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Shippee TP, Parikh RR, Baker ZG, Bucy TI, Ng W, Jarosek S, Qin X, Woodhouse M, Nkimbeng M, McCarthy T. Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer's Disease and Related Dementias. J Aging Health 2024; 36:379-389. [PMID: 37493607 DOI: 10.1177/08982643231191164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ObjectivesAmong nursing home (NH) residents with Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012-2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0-100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.
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Affiliation(s)
- Tetyana Pylypiv Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Taylor I Bucy
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Weiwen Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Jarosek
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Xuanzi Qin
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA
| | - Mark Woodhouse
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Manka Nkimbeng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Teresa McCarthy
- Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Shippee T, Simon Rosser BR, Wright MM, Aumock C, Moone R, Talley KMC, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports. J Appl Gerontol 2024; 43:562-576. [PMID: 37975683 PMCID: PMC10981565 DOI: 10.1177/07334648231213532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Phil Duran
- Aging and Gender Care Access, Saint Paul, MN, USA
| | | | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, MA, USA
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Rosser BRS, Shippee T, Wright MM, Aumock C, Moone R, Talley KM, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. "Going Back in the Closet": Addressing Discrimination Against Sexual and Gender Minority Residents in Long-Term Services and Supports by Providing Culturally Responsive Care. J Aging Soc Policy 2023:1-13. [PMID: 37348486 PMCID: PMC10739643 DOI: 10.1080/08959420.2023.2226300] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/27/2022] [Indexed: 06/24/2023]
Abstract
Sexual and gender minority (SGM) older adults face discrimination in long-term services and supports (LTSS). Yet, SGM older adults use LTSS disproportionately higher relative to their non-SGM counterparts. The discrimination is compounded by existing disparities, resulting in worse health outcomes and well-being for SGM older adults. Guided by socioecological model, we posit that training LTSS staff in SGM responsive care and implementing SGM anti-discrimination policies will be needed to improve care. Considering accessibility and turnover challenges, training should be online, interactive, and easily accessible. Studies that assess interventions for SGM responsive care are needed to guide policy and practice.
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Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Morgan M. Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cailynn Aumock
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rajean Moone
- Long Term Care Administration Program, College of Continuing and Professional Studies, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristine M.C. Talley
- Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - Carrie Henning-Smith
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jason D. Flatt
- Department of Social and Behavior Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Jaime Slaughter-Acey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel Greenwald
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Teresa McCarthy
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael W. Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Oberstar JS, Bakker CJ, Sorich M, McCarthy T. What Postoperative Nutritional Interventions Lead to Better Outcomes in Fragility Hip Fractures? A Systematic Review. Geriatr Orthop Surg Rehabil 2023; 14:21514593231155828. [PMID: 36817328 PMCID: PMC9936399 DOI: 10.1177/21514593231155828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/22/2023] [Indexed: 02/24/2023] Open
Abstract
Background Fragility hip fracture patients are often malnourished. Nutrition supplementation may help, but it is unclear if supplementation is impactful when considering outcomes. A systematic review of literature examining perioperative nutrition status for older adults experiencing a hip fracture was performed. Methods We searched Medline, CAB Abstracts and Embase (Ovid); Cochrane Library (Wiley); PubMed; Scopus; Global Index Medicus; Web of Science Core Collection; SPORTDiscus (EBSCO); and clinical trial registries ClinicalTrials.gov and WHO ICTRP from inception to April 2021, incorporating terminology related to nutritional interventions, fragility fractures, and postoperative outcomes. Two investigators reviewed citations for inclusion, extracted nutrition intervention criteria, and categorized hip fragility outcomes. Results Of 1792 citations, 90 articles underwent full-text screening, and 14 articles were included in the final sample. We identified nutritional interventions and 4 outcomes of interest. 8 studies (n = 649) demonstrated a mean difference of .78 days (CI .34-1.21) in length of stay (LOS) between the nutritional intervention and control groups. Rehabilitation ward stays were discussed in 2 studies demonstrating a non-statistically significant difference. 7 studies (n = 341) reported mortality rates; when pooled there was no statistically significant difference. 5 studies showed data for postoperative infections and 4 studies reported on postoperative urinary tract infections. Pooling of data found a statistically significant result (Relative Risk: .49 [.32, .75], P = .001) with low heterogeneity (I2 = 27%). 4 studies reported urinary tract infections (n = 140) in the intervention group and (n = 121) in the control group with a non-statistically significant result. Grip strength was only reported in two studies but pooling of the data was non-statistically significant. Conclusions This systematic review highlighted the lack of consensus regarding the type of nutrition interventions available and impact on outcomes of interest including mortality, length of stay, infections, and grip strength for fragility hip fractures in older adults.
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Affiliation(s)
- Jennifer S. Oberstar
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA,Jennifer S. Oberstar; Department of Family Medicine and Community Health, University of Minnesota 516 Delaware St SE, MMC381, Minneapolis, MN 55455, MN, USA.
| | - Caitlin J. Bakker
- Dr. John Archer Library & Archives, University of Regina, Regina, SK, Canada
| | - Megan Sorich
- Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa McCarthy
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
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Verdoorn BP, Evans TK, Hanson GJ, Zhu Y, Langhi Prata LGP, Pignolo RJ, Atkinson EJ, Wissler‐Gerdes EO, Kuchel GA, Mannick JB, Kritchevsky SB, Khosla S, Rizza SA, Walston JD, Musi N, Lipsitz LA, Kiel DP, Yung R, LeBrasseur NK, Singh RJ, McCarthy T, Puskarich MA, Niedernhofer LJ, Robbins PD, Sorenson M, Tchkonia T, Kirkland JL. Fisetin for COVID-19 in skilled nursing facilities: Senolytic trials in the COVID era. J Am Geriatr Soc 2021; 69:3023-3033. [PMID: 34375437 PMCID: PMC8447437 DOI: 10.1111/jgs.17416] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 01/19/2023]
Abstract
The burden of senescent cells (SnCs), which do not divide but are metabolically active and resistant to death by apoptosis, is increased in older adults and those with chronic diseases. These individuals are also at the greatest risk for morbidity and mortality from SARS-CoV-2 infection. SARS-CoV-2 complications include cytokine storm and multiorgan failure mediated by the same factors as often produced by SnCs through their senescence-associated secretory phenotype (SASP). The SASP can be amplified by infection-related pathogen-associated molecular profile factors. Senolytic agents, such as Fisetin, selectively eliminate SnCs and delay, prevent, or alleviate multiple disorders in aged experimental animals and animal models of human chronic diseases, including obesity, diabetes, and respiratory diseases. Senolytics are now in clinical trials for multiple conditions linked to SnCs, including frailty; obesity/diabetes; osteoporosis; and cardiovascular, kidney, and lung diseases, which are also risk factors for SARS-CoV-2 morbidity and mortality. A clinical trial is underway to test if senolytics decrease SARS-CoV-2 progression and morbidity in hospitalized older adults. We describe here a National Institutes of Health-funded, multicenter, placebo-controlled clinical trial of Fisetin for older adult skilled nursing facility (SNF) residents who have been, or become, SARS-CoV-2 rtPCR-positive, including the rationale for targeting fundamental aging mechanisms in such patients. We consider logistic challenges of conducting trials in long-term care settings in the SARS-CoV-2 era, including restricted access, consent procedures, methods for obtaining biospecimens and clinical data, staffing, investigational product administration issues, and potential solutions for these challenges. We propose developing a national network of SNFs engaged in interventional clinical trials.
