change significantly from the initial nucleation density, and that approximately 15% of the particles that form on the surface are 50% larger than the other particles. The reasons for no significant change in nucleation density stem from the concentration of available disrupted locations in the Stern layer, and variations in the growth rate are discussed in terms of the local electric field and defect influences.
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Affiliation(s)
- S Dunn
- Nanotechnology Centre, Cranfield University, Bedfordshire, UK.
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Aguayo P, Fraser J, Sharp S, St Peter S, Ostlie D. QS177. Stomal Complications in the Newborn Period. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.476] [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]
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Prokopenko I, Langenberg C, Florez JC, Saxena R, Soranzo N, Thorleifsson G, Loos RJF, Manning AK, Jackson AU, Aulchenko Y, Potter SC, Erdos MR, Sanna S, Hottenga JJ, Wheeler E, Kaakinen M, Lyssenko V, Chen WM, Ahmadi K, Beckmann JS, Bergman RN, Bochud M, Bonnycastle LL, Buchanan TA, Cao A, Cervino A, Coin L, Collins FS, Crisponi L, de Geus EJC, Dehghan A, Deloukas P, Doney ASF, Elliott P, Freimer N, Gateva V, Herder C, Hofman A, Hughes TE, Hunt S, Illig T, Inouye M, Isomaa B, Johnson T, Kong A, Krestyaninova M, Kuusisto J, Laakso M, Lim N, Lindblad U, Lindgren CM, McCann OT, Mohlke KL, Morris AD, Naitza S, Orrù M, Palmer CNA, Pouta A, Randall J, Rathmann W, Saramies J, Scheet P, Scott LJ, Scuteri A, Sharp S, Sijbrands E, Smit JH, Song K, Steinthorsdottir V, Stringham HM, Tuomi T, Tuomilehto J, Uitterlinden AG, Voight BF, Waterworth D, Wichmann HE, Willemsen G, Witteman JCM, Yuan X, Zhao JH, Zeggini E, Schlessinger D, Sandhu M, Boomsma DI, Uda M, Spector TD, Penninx BW, Altshuler D, Vollenweider P, Jarvelin MR, Lakatta E, Waeber G, Fox CS, Peltonen L, Groop LC, Mooser V, Cupples LA, Thorsteinsdottir U, Boehnke M, Barroso I, Van Duijn C, Dupuis J, Watanabe RM, Stefansson K, McCarthy MI, Wareham NJ, Meigs JB, Abecasis GR. Variants in MTNR1B influence fasting glucose levels. Nat Genet 2008; 41:77-81. [PMID: 19060907 DOI: 10.1038/ng.290] [Citation(s) in RCA: 549] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 10/14/2008] [Indexed: 12/11/2022]
Abstract
To identify previously unknown genetic loci associated with fasting glucose concentrations, we examined the leading association signals in ten genome-wide association scans involving a total of 36,610 individuals of European descent. Variants in the gene encoding melatonin receptor 1B (MTNR1B) were consistently associated with fasting glucose across all ten studies. The strongest signal was observed at rs10830963, where each G allele (frequency 0.30 in HapMap CEU) was associated with an increase of 0.07 (95% CI = 0.06-0.08) mmol/l in fasting glucose levels (P = 3.2 x 10(-50)) and reduced beta-cell function as measured by homeostasis model assessment (HOMA-B, P = 1.1 x 10(-15)). The same allele was associated with an increased risk of type 2 diabetes (odds ratio = 1.09 (1.05-1.12), per G allele P = 3.3 x 10(-7)) in a meta-analysis of 13 case-control studies totaling 18,236 cases and 64,453 controls. Our analyses also confirm previous associations of fasting glucose with variants at the G6PC2 (rs560887, P = 1.1 x 10(-57)) and GCK (rs4607517, P = 1.0 x 10(-25)) loci.
