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Gillies CL, Rowlands AV, Razieh C, Nafilyan V, Chudasama Y, Islam N, Zaccardi F, Ayoubkhani D, Lawson C, Davies MJ, Yates T, Khunti K. Association between household size and COVID-19: A UK Biobank observational study. J R Soc Med 2022; 115:138-144. [PMID: 35118908 PMCID: PMC8972956 DOI: 10.1177/01410768211073923] [Citation(s) in RCA: 5] [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] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the association between household size and risk of non-severe or
severe COVID-19. Design A longitudinal observational study. Setting This study utilised UK Biobank linked to national SARS-CoV-2 laboratory test
data. Participants 401,910 individuals with available data on household size in UK Biobank. Main outcome measures Household size was categorised as single occupancy, two-person households and
households of three or more. Severe COVID-19 was defined as a positive
SARS-CoV-2 test on hospital admission or death with COVID-19 recorded as the
underlying cause; and non-severe COVID-19 as a positive test from a
community setting. Logistic regression models were fitted to assess
associations, adjusting for potential confounders. Results Of 401,910 individuals, 3612 (1%) were identified as having suffered from a
severe COVID-19 infection and 11,264 (2.8%) from a non-severe infection,
between 16 March 2020 and 16 March 2021. Overall, the odds of severe
COVID-19 was significantly higher among individuals living alone (adjusted
odds ratio: 1.24 [95% confidence interval: 1.14 to 1.36], or living in a
household of three or more individuals (adjusted odds ratio: 1.28 [1.17 to
1.39], when compared to individuals living in a household of two. For
non-severe COVID-19 infection, individuals living in a single-occupancy
household had lower odds compared to those living in a household of two
(adjusted odds ratio: 0.88 [0.82 to 0.93]. Conclusions Odds of severe or non-severe COVID-19 infection were associated with
household size. Increasing understanding of why certain households are more
at risk is important for limiting spread of the infection.
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Affiliation(s)
- Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Alex V Rowlands
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Cameron Razieh
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Vahé Nafilyan
- Office for National Statistics, Government Buildings, Newport, South Wales, NP10 8XG, UK
| | - Yogini Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Nazrul Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, OX1 2JD, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Daniel Ayoubkhani
- Office for National Statistics, Government Buildings, Newport, South Wales, NP10 8XG, UK
| | - Claire Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Tom Yates
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
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2
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Yates T, Summerfield A, Razieh C, Banerjee A, Chudasama Y, Davies MJ, Gillies C, Islam N, Lawson C, Mirkes E, Zaccardi F, Khunti K, Nafilyan V. A population-based cohort study of obesity, ethnicity and COVID-19 mortality in 12.6 million adults in England. Nat Commun 2022; 13:624. [PMID: 35110546 PMCID: PMC8810846 DOI: 10.1038/s41467-022-28248-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
Obesity and ethnicity are known risk factors for COVID-19 outcomes, but their combination has not been extensively examined. We investigate the association between body mass index (BMI) and COVID-19 mortality across different ethnic groups using linked national Census, electronic health records and mortality data for adults in England from the start of pandemic (January 2020) to December 2020. There were 30,067 (0.27%), 1,208 (0.29%), 1,831 (0.29%), 845 (0.18%) COVID-19 deaths in white, Black, South Asian and other ethnic minority groups, respectively. Here we show that BMI was more strongly associated with COVID-19 mortality in ethnic minority groups, resulting in an ethnic risk of COVID-19 mortality that was dependant on BMI. The estimated risk of COVID-19 mortality at a BMI of 40 kg/m2 in white ethnicities was equivalent to the risk observed at a BMI of 30.1 kg/m2, 27.0 kg/m2, and 32.2 kg/m2 in Black, South Asian and other ethnic minority groups, respectively.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK.