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Affiliation(s)
- Brandon P. Verdoorn
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Division of Geriatrics and GerontologyMayo ClinicRochesterMinnesotaUSA
| | - Tamara K. Evans
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | - Gregory J. Hanson
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Division of Geriatrics and GerontologyMayo ClinicRochesterMinnesotaUSA
| | - Yi Zhu
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | | | - Robert J. Pignolo
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Division of Geriatrics and GerontologyMayo ClinicRochesterMinnesotaUSA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - George A. Kuchel
- University of Connecticut Center on Aging, UConn HealthFarmingtonConnecticutUSA
| | | | - Stephen B. Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's PreventionWinston‐SalemNorth CarolinaUSA
| | - Sundeep Khosla
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Division of Endocrinology, Department of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Stacey A. Rizza
- Division of Infectious Diseases, Department of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Jeremy D. Walston
- Department of Medicine, Division of Geriatric Medicine and GerontologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Nicolas Musi
- Barshop Institute for Longevity and Aging StudiesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of GerontologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Douglas P. Kiel
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of GerontologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Raymond Yung
- Geriatrics Center and Institute of GerontologyUniversity of MichiganAnn ArborMichiganUSA
- VA Ann Arbor Geriatrics ResearchEducation and Clinical CenterAnn ArborMichiganUSA
- Department of Internal Medicine Division of Geriatric and Palliative MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Nathan K. LeBrasseur
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Department of Physical Medicine and RehabilitationMayo ClinicRochesterMinnesotaUSA
| | - Ravinder J. Singh
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Teresa McCarthy
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and BiophysicsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Michael A. Puskarich
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and BiophysicsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Laura J. Niedernhofer
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and BiophysicsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Paul D. Robbins
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and BiophysicsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Tamara Tchkonia
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | - James L. Kirkland
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
- Division of Geriatrics and GerontologyMayo ClinicRochesterMinnesotaUSA
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McCarthy T, Burns H, Lyng A, Mullen L, O'Toole E. Addressing challenges to cancer control in Ireland due to the Covid-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574704 DOI: 10.1093/eurpub/ckab164.839] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The Covid-19 pandemic presented a wide range of challenges to cancer control. People with possible symptoms of cancer were considered less likely to present for investigation. Patients with cancer were concerned about increased risk of illness or death from this novel virus. Cancer services had to ensure continued delivery of time-sensitive care. Public health skills and leadership have been key to Ireland's National Cancer Control Programme's COVID response. The multi-disciplinary skill set within the Programme includes an understanding of health protection principles, experience in rapid service redesign, monitoring of service delivery, patient and public communication, advocacy and guidance development, all of which have been integral to the pandemic response. Specific areas addressed include: rapid turnaround of guidance documents for cancer services, to minimise Covid-19 risk; patient information materials for those on treatment or with a history of cancer; development of novel service delivery mechanisms, such as a virtual national psycho-oncology service; a media campaign to combat decreased presentations with possible cancer and to reassure those currently on treatment; development of pre-surgical cocooning guidance and testing pathway; advocating for prioritisation of time-sensitive cancer diagnosis and treatment, and the wider health & wellbeing needs of those cocooning; advocating for and supporting the implementation of priority vaccination for those undergoing cancer treatment. Cross-sectoral collaboration has been facilitated by existing networks and relationships, allowing rapid responses to be deployed and actioned. The leaner guidance development process employed during the pandemic enabled timely response. A two-way communication system with cancer services allowed swift cascade of information and gathering of intelligence which empowered action. Learning from the cancer setting was transferable to other high-risk groups. Key messages The potential impact of the pandemic on non-COVID care was far reaching, including at all stages of the cancer patient journey, from pre-diagnosis to living with or beyond cancer. The programmatic approach to cancer control in Ireland facilitated concerted efforts to respond to the challenges posed by the pandemic.
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Affiliation(s)
- T McCarthy
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - H Burns
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - A Lyng
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - L Mullen
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - E O'Toole
- National Cancer Control Programme, HSE, Dublin, Ireland
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McCarthy T, Dawkins I, Burns H, Nolan E. Use of cancer e-referral data to monitor health-seeking behaviours during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574286 DOI: 10.1093/eurpub/ckab165.650] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
At the outset of the pandemic, concern arose that people with concerning symptoms would not attend their GP and delayed presentations would impact cancer survival. Ireland lacks a national database of GP attendances from which to observe this. Ireland has rapid access clinics in designated cancer centres, providing a streamlined pathway for the diagnosis of certain common cancers. Referral to these clinics can be made electronically from primary care, using a national messaging system Healthlink. Healthlink agreed to report on the volume of referrals at weekly intervals, given the concern regarding non-presentation. Rolling descriptive analytics included the comparison of referral numbers to pre-pandemic weeks in 2020 (Weeks 2-11) and to corresponding time periods in 2019. A marked reduction was observed in wave 1 of the pandemic. Weekly e-referrals dropped by more than 60% in weeks 12-14 (breast 62.5%; lung 57.9%; prostate 61.1%). This was not replicated in subsequent waves. By end-2020, the volume of referrals equated to 112.4% of total referrals in 2019. The objective demonstration of a fall in cancer referrals prompted a media campaign to highlight the importance of early diagnosis and to reassure that cancer diagnostic and treatment services continued to operate. It also prompted national communication in relation to other essential health services. Challenges identified included occasional misinterpretation of referral data as reflective of attendance and investigation at clinics and the potential influence of increased uptake of e-referral systems. While caveats exist in relation to interpretation, e-referral data from primary care to cancer centres is a useful tool to monitor trends in patient presentations with suspected cancer. Automated collection of cancer e-referral data at a national level provides real-time information, compared to manual data collection systems within hospitals which were challenged through redeployment of staff to the Covid response. Key messages Monitoring of e-referral rates provided a useful and timely proxy measure of health-seeking behaviour during the Covid pandemic. The significant drop in referrals during the first wave of the pandemic was not repeated, suggesting an improved understanding among the public of the need to investigate symptoms of possible cancer.
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Affiliation(s)
- T McCarthy
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - I Dawkins
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - H Burns
- National Cancer Control Programme, HSE, Dublin, Ireland
| | - E Nolan
- National Cancer Control Programme, HSE, Dublin, Ireland
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Murphy B, Downey C, Flannery S, Daly T, Conway S, Gaffar M, Dawson P, Collins D, Kenny P, McCarthy T, Cashman J, Hurson C, O'Daly B, Quinlan J. 1235 A Multi-Site Review of Second Hip Fractures Across 6 Dublin Teaching Hospitals. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1034] [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: 11/14/2022]
Abstract
Abstract
Introduction
Hip fractures are a common presentation to Irish hospitals with 3,701 hip fractures recorded by 16 hospitals in the Irish Hip Fracture Database (IHFD) in 2019. Second hip fractures (HF2) make up a significant proportion of hip fractures and represent an opportunity to prevent subsequent fragility fracture.
Method
Hip fracture datasheets from 2019 in six Dublin hospitals were analysed.
Results
1,284 hip fractures in total were recorded in 2019 in these six hospitals. 112 of these were second hip fractures (8.72%). 24.1% of patients had a HF2 in year 1 post their first hip fracture (HF1). 14.3% of patients had a HF2 in Year 2, 8% in Year 3, 8.9% in Year 4 and 6.3% in Year 5. 17.9% of patients had an HF2 at an unknown time in relation to their HF1. 57.6% of all patients with any hip fracture were started on bone protection medications (BPMs) during their admission. 18.9% continued a pre-admission prescription. 7% of all patients were previously assessed and determined not to require BPM. 6.9% of patients were awaiting outpatient department (OPD) assessment for bone protection. 8.6% had no assessment for bone protection conducted. Of all patients with an HF2, 48.2% were started on BPMs on admission with their HF2. 33% continued BPMs started pre-admission.
Discussion
In 2019, approximately 1 in 10 hip fractures were second hip fractures. Evidence suggests that fracture liaison services represent a viable, economic means of preventing second hip fractures to improve patient outcomes and reduce healthcare expenditure.
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Affiliation(s)
- B Murphy
- Department of Trauma & Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - C Downey
- Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - S Flannery
- Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - T Daly
- Department of Trauma & Orthopaedic Surgery, Connolly Hospital, Dublin, Ireland
| | - S Conway
- Department of Trauma & Orthopaedic Surgery, Beaumont Hospital, Dublin, Ireland
| | - M Gaffar
- Department of Trauma & Orthopaedic Surgery, St James' Hospital, Dublin, Ireland
| | - P Dawson
- Department of Trauma & Orthopaedic Surgery, Mater Misericordiae Hospital, Dublin, Ireland
| | - D Collins
- Department of Trauma & Orthopaedic Surgery, Beaumont Hospital, Dublin, Ireland
| | - P Kenny
- Department of Trauma & Orthopaedic Surgery, Connolly Hospital, Dublin, Ireland
| | - T McCarthy
- Department of Trauma & Orthopaedic Surgery, St James' Hospital, Dublin, Ireland
| | - J Cashman
- Department of Trauma & Orthopaedic Surgery, Mater Misericordiae Hospital, Dublin, Ireland
| | - C Hurson
- Department of Trauma & Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - B O'Daly
- Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - J Quinlan
- Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
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Qin X, Baker ZG, Jarosek S, Woodhouse M, Chu H, McCarthy T, Shippee TP. Longitudinal Comparison of Stability and Sensitivity in Quality of Life Scores Among Nursing Home Residents With and Without Diagnoses of Alzheimer's Disease and Related Dementias. Innov Aging 2021; 5:igab024. [PMID: 34549094 PMCID: PMC8448423 DOI: 10.1093/geroni/igab024] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prevalence of nursing home residents with Alzheimer's disease and related dementias (ADRD) has increased along with a growing consensus that person-centered ADRD care in nursing homes should maximize quality of life (QoL). However, concerns about whether residents with ADRD can make appropriate QoL judgments persist. This study assesses the stability and sensitivity of a self-reported, multidomain well-being QoL measure for nursing home residents with and without ADRD. RESEARCH DESIGN AND METHODS This study linked the 2012-2015 Minnesota Nursing Home Resident QoL and Satisfaction with Care Survey, Minimum Data Set 3.0 (nursing home assessments), and Minnesota Department of Human Services Cost Reports. The QoL survey included cohort-resident pairs who participated for 2 consecutive years (N = 12 949; 8 803 unique residents from 2012-2013, 2013-2014, and 2014-2015 cohorts). Change in QoL between 2 years was conceptualized as stable when within 1.5 SD of the sample average. We used linear probability models to estimate associations of ADRD/Cognitive Function Scale status with the stability of QoL summary and domain scores (eg, social engagement) and the absolute change in QoL summary score, controlling for resident and facility characteristics. RESULTS Most (86.82%) residents had stable QoL summary scores. Residents with moderate to severe cognitive impairment, irrespective of ADRD, were less likely to have stable summary scores than cognitively capable residents without ADRD (p < .001), but associations varied by QoL domains. Among those with stable summary QoL scores, changes in health/functional status were associated with absolute changes in summary QoL score (p < .001), suggesting sensitivity of the QoL measure. DISCUSSION AND IMPLICATIONS QoL scores were similarly stable over time for most residents with and without ADRD diagnoses and were sensitive to changes in health/functional status. This self-reported QoL measure may be appropriate for nursing home residents, regardless of ADRD diagnosis, and can efficaciously be recommended to other states.