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Affiliation(s)
- Inga Prokopenko
- [1] Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LJ, UK. [2] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK. [3] These authors contributed equally to this work
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Ekelund U, Brage S, Besson H, Sharp S, Wareham NJ. Time spent being sedentary and weight gain in healthy adults: reverse or bidirectional causality? Am J Clin Nutr 2008; 88:612-7. [PMID: 18779275 DOI: 10.1093/ajcn/88.3.612] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether obesity is a cause or a consequence of a sedentary lifestyle has not yet been fully elucidated, which leaves uncertainty about the direction of causality. OBJECTIVE We aimed to assess the longitudinal associations between objectively measured time spent being sedentary (sedentary time) and obesity indicators. DESIGN The study was a prospective, population-based cohort study in 393 middle-aged healthy whites (n = 176 M, 217 F). Sedentary time (% of daytime hours) was measured by individually calibrated monitoring of the heart rate. Body weight (BW), body mass index (BMI), and waist circumference (WC) were assessed by standard clinical procedures. Fat mass (FM) was assessed with bioimpedance. All measurements were collected at baseline and at 5.6-y follow-up. RESULTS At baseline, sedentary time was significantly correlated with FM (partial r = 0.10, P = 0.043) and WC (partial r = 0.11, P = 0.027) after adjustment for sex and age. At follow-up, sedentary time was significantly correlated with BW (partial r = 0.19, P < 0.0001), BMI (partial r = 0.20, P < 0.0001), WC (partial r = 0.15, P = 0.003), and FM (partial r = 0.19, P < 0.0001). Sedentary time did not predict any of the obesity indicators at follow-up. In contrast, BW (beta = 0.33; 95% CI: 0.15, 0.50), BMI (1.10; 0.58, 1.63), FM (0.59; 0.11, 0.40), and WC (0.44; 0.23, 0.66) predicted sedentary time at follow-up after adjustment for sex, baseline age, baseline sedentary time, baseline physical activity energy expenditure, and follow-up time. CONCLUSION BMI, FM, and WC may predict sedentary time, but our results do not suggest that sedentary time predicts future obesity.
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Affiliation(s)
- Ulf Ekelund
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Cambridge, United Kingdom.
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Simmons RK, Sharp S, Boekholdt SM, Sargeant LA, Khaw KT, Wareham NJ, Griffin SJ. Evaluation of the Framingham risk score in the European Prospective Investigation of Cancer-Norfolk cohort: does adding glycated hemoglobin improve the prediction of coronary heart disease events? ACTA ACUST UNITED AC 2008; 168:1209-16. [PMID: 18541829 DOI: 10.1001/archinte.168.11.1209] [Citation(s) in RCA: 52] [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: 11/14/2022]
Abstract
BACKGROUND There is a continuous relationship between glycated hemoglobin (HbA(1c)) and coronary heart disease (CHD) risk, even below diagnostic thresholds for diabetes mellitus. METHODS To evaluate the Framingham risk score in a UK population-based prospective cohort (European Prospective Investigation of Cancer [EPIC]-Norfolk) and to assess whether adding HbA(1c) improves the prediction of CHD. Participants aged 40 to 79 years were recruited from UK general practices, attended a health check, and were followed up for CHD events and death. The Framingham risk score was computed for 10,295 individuals with data on age, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, diabetes mellitus, and smoking status. We developed a Cox proportional hazards regression model with the original Framingham covariates and then added HbA(1c) to determine whether this improved the prediction of CHD. Model discrimination was compared by using area under the receiver operating characteristic curves (AUROCs), and the correctness of reclassification was determined by calculating the net reclassification improvement and the integrated discrimination improvement. The main outcome measures were CHD-related hospital admission and death. RESULTS A total of 430 men and 250 women developed CHD during 8.5 years of follow-up. The AUROC for the original Framingham risk score was 0.71. Using the Framingham variables with coefficients fitted from the EPIC-Norfolk data, the AUROC was 0.72 for men and 0.80 for women, compared with 0.73 and 0.80, respectively, in a score including HbA(1c). This difference was significant for men only (P = .005). The net reclassification improvement was 3.4% (P = .06) in men and -2.2% (P = .27) in women. CONCLUSIONS The Framingham risk score predicts CHD in this cohort. The addition of HbA(1c) made a small but statistically significant improvement to discrimination in men but not in women, without significant improvement in reclassification of risk category.
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Affiliation(s)
- Rebecca K Simmons
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, England
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Sharp S. Tests for Independence in Two-Way Contingency Tables with Small Samples. J Mod App Stat Meth 2008. [DOI: 10.22237/jmasm/1209615180] [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: 11/13/2022]
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