| | | | - Cameron Razieh
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Nazrul Islam
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Claire Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Evgeny Mirkes
- Department of Mathematics, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Faculty of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, UK
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3
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Rowlands AV, Dempsey PC, Gillies C, Kloecker DE, Razieh C, Chudasama Y, Islam N, Zaccardi F, Lawson C, Norris T, Davies MJ, Khunti K, Yates T. Association Between Accelerometer-Assessed Physical Activity and Severity of COVID-19 in UK Biobank. Mayo Clin Proc Innov Qual Outcomes 2021; 5:997-1007. [PMID: 34430796 PMCID: PMC8376658 DOI: 10.1016/j.mayocpiqo.2021.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To quantify the association between accelerometer-assessed physical activity and coronavirus disease 2019 (COVID-19) outcomes. METHODS Data from 82,253 UK Biobank participants with accelerometer data (measured 2013-2015), complete covariate data, and linked COVID-19 data from March 16, 2020, to March 16, 2021, were included. Two outcomes were investigated: severe COVID-19 (positive test result from in-hospital setting or COVID-19 as primary cause of death) and nonsevere COVID-19 (positive test result from community setting). Logistic regressions were used to assess associations with moderate to vigorous physical activity (MVPA), total activity, and intensity gradient. A higher intensity gradient indicates a higher proportion of vigorous activity. RESULTS Average MVPA was 48.1 (32.7) min/d. Physical activity was associated with lower odds of severe COVID-19 (adjusted odds ratio per standard deviation increase: MVPA, 0.75 [95% CI, 0.67 to 0.85]; total, 0.83 [0.74 to 0.92]; intensity, 0.77 [0.70 to 0.86]), with stronger associations in women (MVPA, 0.63 [0.52 to 0.77]; total, 0.76 [0.64 to 0.90]; intensity, 0.63 [0.53 to 0.74]) than in men (MVPA, 0.84 [0.73 to 0.97]; total, 0.88 [0.77 to 1.01]; intensity, 0.88 [0.77 to 1.00]). In contrast, when mutually adjusted, total activity was associated with higher odds of a nonsevere infection (1.10 [1.04 to 1.16]), whereas the intensity gradient was associated with lower odds (0.91 [0.86 to 0.97]). CONCLUSION Odds of severe COVID-19 were approximately 25% lower per standard deviation (∼30 min/d) MVPA. A greater proportion of vigorous activity was associated with lower odds of severe and nonsevere infections. The association between total activity and higher odds of a nonsevere infection may be through greater community engagement and thus more exposure to the virus. Results support calls for public health messaging highlighting the potential of MVPA for reducing the odds of severe COVID-19.
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Affiliation(s)
- Alex V. Rowlands
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
| | - Paddy C. Dempsey
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Physical Activity and Behavioural Epidemiology Laboratories, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Clare Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - David E. Kloecker
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- St George’s University of London, Tooting, London, United Kingdom
| | - Cameron Razieh
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
| | - Yogini Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Nazrul Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Claire Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Tom Norris
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Melanie J. Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands (ARC-EM), Leicester General Hospital, Leicester, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
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4
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Yates T, Zaccardi F, Islam N, Razieh C, Gillies CL, Lawson CA, Chudasama Y, Rowlands A, Davies MJ, Docherty AB, Openshaw PJM, Baillie JK, Semple MG, Khunti K. Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort. BMC Infect Dis 2021; 21:717. [PMID: 34330226 PMCID: PMC8324452 DOI: 10.1186/s12879-021-06466-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. Methods We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included: chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories. Results The analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI: 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50–69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease. Conclusion Obesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06466-0.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Cameron Razieh
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Clare L Gillies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Claire A Lawson
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Yogini Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alex Rowlands
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.,Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | | | | | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Respiratory Medicine, Alder Hey Children's Hospital, Institute in The Park, University of Liverpool, Alder Hey Children's Hospital, L12 2AP, Liverpool, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