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Affiliation(s)
- Xuanzi Qin
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Zachary G Baker
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephanie Jarosek
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark Woodhouse
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Teresa McCarthy
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana P Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Affiliation(s)
- P. Ellanti
- Department of Trauma and Orthopaedics, St James’ University Hospital, Dublin, Ireland
| | - A. Moriarty
- Department of Trauma and Orthopaedics, St James’ University Hospital, Dublin, Ireland
| | - M. Nagle
- Department of Trauma and Orthopaedics, St James’ University Hospital, Dublin, Ireland
| | - T. McCarthy
- Department of Trauma and Orthopaedics, St James’ University Hospital, Dublin, Ireland
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Affiliation(s)
- P. Ellanti
- Department of Orthopaedics, St James’s Hospital, Dublin, Ireland
| | - A. Moriarity
- Department of Orthopaedics, St James’s Hospital, Dublin, Ireland
| | - N. Wainberg
- Department of Orthopaedics, St James’s Hospital, Dublin, Ireland
| | - C.N. Fhoghlu
- Department of Orthopaedics, St James’s Hospital, Dublin, Ireland
| | - T. McCarthy
- Department of Orthopaedics, St James’s Hospital, Dublin, Ireland
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Abstract
Background and context: World Cancer Day (WCD) aims to increase awareness and empower individuals to reduce their risk of cancer. Each year in Ireland approximately 800 new cancer cases and 300 cancer deaths are due to obesity. Aim: For WCD the Irish National Cancer Control Program (NCCP) aimed to increase public awareness of the risk of cancer due to obesity and the protective link with physical activity. Behavioral action was encouraged by partnering with parkrun ( www.parkrun.ie , a national free running event) to encourage participants to bring a friend and spread the cancer prevention message. Strategy/Tactics: A single overarching message was established: bring a friend to parkrun on the 3rd February for World Cancer Day. Two target audiences were identified: - General public watching Operation Transformation a national interactive TV program supporting weight loss and encouraging health behaviors - parkrun participants. Program/Policy process: Campaign activities were planned in conjunction with parkrun and HSE communications: - Digital assets designed - Press release issued to local and national media - Partner pack with key messages, social assets, campaign activity and supporting evidence disseminated to statutory bodies, NGOs and charities - NCCP cancer expert feature on Operation Transformation - Social media campaign @HSELive and @parkrunIE - Articles in parkrun newsletter prior to WCD - Announcements at parkrun events around the country prior to WCD - Communication to health service staff. Outcomes: On the 3rd February 10,169 individuals participated in parkrun, coordinated by 1153 volunteers. Cancer prevention and survivorship articles were published in 3 parkrun newsletters. #WorldCancerDay posts reached 39,000 on parkrun Facebook and 33,700 on parkrun Twitter. HSE paid Facebook posts reached 375,861 with a high level of engagement. Unpaid posts reached 5458. Tweets issued had a total reach of over 280,000. Parkrun directors provided the following feedback: “I think it was a great success - the engagement on social media both through parkrun Ireland and through the local event social media was brilliant.” “I think all the local events had at least one post on #WorldCancerDay during that time and most had had more and the feedback was uniformly positive, a couple of the parkruns (notably Dundalk parkrun) invited local cancer support groups to the event as well and in Dundalk´s case they actually gave a little talk before the event which was well received.” What was learned: - Inclusion of digital images for partners to share on social media was an integral element of the partner pack. - Straightforward message with a call to action built on an existing initiative with a broad reach across the country. - At the time of the campaign there was a large amount of national media coverage of Operation Transformation, impacting on space for media coverage. In the future consider a more local approach.
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Affiliation(s)
- A. Lyng
- National Cancer Control Programme, Ireland, Dublin, Ireland
| | - T. McCarthy
- National Cancer Control Programme, Ireland, Dublin, Ireland
| | - R. Glynn
- HSE, Public Health, Dublin, Ireland
| | - R. Guiry
- HSE, Communications, Dublin, Ireland
| | | | - F. Bonas
- National Cancer Control Programme, Ireland, Dublin, Ireland
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Murphy H, McCarthy T, Lyng A, Doherty K, Mullen L, Bonas F. Sexual Well-Being After Breast or Pelvic Cancer Treatment: A Guide for Women. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.68000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: As part of the National Cancer Strategy 2017-2026, the NCCP aims to improve the experience and care for cancer survivors. A key objective of survivorship care is to empower patients to achieve their best possible health outcomes while living with and beyond a diagnosis of cancer. Aim: To develop a guide to provide a support on sexual well-being for women who have completed cancer treatment of breast cancer; gynecologic cancer; bowel, rectal and anal cancer; or bladder cancer. Strategy/Tactics: A project design team was established with stakeholders including healthcare professionals and patients. Program/Policy process: The guides were designed to facilitate conversation around what is a sensitive subject for many people. Having cancer may change the relationships a cancer survivor has with their family and friends; it is natural to need some time to adjust. But while cancer treatment may affect sexuality, sex life doesn't have to end. The guide was reviewed by patient groups prior to printing. It is approved by National Adult Literacy Agency (NALA). The guide was nationally distributed to all clinical areas and is available on the Web. Outcomes: The final publication is entitled Sexual Well-Being After Breast or Pelvic Cancer Treatment: A Guide for Women. It gives details of treatments that may help improve sexual well-being and encourages women to be their own strongest resource. It includes advice on how to talk about sexual well-being, how to create physical and emotional intimacy, and what to do if you are not in a sexual relationship but would like to be. The guide is a companion to the previously published Information for Men on Sexual Well-Being After Pelvic Cancer Treatment, which has been widely used by men to understand the sexual changes caused by cancer treatment. The guide was launched in January 2018. With support from HSE communications it was promoted across social media. It received a positive response with the guides requested nationally. The guide was also distributed to all the cancer centers, support services, and primary care centers. What was learned: Healthcare professionals find it difficult to discuss sexuality with their patients and this booklet allows sexuality to be discussed. Workshops will be required with healthcare professionals to empower themselves and their patients to address the issue of sexuality in survivorship.