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5
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Yates T, Zaccardi F, Islam N, Razieh C, Gillies CL, Lawson CA, Chudasama Y, Rowlands A, Davies MJ, Docherty AB, Openshaw PJM, Baillie JK, Semple MG, Khunti K. Obesity, Ethnicity, and Risk of Critical Care, Mechanical Ventilation, and Mortality in Patients Admitted to Hospital with COVID-19: Analysis of the ISARIC CCP-UK Cohort. Obesity (Silver Spring) 2021; 29:1223-1230. [PMID: 33755331 PMCID: PMC8251439 DOI: 10.1002/oby.23178] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the association of obesity with in-hospital coronavirus disease 2019 (COVID-19) outcomes in different ethnic groups. METHODS Patients admitted to hospital with COVID-19 in the United Kingdom through the Clinical Characterisation Protocol UK (CCP-UK) developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) were included from February 6 to October 12, 2020. Ethnicity was classified as White, South Asian, Black, and other minority ethnic groups. Outcomes were admission to critical care, mechanical ventilation, and in-hospital mortality, adjusted for age, sex, and chronic diseases. RESULTS Of the participants included, 54,254 (age = 76 years; 45.0% women) were White, 3,728 (57 years; 41.1% women) were South Asian, 2,523 (58 years; 44.9% women) were Black, and 5,427 (61 years; 40.8% women) were other ethnicities. Obesity was associated with all outcomes in all ethnic groups, with associations strongest for black ethnicities. When stratified by ethnicity and obesity status, the odds ratios for admission to critical care, mechanical ventilation, and mortality in black ethnicities with obesity were 3.91 (3.13-4.88), 5.03 (3.94-6.63), and 1.93 (1.49-2.51), respectively, compared with White ethnicities without obesity. CONCLUSIONS Obesity was associated with an elevated risk of in-hospital COVID-19 outcomes in all ethnic groups, with associations strongest in Black ethnicities.
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Affiliation(s)
- Thomas Yates
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Francesco Zaccardi
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Cameron Razieh
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Clare L. Gillies
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Claire A. Lawson
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
| | - Yogini Chudasama
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Alex Rowlands
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Melanie J. Davies
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
| | - Annemarie B. Docherty
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUK
- Intensive Care UnitRoyal Infirmary EdinburghEdinburghUK
| | | | | | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
- Respiratory MedicineAlder Hey Children’s HospitalInstitute in The ParkUniversity of LiverpoolAlder Hey Children’s HospitalLiverpoolUK
| | | | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicester General HospitalLeicesterUK
- Leicester Real World Evidence UnitDiabetes Research CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration – East Midlands (ARC‐EM)University Hospitals of Leicester NHS Trust and University of LeicesterLeicesterUK
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6
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Rowlands AV, Gillies C, Chudasama Y, Davies MJ, Islam N, Kloecker DE, Lawson C, Pareek M, Razieh C, Zaccardi F, Yates T, Khunti K. Association of working shifts, inside and outside of healthcare, with severe COVID-19: an observational study. BMC Public Health 2021; 21:773. [PMID: 33888095 PMCID: PMC8061465 DOI: 10.1186/s12889-021-10839-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/01/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Health and key workers have elevated odds of developing severe COVID-19; it is not known, however, if this is exacerbated in those with irregular work patterns. We aimed to investigate the odds of developing severe COVID-19 in health and shift workers. METHODS We included UK Biobank participants in employment or self-employed at baseline (2006-2010) and with linked COVID-19 data to 31st August 2020. Participants were grouped as neither a health worker nor shift worker (reference category) at baseline, health worker only, shift worker only, or both, and associations with severe COVID-19 investigated in logistic regressions. RESULTS Of 235,685 participants (81·5% neither health nor shift worker, 1·4% health worker only, 16·9% shift worker only, and 0·3% both), there were 580 (0·25%) cases of severe COVID-19. The odds of severe COVID-19 was higher in health workers (adjusted odds ratio: 2·32 [95% CI: 1·33, 4·05]; shift workers (2·06 [1·72, 2·47]); and in health workers who worked shifts (7·56 [3·86, 14·79]). Being both a health worker and a shift worker had a possible greater impact on the odds of severe COVID-19 in South Asian and Black and African Caribbean ethnicities compared to White individuals. CONCLUSIONS Both health and shift work (measured at baseline, 2006-2010) were independently associated with over twice the odds of severe COVID-19 in 2020; the odds were over seven times higher in health workers who work shifts. Vaccinations, therapeutic and preventative options should take into consideration not only health and key worker status but also shift worker status.
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Affiliation(s)
- A V Rowlands
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK.
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK.
| | - C Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
| | - Y Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
| | - M J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - N Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D E Kloecker
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- St George's University of London, Tooting, London, UK
| | - C Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
| | - M Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - C Razieh
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - F Zaccardi
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
| | - T Yates
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - K Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Rd, Leicester, LE5 4PW, UK
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
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7
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Rowlands AV, Kloecker DE, Chudasama Y, Davies MJ, Dawkins NP, Edwardson CL, Gillies C, Khunti K, Razieh C, Islam N, Zaccardi F, Yates T. Association of Timing and Balance of Physical Activity and Rest/Sleep With Risk of COVID-19: A UK Biobank Study. Mayo Clin Proc 2021; 96:156-164. [PMID: 33413813 PMCID: PMC7604071 DOI: 10.1016/j.mayocp.2020.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022]
Abstract
Behavioral lifestyle factors are associated with cardiometabolic disease and obesity, which are risk factors for coronavirus disease 2019 (COVID-19). We aimed to investigate whether physical activity, and the timing and balance of physical activity and sleep/rest, were associated with SARS-CoV-2 positivity and COVID-19 severity. Data from 91,248 UK Biobank participants with accelerometer data and complete covariate and linked COVID-19 data to July 19, 2020, were included. The risk of SARS-CoV-2 positivity and COVID-19 severity-in relation to overall physical activity, moderate-to-vigorous physical activity (MVPA), balance between activity and sleep/rest, and variability in timing of sleep/rest-was assessed with adjusted logistic regression. Of 207 individuals with a positive test result, 124 were classified as having a severe infection. Overall physical activity and MVPA were not associated with severe COVID-19, whereas a poor balance between activity and sleep/rest was (odds ratio [OR] per standard deviation: 0.71; 95% confidence interval [CI], 0.62 to 0.81]). This finding was related to higher daytime activity being associated with lower risk (OR, 0.75; 95% CI, 0.61 to 0.93) but higher movement during sleep/rest being associated with higher risk (OR, 1.26; 95% CI, 1.12 to 1.42) of severe infection. Greater variability in timing of sleep/rest was also associated with increased risk (OR, 1.21; 95% CI, 1.08 to 1.35). Results for testing positive were broadly consistent. In conclusion, these results highlight the importance of not just physical activity, but also quality sleep/rest and regular sleep/rest patterns, on risk of COVID-19. Our findings indicate the risk of COVID-19 was consistently approximately 1.2-fold greater per approximately 40-minute increase in variability in timing of proxy measures of sleep, indicative of irregular sleeping patterns.
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Affiliation(s)
- Alex V Rowlands
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom.