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Lyng A, McCarthy T, Glynn R, Costello S, Harte A, Bonas F, Laffoy M. Ireland Takes Action on Alcohol and Cancer. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.39900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: The 2006 EU strategy to reduce alcohol-related harm focuses on protecting young people and children; preventing alcohol-related harm in adults; raising awareness of the impact of harmful alcohol consumption. Ireland is the first EU country to develop alcohol legislation with a focus on cancer control. The Irish Public Health Alcohol Bill (PHAB) aims to reduce alcohol harm. Each year in Ireland > 900 new cancer cases are attributed to alcohol. < 20% of people are aware of the link between alcohol and breast cancer. It was timely the theme for 2017 European Awareness Week on Alcohol Related Harm (20-24th Nov) was “Alcohol and Cancer”. Aim: Capitalising on the theme, Ireland's National Cancer Control Program partnered with the Health Service Alcohol Program for “Action on Alcohol” a national public campaign to - raise awareness of the link between alcohol and cancer - call the public to action, to assess alcohol intake using the drinks calculator on askaboutalcohol.ie - enhance support for the PHAB Strategy/Tactics: Overarching message: “Drinking alcohol increases your risk of developing cancer. Drink less to reduce the risk”. Each day a target audience and message was identified: Monday: Women – 1 in 8 breast cancers are caused by alcohol Tuesday: Youth – drinking less in your teens and 20s can reduce your risk of developing cancer in later life Wednesday: Men – drinking less cancer reduce your risk of developing mouth, head and neck cancer. Thursday: LGBT – drinking less can reduce your risk of developing 7 types of cancer Program/Policy process: Statutory bodies, NGOs and charities were briefed and supplied with partner packs containing key messages, social assets, supporting research and planned campaign activity: - Press release to local and national media and health service staff - Local radio interviews with spokespeople (cancer expert and target audience expert) - National radio advertisement highlighted link between alcohol and breast cancer - Articles in print and online media - Social media campaign. Outcomes: - askaboutalcohol.ie received 35,855 page views (highest in 2 week period) 1,157 direct Web site visits, 427 completed drinks calculator (previous fortnight 409 visits, 58 completed drinks calculator) - > 25k people read “6 alcohol-related health risks everyone in their 20s should know about”, 38% completed drinks calculator - 9 Facebook posts had 109,852 views - National TV program invited spokesperson for interview - National and local newspapers coverage. In the period after campaign the PHAB passed through the next stage of legislation process with an amendment nominated by senators to add cancer warning labels to alcohol products.What was learned: - Clear division of target audiences and themes provided varied content with a consistent message - Partner pack empowered partners to deliver messages - Allow time for structured collaboration and communication with partners in advance.
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Affiliation(s)
- A. Lyng
- National Cancer Control Programme, Dublin, Ireland
| | - T. McCarthy
- National Cancer Control Programme, Dublin, Ireland
| | - R. Glynn
- HSE, Public Health, Dublin, Ireland
| | - S. Costello
- HSE, Alcohol Programme, Dublin, Ireland
- Alcohol Action Ireland, Dublin, Ireland
| | - A. Harte
- HSE, Communications, Dublin, Ireland
| | - F. Bonas
- National Cancer Control Programme, Dublin, Ireland
| | - M. Laffoy
- National Cancer Control Programme, Dublin, Ireland
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Collins A, McCarthy T, Laffoy M. Cancer Incidence and Mortality due to Excess Body Weight in Ireland: An Analysis of 10-year data. Ir Med J 2017; 110:614. [PMID: 29168996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Excess body weight (EBW) increases the risk of specific cancers. The prevalence of EBW has risen significantly in Ireland over recent decades. To highlight the impact on cancer, and to inform future policies, we calculated the proportion of cancers in Ireland that were attributable to EBW using the Population Attributable Fraction (PAF). This fraction was then applied to Irish incidence and mortality data for specific cancers from 2003-2012 to estimate the number of new cancers and cancer deaths attributable to EBW. We found that each year in Ireland, approximately 800 new cancers and 300 cancer deaths are attributable to EBW. The greatest attributable risk of cancer was seen for the upper digestive tract and endometrium, whilst breast and colorectal have the greatest numbers of attributable cancers. EBW is a major cause of cancer, responsible for 4.5% of all cancers in Ireland. Public awareness of this significant preventable risk must improve.
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Affiliation(s)
- A Collins
- Department of Public Health, Area Office, Arden Road, Tullamore, Co. Offaly
| | - T McCarthy
- National Cancer Control Programme, HSE, King Inn House, 200 Parnell St, Dublin 1
| | - M Laffoy
- National Cancer Control Programme, HSE, King Inn House, 200 Parnell St, Dublin 1
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Colgan G, Baker JF, Donlon N, Hogan N, McCarthy T. Total hip arthroplasty in patients with haemophilia - What are the risks of bleeding in the immediate peri-operative period? J Orthop 2016; 13:389-93. [PMID: 27504059 PMCID: PMC4969191 DOI: 10.1016/j.jor.2016.06.022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/24/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Undergoing a major surgical intervention such as total hip arthroplasty (THA) with an underlying clotting disorder like haemophilia poses its own unique challenges. Despite the advances in factor replacement and medical management, the potential for excessive and uncontrolled haemorrhage still exists. The aim of this study was to quantify blood loss, peri-operative transfusion requirements and risk of haematoma formation in a cohort of patients with haemophilia undergoing THA. METHODS All patients with haemophilia types A or B who had undergone THA in the previous 10 years were identified from the Hospital In-Patient Enquiry system and theatre logs. A comprehensive review of operative records, laboratory parameters and peri-operative haematological management was conducted. RESULTS Eleven male patients (12 THA) were identified. The mean age was 56 years (range 28-76). The mean intra-operative blood loss was 502 ml (100-1250 ml) compared to an established normal blood loss of 400 ml. The mean drop in haemoglobin was 3.25 g/dl in 48 h. Only one patient required a post-operative transfusion of two units of red cell concentrate. There were no complications of haematoma formation. CONCLUSION The results in our institution compare favourably with the established blood loss reported in the literature and by assessment with International Guidelines. Average blood loss in patients with haemophilia was higher than the established normal, but there was no increased transfusion requirement.
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Affiliation(s)
- Grainne Colgan
- Department of Orthopaedic Surgery, St James Hospital, Dublin 8, Ireland
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Anand U, Sinisi M, Fox M, MacQuillan A, Quick T, Korchev Y, Bountra C, McCarthy T, Anand P. Mycolactone-mediated neurite degeneration and functional effects in cultured human and rat DRG neurons: Mechanisms underlying hypoalgesia in Buruli ulcer. Mol Pain 2016; 12:12/0/1744806916654144. [PMID: 27325560 PMCID: PMC4956182 DOI: 10.1177/1744806916654144] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/16/2016] [Indexed: 01/08/2023] Open
Abstract
Background Mycolactone is a polyketide toxin secreted by the mycobacterium Mycobacterium ulcerans, responsible for the extensive hypoalgesic skin lesions characteristic of patients with Buruli ulcer. A recent pre-clinical study proposed that mycolactone may produce analgesia via activation of the angiotensin II type 2 receptor (AT2R). In contrast, AT2R antagonist EMA401 has shown analgesic efficacy in animal models and clinical trials for neuropathic pain. We therefore investigated the morphological and functional effects of mycolactone in cultured human and rat dorsal root ganglia (DRG) neurons and the role of AT2R using EMA401. Primary sensory neurons were prepared from avulsed cervical human DRG and rat DRG; 24 h after plating, neurons were incubated for 24 to 96 h with synthetic mycolactone A/B, followed by immunostaining with antibodies to PGP9.5, Gap43, β tubulin, or Mitotracker dye staining. Acute functional effects were examined by measuring capsaicin responses with calcium imaging in DRG neuronal cultures treated with mycolactone. Results Morphological effects: Mycolactone-treated cultures showed dramatically reduced numbers of surviving neurons and non-neuronal cells, reduced Gap43 and β tubulin expression, degenerating neurites and reduced cell body diameter, compared with controls. Dose-related reduction of neurite length was observed in mycolactone-treated cultures. Mitochondria were distributed throughout the length of neurites and soma of control neurons, but clustered in the neurites and soma of mycolactone-treated neurons. Functional effects: Mycolactone-treated human and rat DRG neurons showed dose-related inhibition of capsaicin responses, which were reversed by calcineurin inhibitor cyclosporine and phosphodiesterase inhibitor 3-isobutyl-1-Methylxanthine, indicating involvement of cAMP/ATP reduction. The morphological and functional effects of mycolactone were not altered by Angiotensin II or AT2R antagonist EMA401. Conclusion Mycolactone induces toxic effects in DRG neurons, leading to impaired nociceptor function, neurite degeneration, and cell death, resembling the cutaneous hypoalgesia and nerve damage in individuals with M. Ulcerans infection.