| | - David E Kloecker
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Yogini Chudasama
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; NIHR Applied Research Collaboration - East Midlands, Leicester General Hospital, Leicester, United Kingdom
| | - Nathan P Dawkins
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Charlotte L Edwardson
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Clare Gillies
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom; NIHR Applied Research Collaboration - East Midlands, Leicester General Hospital, Leicester, United Kingdom
| | - Cameron Razieh
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Nazrul Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
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8
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Singh AK, Gillies CL, Singh R, Singh A, Chudasama Y, Coles B, Seidu S, Zaccardi F, Davies MJ, Khunti K. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: A systematic review and meta-analysis. Diabetes Obes Metab 2020; 22:1915-1924. [PMID: 32573903 PMCID: PMC7361304 DOI: 10.1111/dom.14124] [Citation(s) in RCA: 264] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023]
Abstract
AIM To estimate the prevalence of both cardiometabolic and other co-morbidities in patients with COVID-19, and to estimate the increased risk of severity of disease and mortality in people with co-morbidities. MATERIALS AND METHODS Medline, Scopus and the World Health Organization website were searched for global research on COVID-19 conducted from January 2019 up to 23 April 2020. Study inclusion was restricted to English language publications, original articles that reported the prevalence of co-morbidities in individuals with COVID-19, and case series including more than 10 patients. Eighteen studies were selected for inclusion. Data were analysed using random effects meta-analysis models. RESULTS Eighteen studies with a total of 14 558 individuals were identified. The pooled prevalence for co-morbidities in patients with COVID-19 disease was 22.9% (95% CI: 15.8 to 29.9) for hypertension, 11.5% (9.7 to 13.4) for diabetes, and 9.7% (6.8 to 12.6) for cardiovascular disease (CVD). For chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), cerebrovascular disease and cancer, the pooled prevalences were all less than 4%. With the exception of cerebrovascular disease, all the other co-morbidities presented a significantly increased risk for having severe COVID-19. In addition, the risk of mortality was significantly increased in individuals with CVD, COPD, CKD, cerebrovascular disease and cancer. CONCLUSIONS In individuals with COVID-19, the presence of co-morbidities (both cardiometabolic and other) is associated with a higher risk of severe COVID-19 and mortality. These findings have important implications for public health with regard to risk stratification and future planning.
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Affiliation(s)
| | - Clare L. Gillies
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Ritu Singh
- GD Hospital & Diabetes InstituteKolkataIndia
| | - Akriti Singh
- College of Medicine and JNM HospitalKalyani, NadiaWest BengalIndia
| | - Yogini Chudasama
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Briana Coles
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
| | - Sam Seidu
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Francesco Zaccardi
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Melanie J. Davies
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- Leicester Real World Evidence UnitLeicester Diabetes CentreLeicesterUK
- National Institute for Health Research (NIHR) Applied Research Collaboration ‐ East Midlands (ARC‐EM), Diabetes Research Centre, Leicester General HospitalUniversity of LeicesterLeicesterUK
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9
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Woolley AK, Chudasama Y, Seidu SI, Gillies C, Schreder S, Davies MJ, Khunti K. Influence of sociodemographic characteristics on the preferred format of health education delivery in individuals with type 2 diabetes mellitus and or cardiovascular disease: a questionnaire study. Diabet Med 2020; 37:982-990. [PMID: 32096573 DOI: 10.1111/dme.14275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 12/27/2022]
Abstract
AIM To examine the influence of sociodemographic factors of interest on preference for a particular health education format among people with type 2 diabetes and/or cardiovascular disease. METHODS A questionnaire was used to collect information on the influence of six sociodemographic factors of interest on the preference for health education formats in people with type 2 diabetes and/or cardiovascular disease. Chi-squared tests were used to examine the distribution of preferences between groups. The characteristics of the population preferring the online format were then examined in more detail using logistic regression. RESULTS Responses were received from 1559 participants. Overall the preferred health education format was one-to-one learning from a doctor or nurse (67%). Age, gender, diagnosis and educational level all affected the preferences expressed. The characteristics showing most consistent and significant influence were age and educational level. Overall, 29% ranked the online format highly (scores 1 or 2). This group were more likely to be aged < 65 years (P < 0.001) and to have a higher level of educational attainment (upper secondary education or higher; P < 0.001). CONCLUSIONS Significant differences between sociodemographic groups exist in preferences for health education formats among people with type 2 diabetes and/or cardiovascular disease. Preferences should be considered when designing educational interventions to ensure they are accessible to the target group and to avoid increases in health inequality.