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Affiliation(s)
- U Anand
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - M Sinisi
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - M Fox
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - A MacQuillan
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - T Quick
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - Y Korchev
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - C Bountra
- University of Oxford Structural Genomics Consortium, Headington, Oxford, UK
| | - T McCarthy
- Spinifex Pharmaceuticals Pty Ltd, St. Preston, VIC, Australia
| | - P Anand
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Cassidy A, Dunwoody G, McCarthy T, Jeganathan R, Graham A. 29 Deaths awaiting cardiac surgery in Northern Ireland. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McCarthy T. Development of EMA401 as an orally-administered, highly-selective angiotensin II type 2 receptor antagonist for the treatment of neuropathic pain. J Peripher Nerv Syst 2015; 19 Suppl 2:S13-4. [PMID: 25269730 DOI: 10.1111/jns.12080_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T McCarthy
- Chief Executive Officer & Managing Director, Spinifex Pharmaceuticals, Victoria, Australia
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McCarthy T, Mullen L, Murphy H, Carey D, Laffoy M. Long-term follow-up of women with breast cancer: rationale for policy change. Ir J Med Sci 2014; 184:855-62. [PMID: 25271102 DOI: 10.1007/s11845-014-1202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 09/16/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The number of breast cancer survivors in our ageing population continues to rise. Policy makers internationally are seeking to identify alternatives to follow-up care in an acute setting. AIMS The National Cancer Control Programme set out to develop a new policy for long-term follow-up of breast cancer survivors in Ireland. METHODS Policy development was informed by analysis of current attendances at breast surgical clinics for routine follow-up, extraction of the necessary components of follow-up from international guidelines and focus group research with Irish patients. RESULTS Intensive follow-up investigations, other than mammography, do not confer additional survival benefit or improved quality of life. Provision of routine follow-up care of breast cancer survivors by GPs has been shown to be equivalent to follow-up by specialist clinics, in terms of clinical outcomes, patient quality of life and patient satisfaction. In Ireland, routine follow-up accounted for 15.4% (95% CI: 13.8-17.0%) of clinic appointments. A third were at least 5 years post-operative. Women highlighted issues such as attachment to specialist services, importance of communication and need for clarity as to where responsibility of care lies. Reassurance, confidence in the primary care practitioner, and coordination of multiple appointments were also identified as important issues. CONCLUSION A significant proportion of breast cancer survivors attending hospital surgical clinics for long-term follow-up could be safely discharged at 5 years, with the hospital maintaining responsibility for annual mammography. Successful implementation will depend on informed patients, clinicians' acceptance and communication between primary and secondary care.
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Affiliation(s)
- T McCarthy
- National Cancer Control Programme, Kings Inns House, 200 Parnell St, Dublin, 1, Ireland.
| | - L Mullen
- National Cancer Control Programme, Kings Inns House, 200 Parnell St, Dublin, 1, Ireland
| | - H Murphy
- National Cancer Control Programme, Kings Inns House, 200 Parnell St, Dublin, 1, Ireland
| | - D Carey
- Health Services Executive, Dr. Steevens' Hospital, Dublin, 8, Ireland
| | - M Laffoy
- National Cancer Control Programme, Kings Inns House, 200 Parnell St, Dublin, 1, Ireland
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Cummins F, Ramasubbu B, McCarthy T, Bergin C, Grieve PP. Surgery of the femur in HIV positive patients: a retrospective review from 2005 to 2011. Ir J Med Sci 2014; 184:505-10. [PMID: 24917418 DOI: 10.1007/s11845-014-1156-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 06/03/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND There are an estimated 6,900 people with HIV living in Ireland. There is a significant prevalence of femoral osteonecrosis and risk factors for osteoporotic fractures. With this potential, increasing surgical workload, it is important to assess surgical demand and audit outcomes. METHODS The hospital's electronic records were examined. Between January 2005 and August 2011, 17 femoral surgeries were identified in seven patients. Patient records were retrospectively reviewed. RESULTS Elective operations undertaken were eight hip replacements and one nail dynamisation. Eight emergency operations were undertaken: two DHS, one plating, one nailing, one revision nailing, two incision and drainages and one biopsy. All procedures were carried out using appropriate safety guidelines. Indications for surgery included femoral head osteonecrosis (n = 7), osteomyelitis (n = 3), proximal femoral fracture (n = 2), femoral shaft non-union (n = 1), dynamisation of a nail (n = 1), osteoarthritis (n = 1), fractured femur (n = 1), and revision nailing (n = 1). For two procedures the patient was not on highly active anti-retroviral treatment. All elective patients had CD4 counts greater than 200 pre-operatively. Six patients had undetectable viral loads. Of the eight emergency procedures, four procedures had no preoperative immune status recorded. Complications recorded were three non-unions, one nail fracture, one lesser trochanter fracture and recurrence of osteomyelitis. No surgical site infections were recorded. CONCLUSIONS Complications were not related to immune status. The rate of surgical site infection in both elective and emergency procedures was low. The elective surgery patients can safely receive orthopaedic treatment in their regional orthopaedic unit. Due to the high non-infectious complication rates recorded in the emergency group, transfer to a tertiary facility with infectious disease expertise is advised.
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Affiliation(s)
- F Cummins
- Departments of Trauma and Orthopaedics, St James's Hospital, Dublin, Ireland,
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Laffoy M, McCarthy T, Mullen L, Byrne D, Martin J. Cancer incidence and mortality due to alcohol: an analysis of 10-year data. Ir Med J 2013; 106:294-297. [PMID: 24579406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Alcohol consumption is causally related to cancer of the upper aero-digestive tract, liver, colon, rectum, female breast and pancreas. The dose response relationship varies for each site. We calculated Ireland's cancer incidence and mortality attributable to alcohol over a 10-year period. Between 2001 and 2010, 4,585 (4.7%) male and 4,593 (4.2%) female invasive cancer diagnoses were attributable to alcohol. The greatest risk was for the upper aero-digestive tract where 2,961 (52.9%) of these cancers in males and 866 (35.2%) in females were attributable to alcohol. Between 2001 and 2010, 2,823 (6.7%) of male cancer deaths and 1,700 (4.6%) of female cancer deaths were attributable to alcohol. Every year approximately 900 new cancers and 500 cancer deaths are attributable to alcohol. Alcohol is a major cause of cancer after smoking, obesity and physical inactivity. Public awareness of risk must improve. Over half of alcohol related cancers are preventable by adhering to Department of Health alcohol consumption guidelines.
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Affiliation(s)
- M Laffoy
- National Cancer Control Programme, HSE, Parnell St, Dublin 1
| | - T McCarthy
- National Cancer Control Programme, HSE, Parnell St, Dublin 1
| | - L Mullen
- National Cancer Control Programme, HSE, Parnell St, Dublin 1
| | | | - J Martin
- Department of Public Health, Dr Steeven's Hospital, HSE, Dublin 8
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Anand U, Facer P, Yiangou Y, Sinisi M, Fox M, McCarthy T, Bountra C, Korchev YE, Anand P. Angiotensin II type 2 receptor (AT2 R) localization and antagonist-mediated inhibition of capsaicin responses and neurite outgrowth in human and rat sensory neurons. Eur J Pain 2013; 17:1012-26. [PMID: 23255326 PMCID: PMC3748799 DOI: 10.1002/j.1532-2149.2012.00269.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [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] [Accepted: 11/09/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND The angiotensin II (AngII) receptor subtype 2 (AT2 R) is expressed in sensory neurons and may play a role in nociception and neuronal regeneration. METHODS We used immunostaining with characterized antibodies to study the localization of AT2 R in cultured human and rat dorsal root ganglion (DRG) neurons and a range of human tissues. The effects of AngII and AT2 R antagonist EMA401 on capsaicin responses in cultured human and rat (DRG) neurons were measured with calcium imaging, on neurite length and density with Gap43 immunostaining, and on cyclic adenosine monophosphate (cAMP) expression using immunofluorescence. RESULTS AT2 R expression was localized in small-/medium-sized cultured neurons of human and rat DRG. Treatment with the AT2 R antagonist EMA401 resulted in dose-related functional inhibition of capsaicin responses (IC50 = 10 nmol/L), which was reversed by 8-bromo-cAMP, and reduced neurite length and density; AngII treatment significantly enhanced capsaicin responses, cAMP levels and neurite outgrowth. The AT1 R antagonist losartan had no effect on capsaicin responses. AT2 R was localized in sensory neurons of human DRG, and nerve fibres in peripheral nerves, skin, urinary bladder and bowel. A majority sub-population (60%) of small-/medium-diameter neuronal cells were immunopositive in both control post-mortem and avulsion-injured human DRG; some very small neurons appeared to be intensely immunoreactive, with TRPV1 co-localization. While AT2 R levels were reduced in human limb peripheral nerve segments proximal to injury, they were preserved in painful neuromas. CONCLUSIONS AT2 R antagonists could be particularly useful in the treatment of chronic pain and hypersensitivity associated with abnormal nerve sprouting.
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Affiliation(s)
- U Anand
- Peripheral Neuropathy Unit, Department of Clinical Neuroscience, Imperial College London, UK
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Lazaroff A, Morishita L, Schoephoerster G, McCarthy T. Using dementia as the organizing principle when caring for patients with dementia and comorbidities. Minn Med 2013; 96:41-46. [PMID: 23437584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Most patients with dementia have other chronic health concerns as well. Because dementia affects every aspect of a patient's life, its consequences need to be considered in each care decision, including the treatment of comorbid illnesses. In this article, we present a framework for organizing the care of such patients around their dementia, rather than around their other conditions.
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McCarthy T, Telec N, Dennis A, Griffiths J, Buettner A. Ability of non-invasive intermittent blood pressure monitoring and a continuous non-invasive arterial pressure monitor (CNAP™) to provide new readings in each 1-min interval during elective caesarean section under spinal anaesthesia. Anaesthesia 2012; 67:274-9. [PMID: 22321084 DOI: 10.1111/j.1365-2044.2011.06996.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We compared the ability of automated non-invasive intermittent oscillometric blood pressure monitoring with a new device, CNAP(TM) (continuous non-invasive arterial pressure) to provide a new blood pressure reading in each 1-min interval between spinal anaesthesia and delivery during caesarean section. We also compared the accuracy of continuous non-invasive arterial pressure readings with non-invasive blood pressure measurements before spinal anaesthesia. Fifty-nine women participated. The non-invasive and continuous non-invasive monitors displayed new blood pressure readings in a mean of 82% (11%) and 83% (13%) (p = 0.97) of the one-minute intervals between spinal anaesthesia and delivery, respectively. Continuous non-invasive arterial pressure was more likely to fail on two or more consecutive minutes (p=0.001). From the pre-spinal readings, the mean bias, defined as non-invasive-continuous non-invasive arterial pressure, and limits of agreement (±2SD mean bias) for systolic, diastolic and mean blood pressure respectively were +1.3 (±26.0), -2.9 (±21.8) and +2.6 (±20.4) mmHg. The new monitor has disadvantages compared with conventional non-invasive intermittent blood pressure monitoring.
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Affiliation(s)
- T McCarthy
- Department of Anaesthesia, The Royal Women's Hospital, Melbourne, Australia.
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Abstract
AIMS To examine the associations between psychological adjustment to Type 2 diabetes and the reported quality and type of relationships with partners. METHODS All participants (n=88) completed a number of questionnaires, including two measures of relationship quality: the Dyadic Adjustment Scale and the Personal Assessment of Intimacy in Relationships Scale, the Diabetes Quality of Life Scale and the ATT-19 (which assesses personal integration of diabetes). Additionally, HbA(1c) levels were obtained from medical notes. RESULTS Measures of relationship quality significantly contributed to the explanation of two outcomes: personal integration of diabetes and satisfaction with the burden of self-management behaviours. More specifically, the findings demonstrate that a specific aspect of relationship quality--intimacy in recreational activities--is positively associated with the outcomes mentioned above. CONCLUSIONS People with Type 2 diabetes who are not taking insulin, who share engagement in physical activities with their partner are more likely to be psychologically well-adjusted to their diagnosis of diabetes.
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Affiliation(s)
- M Dempster
- School of Psychology, Queen's University Belfast Western Health and Social Care Trust, Omagh Belfast Health and Social Care Trust, Belfast, UK.
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McCarthy T, Mayer TM, Stein MN, Anand M, Collins F, Jeyamohan C, Metzger D, Moore D, White E, DiPaola RS. Modulating autophagy using hydroxychloroquine (HCQ) in patients with hormone-dependent PSA progression after local therapy for prostate cancer (PC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
164 Background: Autophagy is conserved, genetically controlled catabolic response to starvation and stress whereby cells self- digest intracellular proteins and organelles by targeting them for degradation in lysosomes to generate energy and mitigate damage, thereby supporting cancer cell survival. We hypothesized that HCQ, by blocking autophagy, would slow PC growth. Methods: Pts had rising PSA after primary therapy for PC, no radiographic evidence of metastasis, no (neo)adjuvant ADT within 3 months of enrollment and testosterone > 150 ng/dL. HCQ was dosed at 400 mg/day (cohort 1) or 600 mg/day (cohort 2). Endpoints were PSA response (defined as a change in slope of PSA rise by at least 25%, when log (PSA) is plotted vs. time) and assessment of safety and tolerability. Levels of p62 (which accumulates upon autophagy inhibition) and accumulation of autophagosomes (measured by EM) were assessed in blood mononuclear cells. Results: 38 pts (35 cohort 1; 3 cohort 2) of planned 64 pts with median age 65 (52-81), Gleason scores: 5 (5%), 6 (18%), 7 (55%), 8 (8%), 9 (13%) have been accrued. 30 pts have completed 6 cycles of therapy and 2 pts have completed 4 cycles of HCQ. 14/32 (44%) pts included in the analysis had a decrease in doubling time after treatment. 2 (6%) had declining PSA. Treatment was well tolerated, with grade 1 rash (10%), grade 1 nausea (10%) and grade 1 diarrhea (20%) being the predominant side effects noted. 3 pts had grade 2 toxicities (rash and diarrhea). There were no grade 3/4 toxicities. EM and p62 was assessed in 12 and 20 pts, respectively, and showed evidence of mitochondrial dysfunction and p62 accumulation. Conclusions: HCQ 400 mg/day appears to have some activity in PSA progression after localized therapy with minimal toxicity. Evaluation with higher doses of HCQ is ongoing. Assessing markers of autophagy including EM and p62 are feasible in pts and will require further validation in larger trials. No significant financial relationships to disclose.
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Affiliation(s)
- T. McCarthy
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - T. M. Mayer
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - M. N. Stein
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - M. Anand
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - F. Collins
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - C. Jeyamohan
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - D. Metzger
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - D. Moore
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - E. White
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - R. S. DiPaola
- Robert Wood Johnson Medical School, Piscataway, NJ; The Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
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Abstract
OBJECTIVES The aim of this study was to examine the impact of the use of an inter-professional care team on patient length of stay and payer charges in a geriatric transitional care unit. METHODS An analysis of de-identified administrative records for transitional care patients for the 12-month period (2003-2004) cared for by the inter-professional team (n = 163) and cared for by traditional single provider care model (n = 176) was carried out. We conducted logistic regression on length of stay and charges controlling for patient demographics and acuity levels. RESULTS The inter-professional care team patients had significantly shorter lengths of stay, fewer patient days and lower total charges. Patient diagnosis and acuity were similar across groups. CONCLUSION This study provides empirical evidence of the impact of an inter-professional care model in providing cost-effective transitional care in a nursing home setting. Evidence of shorter lengths of stay, shorter patient days and lower charges suggests benefit in the development and financing of inter-professional care teams for transitional care services.
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Affiliation(s)
- Lynn A Blewett
- University of Minnesota, School of Public Health, Minneapolis, MN 55455, USA.
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Cram D, McCarthy T, Goetz M, Kralevski V, Osborne E, Hussey N. A novel array CGH platform for PGD. Reprod Biomed Online 2009. [DOI: 10.1016/s1472-6483(10)61204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Luptak M, Kaas MJ, Artz M, McCarthy T. Project ADAPT: a program to assess depression and provide proactive treatment in rural areas. Gerontologist 2008; 48:542-8. [PMID: 18728304 DOI: 10.1093/geront/48.4.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We describe and evaluate a project designed to pilot test an evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. Project ADAPT-Assuring Depression Assessment and Proactive Treatment-utilized existing primary care resources to overcome barriers to sustainability experienced by similar projects. DESIGN AND METHODS This multifaceted intervention, which was structured after the successful IMPACT (Improving Mood/Promoting Access to Collaborative Treatment) research intervention, used on-site geriatric depression specialists, clinic staff training, team collaboration, and depression practice guidelines to improve depression care for rural elders. IMPACT screening and assessment instruments and treatment protocols were modified for use by less highly trained staff already employed by the rural primary care clinics. Patient and provider depression educational materials and depression screening and monitoring protocols were provided by means of regional training sessions and phone contact. Evaluation data were collected by mail and phone surveys. RESULTS Although Project ADAPT materials and training were initially developed for providers in rural primary care clinics, most participants came from long-term-care facilities, hospitals, home care, and public health and social service agencies. Forty-four sites sent 56 staff to Project ADAPT regional trainings, but many did not participate after the initial training. Participants who did continue reported that training improved geriatric depression screening and communication with the primary provider. IMPLICATIONS Outcomes suggest that provider, patient, and system issues have to be addressed differently in rural areas to improve geriatric depression treatment in primary care settings.
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Affiliation(s)
- Marilyn Luptak
- University of Utah College of Social Work, Salt Lake City, UT 84112, USA.