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Affiliation(s)
- A K Woolley
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Y Chudasama
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - S I Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - C Gillies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - S Schreder
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - M J Davies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - K Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
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10
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Abstract
RATIONALE The neuropeptide galanin has been implicated in a wide range of pathological conditions in which frontal and temporal structures are compromised. It works through three subtypes of G-protein-coupled receptors. One of these, the galanin receptor 1 (Gal-R1) subtype, is densely expressed in the ventral hippocampus (vHC) and ventral prefrontal cortex (vPFC); two brain structures that have similar actions on behavioral control. We hypothesize that Gal-R1 contributes to cognitive-control mechanisms that require hippocampal-prefrontal cortical circuitry. OBJECTIVE To examine the effect of local vHC and vPFC infusions of M617, a Gal-R1 agonist, on inhibitory mechanisms of response control. METHODS Different cohorts of rats were implanted with bilateral guide cannulae targeting the vPFC or the vHC. Following infusion of the Gal-R1 agonist, we examined the animals' behavior using a touchscreen version of the 5-choice reaction time task (5-choice task). RESULTS The Gal-R1 agonist produced opposing behaviors in the vPFC and vHC, leading to disruption of impulse control when infused in the vPFC but high impulse control when infused into the vHC. This contrast between areas was accentuated when we added variability to the timing of the stimulus, which led to long decision times and reduced accuracy in the vPFC group but a general improvement in performance accuracy in the vHC group. CONCLUSIONS These results provide the first evidence of a selective mechanism of Gal-R1-mediated modulation of impulse control in prefrontal-hippocampal circuitry.
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Affiliation(s)
- F Messanvi
- Section on Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD, USA.
| | - A Perkins
- Section on Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - J du Hoffmann
- Rodent Behavioral Core, National Institute of Mental Health, Bethesda, MD, USA
| | - Y Chudasama
- Section on Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
- Rodent Behavioral Core, National Institute of Mental Health, Bethesda, MD, USA
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11
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Mani H, Chudasama Y, Hadjiconstantinou M, Bodicoat DH, Edwardson C, Levy MJ, Gray LJ, Barnett J, Daly H, Howlett TA, Khunti K, Davies MJ. Structured education programme for women with polycystic ovary syndrome: a randomised controlled trial. Endocr Connect 2018; 7:26-35. [PMID: 29133383 PMCID: PMC5744630 DOI: 10.1530/ec-17-0274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a structured education programmes in women with polycystic ovary syndrome (PCOS). METHODS Single-centre, randomised controlled trial, testing a single exposure to a group-based, face-to-face, structured education programme. Inclusion criteria were women with PCOS, aged 18-49 years inclusive and body mass index ≥23 kg/m2 for black and minority ethnicities or ≥25 kg/m2 for white Europeans. Primary outcome was step-count/day at 12 months. Secondary outcomes included indices of physical activity, cardiovascular risk factors, quality of life (QoL) and illness perception (IP). RESULTS 161 women were included (78 control, 83 intervention); 69% white; mean age 33.4 (s.d. 7.6) years, of whom 100 (48 intervention; 52 control) attended their 12-month visit (38% attrition). 77% of the intervention arm attended the education programme. No significant change in step-count was observed at 12 months (mean difference: +351 steps/day (95% confidence interval -481, +1183); P = 0.40). No differences were found in biochemical or anthropometric outcomes. The education programme improved participants' IP in 2 dimensions: understanding their PCOS (P < 0.001) and sense of control (P < 0.01) and improved QoL in 3 dimensions: emotions (P < 0.05), fertility (P < 0.05), weight (P < 0.01) and general mental well-being (P < 0.01). DISCUSSION A single exposure to structured education programme did not increase physical activity or improve biochemical markers in overweight and obese women with PCOS. However, providing a structured education in parallel to routine medical treatment can be beneficial for participants' understanding of their condition, reducing their anxiety and improving their QoL.