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Wootton-Gorges SL, Buonocore MH, Kuppermann N, Marcin JP, Barnes PD, Neely EK, DiCarlo J, McCarthy T, Glaser NS. Cerebral proton magnetic resonance spectroscopy in children with diabetic ketoacidosis. AJNR Am J Neuroradiol 2007; 28:895-9. [PMID: 17494665 PMCID: PMC8134352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND PURPOSE Subclinical cerebral edema occurs in many, if not most, children with diabetic ketoacidosis (DKA) and may be an indicator of subtle brain injury. Brain ratios of N-acetylaspartate (NAA) to creatine (Cr), measured by proton MR spectroscopy, decrease with neuronal injury or dysfunction. We hypothesized that brain NAA/Cr ratios may be decreased in children in DKA, indicating subtle neuronal injury. MATERIALS AND METHODS Twenty-nine children with DKA underwent cerebral proton MR spectroscopy during DKA treatment (2-12 hours after initiating therapy) and after recovery from the episode (72 hours or more after the initiation of therapy). We measured peak heights of NAA, Cr, and choline (Cho) in 3 locations within the brain: the occipital gray matter, the basal ganglia, and periaqueductal gray matter. These regions were identified in previous studies as areas at greater risk for neurologic injury in DKA-related cerebral edema. We calculated the ratios of NAA/Cr and Cho/Cr and compared these ratios during the acute illness and recovery periods. RESULTS In the basal ganglia, the ratio of NAA/Cr was significantly lower during DKA treatment compared with that after recovery (1.68 +/- 0.24 versus 1.86 +/- 0.28, P<.005). There was a trend toward lower NAA/Cr ratios during DKA treatment in the periaqueductal gray matter (1.66 +/- 0.38 versus 1.91 +/- 0.50, P=.06) and the occipital gray matter (1.97 +/- 0.28 versus 2.13 +/- 0.18, P=.08). In contrast, there were no significant changes in Cho/Cr ratios in any region. CONCLUSIONS NAA/Cr ratios are decreased in children during DKA and improve after recovery. This finding suggests that during DKA neuronal function or viability or both are compromised and improve after treatment and recovery.
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Affiliation(s)
- S L Wootton-Gorges
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
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Byrne AM, Morris S, McCarthy T, Quinlan W, O'byrne JM. Outcome following deep wound contamination in cemented arthroplasty. Int Orthop 2007; 31:27-31. [PMID: 16586132 PMCID: PMC2267550 DOI: 10.1007/s00264-006-0121-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 02/16/2006] [Accepted: 02/16/2006] [Indexed: 12/13/2022]
Abstract
Infection remains a devastating complication of joint replacement surgery causing a significant burden to both patient and surgeon. However, despite exhaustive prophylactic measures, intraoperative contamination still occurs during cemented arthroplasty with current infection rates of 1-2%. A study was undertaken to determine the incidence of perioperative contamination in cemented arthroplasty patients, to identify contaminating organisms, to identify contaminated regions within the operative wound, to identify factors associated with increased contamination, and finally to assess the medium-term clinical outcome in patients with confirmed intraoperative wound contamination. Eighty consecutive patients undergoing hip and knee cemented arthroplasty were prospectively enrolled over a 6-month period. All scrubbed personnel wore total body exhaust isolation suits and procedures were carried out in ultra-clean air theatres. Of 441 samples, contamination was identified at 21 sites (4.8%) representing a cohort of 18 patients (22.5%). Longer duration of surgery predisposed to higher contamination rates while lower contamination rates were significantly related to fewer gowned personnel within the ultra-clean system, and fewer total personnel in theatre during the procedure. None of the patients developed clinical evidence of deep prosthetic infection at follow-up. We noted a high incidence of intraoperative contamination despite standard prophylaxis. However, this was not reflected by a similar rate of postoperative infection. This may be due to a small bacterial inoculum in each case or may be due to the therapeutic effect of perioperative intravenous antibiotic prophylaxis.
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Affiliation(s)
- A M Byrne
- Cappagh National Orthopaedic Hospital, Dublin, 11, Ireland.
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Jarman SE, Pinchin J, Brushwood JM, McCarthy T, Bray M, Beeley PA. Design and construction of a facility for neutron activation analysis using the 14 MeV neutron generator at HMS Sultan. J Radioanal Nucl Chem 2007. [DOI: 10.1007/s10967-007-0105-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Gladman DD, Urowitz M, Fortin PR, Petri M, Barr S, Gordon C, Bae SC, Isenberg D, Zoma A, Aranow C, Dooley MA, Nived O, Sturfelt G, Steinsson K, Alarcón G, Senécal JL, Zummer M, Hanly J, Ensworth S, Pope J, Edworthy S, Rahman A, Sibley J, El-Gabalawy H, McCarthy T, St Pierre Y, Clarke A, Ramsey-Goldman R. Mortality in systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 54:2550-7. [PMID: 16868977 DOI: 10.1002/art.21955] [Citation(s) in RCA: 745] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled. METHODS Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined. RESULTS The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001. CONCLUSION Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.
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Affiliation(s)
- S Bernatsky
- Montreal General Hospital, Montreal, Quebec, Canada
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Sayers G, McCarthy T, O'Connell M, O'Leary M, O'Brien D, Cafferkey M, McNamara E. Haemolytic uraemic syndrome associated with interfamilial spread of E. coli O26:H11. Epidemiol Infect 2006; 134:724-8. [PMID: 16371176 PMCID: PMC2870445 DOI: 10.1017/s0950268805005455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2005] [Indexed: 11/06/2022] Open
Abstract
In September 2000, haemolytic uraemic syndrome (HUS) was diagnosed in a 10-month-old child with a prodromal history of vomiting and diarrhoea (non-bloody). Investigation revealed that a self-limiting gastrointestinal illness (mean duration 48 h) had occurred among immediate and extended family in the 2 weeks prior to the child's admission. The epidemiology of the illness suggested person-to-person spread. Five children (close family contacts) had E. coli O26 verocytotoxin (VT1 and VT2) isolated from stools. Stool culture and serology from the index case were negative for shiga toxin-producing E. coli (STEC) organisms. Control measures in accordance with the Public Health Laboratory Service (PHLS), verocytotoxogenic organisms (VTEC) guidelines were applied to prevent further spread among the extended family and contacts. Despite detailed food and environmental exposure histories, the source of the illness was not identified. This incident highlights the importance of investigation of cases of post-diarrhoeal HUS, for potential shiga toxin E. coli aetiology.
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Affiliation(s)
- G Sayers
- Department of Public Health, Health Service Executive Eastern Region, Dublin.
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Gray G, McCarthy T, Capuano A, LeBeck M, Setterquist S, Wellman D, Olsen C, Lynch C, Miller N, Gillette P, Lesher K, Klimov A, Alavanja M, Katz J. Population-Based Surveillance for Zoonotic Influenza a Infections Among Agricultural Workers. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s195-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morozov A, Krücken R, Ulrich A, Wieser J, McCarthy T. Energy-transfer processes in neon-hydrogen mixtures excited by electron beams. J Chem Phys 2005; 123:234311. [PMID: 16392924 DOI: 10.1063/1.2134697] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Energy- and charge-transfer processes in neon-hydrogen mixtures (500-1400 hPa neon and 0.001-3 hPa hydrogen partial pressures) excited by a pulsed low-energy (approximately 10 keV) electron beam were investigated using time-resolved spectroscopy. Time spectra of the hydrogen Lyman-alpha line, neon excimer emission (second continuum), and neon atomic lines (3p-3s transitions) were recorded. The time-integrated intensity of the Lyman-alpha emission was measured for the same range of gas mixtures. It is shown that direct energy transfer from Ne*2 excimers and neon atoms in the four lowest excited states as well as recombination of H3+ ions are the main channels populating atomic hydrogen in the n=2 state. A rate constant of (4.2+/-1.4)x10(-11) cm3 s(-1) was obtained for the charge transfer from Ne2+ ions to molecular hydrogen. A lower limit for the depopulation rate constant of Ne*2 excimers by molecular hydrogen (combination of energy transfer and ionization) was found to be 1.0 x 10(-10) cm3 s(-1).
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Affiliation(s)
- A Morozov
- Fakultät für Physik E12, Technische Universität München, 85748 Garching, Germany.
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Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Urowitz M, Gladman D, Fortin P, Gordon C, Barr S, Edworthy S, Bae SC, Petri M, Sibley J, Isenberg D, Rahman A, Steinsson K, Aranow C, Dooley MA, Alarcon GS, Hanly J, Sturfelt G, Nived O, Pope J, Ensworth S, Rajan R, El-Gabalawy H, McCarthy T, St Pierre Y, Clarke A, Ramsey-Goldman R. Race/ethnicity and cancer occurrence in systemic lupus erythematosus. ACTA ACUST UNITED AC 2005; 53:781-4. [PMID: 16208671 DOI: 10.1002/art.21458] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Bernatsky
- McGill University, Montreal, Quebec, Canada.
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Abstract
Sciatic nerve palsy is a recognised complication of primary total hip replacement. In our unit this complication was rare with an incidence of < 0.2% in the past ten years. We describe six cases of sciatic nerve palsy occurring in 355 consecutive primary total hip replacements (incidence 1.69%). Each of these palsies was caused by post-operative haematoma in the region of the sciatic nerve. Cases, which were recognised early and surgically-evacuated promptly, showed earlier and more complete recovery. Those patients for whom the diagnosis was delayed, and who were therefore managed expectantly, showed little or no recovery. Unexpected pain and significant swelling in the buttock, as well as signs of sciatic nerve irritation, suggest the presence of haematoma in the region of the sciatic nerve. It is, therefore, of prime importance to be vigilant for the features of a sciatic nerve palsy in the early post-operative period as, when recognised and treated early, the injury to the sciatic nerve may be reversed.
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Affiliation(s)
- A J Butt
- Kilcreen Regional Orthopaedic Hospital, Kilcreen, County Kilkenny, Ireland.
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Bernatsky S, Boivin JF, Joseph L, Rajan R, Zoma A, Manzi S, Ginzler E, Urowitz M, Gladman D, Fortin PR, Petri M, Edworthy S, Barr S, Gordon C, Bae SC, Sibley J, Isenberg D, Rahman A, Aranow C, Dooley MA, Steinsson K, Nived O, Sturfelt G, Alarcón G, Senécal JL, Zummer M, Hanly J, Ensworth S, Pope J, El-Gabalawy H, McCarthy T, St Pierre Y, Ramsey-Goldman R, Clarke A. An international cohort study of cancer in systemic lupus erythematosus. ACTA ACUST UNITED AC 2005; 52:1481-90. [PMID: 15880596 DOI: 10.1002/art.21029] [Citation(s) in RCA: 231] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There is increasing evidence in support of an association between systemic lupus erythematosus (SLE) and malignancy, but in earlier studies the association could not be quantified precisely. The present study was undertaken to ascertain the incidence of cancer in SLE patients, compared with that in the general population. METHODS We assembled a multisite (23 centers) international cohort of patients diagnosed as having SLE. Patients at each center were linked to regional tumor registries to determine cancer occurrence. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Cancers expected were determined by multiplying person-years in the cohort by the geographically matched age, sex, and calendar year-specific cancer rates, and summing over all person-years. RESULTS The 9,547 patients from 23 centers were observed for a total of 76,948 patient-years, with an average followup of 8 years. Within the observation interval, 431 cancers occurred. The data confirmed an increased risk of cancer among patients with SLE. For all cancers combined, the SIR estimate was 1.15 (95% confidence interval [95% CI] 1.05-1.27), for all hematologic malignancies, it was 2.75 (95% CI 2.13-3.49), and for non-Hodgkin's lymphoma, it was 3.64 (95% CI 2.63-4.93). The data also suggested an increased risk of lung cancer (SIR 1.37; 95% CI 1.05-1.76), and hepatobiliary cancer (SIR 2.60; 95% CI 1.25, 4.78). CONCLUSION These results support the notion of an association between SLE and cancer and more precisely define the risk of non-Hodgkin's lymphoma in SLE. It is not yet known whether this association is mediated by genetic factors or exogenous exposures.
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Affiliation(s)
- S Bernatsky
- Montreal General Hospital, Montreal, Quebec, Canada
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46
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McCarthy T, Hanniffy O, Lalor E, Savage A, Tuohy M. Evaluation of three thermostable fungal endo-β-glucanases from Talaromyces emersonii for brewing and food applications. Process Biochem 2005. [DOI: 10.1016/j.procbio.2004.06.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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McCarthy T, Crushell E, Synnott K, Kiely P, McCormack D. Play-wrestlers and their injuries. Ir Med J 2005; 98:84. [PMID: 15869066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Television (TV) broadcast wrestling series have become very popular amongst Irish children in recent years. Over a four-month study period, 2.3% of injuries seen at a busy paediatric fracture clinic were attributable to play-wrestling. The mean age was 9.5 years (range 4-15 years). All of the children had been role-playing wrestlers and imitating wrestling "moves" seen on TV. None had formal training in wrestling or martial arts. The commonest injury was fracture of the distal radius (7/13). One child required general anaesthetic for manipulation of a dorsally displaced fracture of radius. All other injuries were treated conservatively and resolved without sequelae.
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Affiliation(s)
- T McCarthy
- Department of Orthopaedics, The Children's University Hospital, Dublin, Ireland.
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48
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Bernstein DI, Stanberry LR, Sacks S, Ayisi NK, Gong YH, Ireland J, Mumper RJ, Holan G, Matthews B, McCarthy T, Bourne N. Evaluations of unformulated and formulated dendrimer-based microbicide candidates in mouse and guinea pig models of genital herpes. Antimicrob Agents Chemother 2004; 47:3784-8. [PMID: 14638483 PMCID: PMC296200 DOI: 10.1128/aac.47.12.3784-3788.2003] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [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: 11/20/2022] Open
Abstract
Prevention of sexually transmitted infections is a priority in developed and developing countries. One approach to prevention is the use of topical microbicides, and one promising approach is the use of dendrimers, highly branched macromolecules synthesized from a polyfunctional core. Three new dendrimer products developed to provide stable and cost-efficient microbicides were initially evaluated in vitro for anti-herpes simplex virus activity and then in vivo by using a mouse model of genital herpes. From these experiments one product, SPL7013, was chosen for further evaluation to define the dose and duration of protection. Unformulated SPL7013 provided significant protection from genital herpes disease and infection at concentrations as low as 1 mg/ml and for at least 1 h following topical (intravaginal) administration of 10 mg/ml. This compound was then formulated into three vehicles and further evaluated in mouse and guinea pig models of genital herpes infection. In the murine evaluations each of the formulations provided significant protection at concentrations of 10 and 50 mg/ml. Formulated compounds provided protection for at least 1 h at a concentration of 10 mg/ml. From these experiments formulation 2V was chosen for dose ranging experiments using the guinea pig model of genital herpes. The guinea pig evaluations suggested that doses of 30 to 50 mg/ml were required for optimal protection. From these studies a lead compound and formulation (2V of SPL7013) was chosen for ongoing evaluations in primate models of simian immunodeficiency virus and Chlamydia trachomatis infection.
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Affiliation(s)
- D I Bernstein
- Division of Infectious Diseases, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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49
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Abstract
Recent studies have demonstrated significant synergistic physiological and biochemical effects between low-dose endotoxin (Etx) administration and oleic acid (OA)-induced canine lung injury. To evaluate whether this interaction depends on Etx priming of some key cell population, we compared the effects of giving low-dose Etx both after as well as before inducing lung injury with OA. In addition to hemodynamic and blood-gas measurements, positron emission tomographic imaging was used to measure edema accumulation and intrapulmonary blood flow distribution. Biochemical measurements of the stable metabolites of prostacyclin and thromboxane were obtained as well as measurements of isoprostanes and reactive sulfhydryls as evidence for possible concomitant oxidant production. We found that the physiological and biochemical effects of low-dose Etx developed 30-45 min after its administration, regardless of whether Etx was administered before or after OA. No increase in either isoprostane or reactive sulfhydryl production after Etx and/or OA was detected. These data suggest that the synergistic effect of low-dose Etx and OA-induced lung injury is not due to a priming effect of Etx.
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Affiliation(s)
- D P Schuster
- Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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O'Brien M, McCarthy T, Jenkins D, Paul P, Dausset J, Carosella ED, Moreau P. Altered HLA-G transcription in pre-eclampsia is associated with allele specific inheritance: possible role of the HLA-G gene in susceptibility to the disease. Cell Mol Life Sci 2001; 58:1943-9. [PMID: 11766889 DOI: 10.1007/pl00000828] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pre-eclampsia is a disorder of human pregnancy occurring in 5-10% of all births, and represents the leading cause of infant morbidity and mortality and maternal death. In pre-eclampsia, invasion of fetal trophoblasts into maternal arteries during early pregnancy is shallow or absent. Here we examined the hypothesis that HLA-G, a non-classical class I HLA expressed in cytotrophoblasts, may act as a key gene in pre-eclampsia. We analysed HLA-G at the level of transcription and genotyped a silent CAC-CAT polymorphism in exon 3 and a 14-bp insertion/deletion in the 3' untranslated region. A deficit in levels of the HLA-G3 transcript was observed in mild pre-eclampsia compared to normal placentas. The distribution of HLA-G polymorphisms was different between normal and pre-eclampsia samples. A correlation between the alteration in transcription of the HLA-G gene and certain HLA-G genotypes was also observed. Thus we provide the first evidence for a possible role of HLA-G in genetic susceptibility to, and pathogenesis of pre-eclampsia.
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Affiliation(s)
- M O'Brien
- CEA, Service de Recherches en Hémato-immunologie, DSV/DRM, Hôpital Saint-Louis, Institut d'Hématologie, Paris, France
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