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Affiliation(s)
- Hamidreza Mani
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Michelle Hadjiconstantinou
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Danielle H Bodicoat
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- The Leicester Biomedical Research CentreLeicester and Loughborough, UK
| | - Miles J Levy
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health SciencesUniversity of Leicester, Leicester, UK
| | - Janette Barnett
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Heather Daly
- Leicester Medical GroupThurmaston Health Centre, Leicester, UK
| | - Trevor A Howlett
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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12
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Dunkley AJ, Tyrer F, Gray LJ, Bhaumik S, Spong R, Chudasama Y, Cooper SA, Ganghadaran S, Davies M, Khunti K. Type 2 diabetes and glucose intolerance in a population with intellectual disabilities: the STOP diabetes cross-sectional screening study. J Intellect Disabil Res 2017; 61:668-681. [PMID: 28544066 DOI: 10.1111/jir.12380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/31/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) may be at increased risk of developing type 2 diabetes and cardiovascular disease, due to lifestyle factors, medications and other diagnosed conditions. Currently, there is lack of evidence on prevalence and prevention in this population. The aim of this study was to conduct a diabetes screening programme to determine prevalence of previously undiagnosed type 2 diabetes and impaired glucose regulation in people with ID. METHODS Screening was conducted in a variety of community settings in Leicestershire, UK. Adults with ID were invited via: general practices; the Leicestershire Learning Disability Register; ID psychiatric services; and some people directly contacted the research team due to publicity about the study. Screening involved collection of anthropometric, biomedical and questionnaire data. Type 2 diabetes and impaired glucose regulation were defined according to (venous) fasting plasma glucose or HbA1c, following current World Health Organisation criteria. RESULTS Nine hundred thirty adults (29% of those approached) participated. Mean age was 43 years, 58% were male and 16% of South Asian ethnicity. Most participants were either overweight or obese (68%). Diabetes status was successfully assessed for 675 (73%) participants: Nine (1.3%, 95% confidence interval 0.6 to 2.5) were found to have undiagnosed type 2 diabetes, and 35 (5.2%, 95% confidence interval 3.6 to 7.1) had impaired glucose regulation. Key factors associated with abnormal glucose regulation included the following: non-white ethnicity and a first degree family history of diabetes. CONCLUSIONS Results from this large multi-ethnic cohort suggest a low prevalence of screen-detected (previously undiagnosed) type 2 diabetes and impaired glucose regulation in adults with ID. However, the high levels of overweight and obesity we found emphasise the need for targeted lifestyle prevention strategies, which are specifically tailored for the needs of people with ID.
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Affiliation(s)
- A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - F Tyrer
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - S Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - R Spong
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Y Chudasama
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK
| | - S Ganghadaran
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - M Davies
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
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13
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O'Donovan G, Chudasama Y, Grocock S, Leigh R, Dalton AM, Gray LJ, Yates T, Edwardson C, Hill S, Henson J, Webb D, Khunti K, Davies MJ, Jones AP, Bodicoat DH, Wells A. The association between air pollution and type 2 diabetes in a large cross-sectional study in Leicester: The CHAMPIONS Study. Environ Int 2017; 104:41-47. [PMID: 28411585 DOI: 10.1016/j.envint.2017.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND Observational evidence suggests there is an association between air pollution and type 2 diabetes; however, there is high risk of bias. OBJECTIVE To investigate the association between air pollution and type 2 diabetes, while reducing bias due to exposure assessment, outcome assessment, and confounder assessment. METHODS Data were collected from 10,443 participants in three diabetes screening studies in Leicestershire, UK. Exposure assessment included standard, prevailing estimates of outdoor nitrogen dioxide and particulate matter concentrations in a 1×1km area at the participant's home postcode. Three-year exposure was investigated in the primary analysis and one-year exposure in a sensitivity analysis. Outcome assessment included the oral glucose tolerance test for type 2 diabetes. Confounder assessment included demographic factors (age, sex, ethnicity, smoking, area social deprivation, urban or rural location), lifestyle factors (body mass index and physical activity), and neighbourhood green space. RESULTS Nitrogen dioxide and particulate matter concentrations were associated with type 2 diabetes in unadjusted models. There was no statistically significant association between nitrogen dioxide concentration and type 2 diabetes after adjustment for demographic factors (odds: 1.08; 95% CI: 0.91, 1.29). The odds of type 2 diabetes was 1.10 (95% CI: 0.92, 1.32) after further adjustment for lifestyle factors and 0.91 (95% CI: 0.72, 1.16) after yet further adjustment for neighbourhood green space. The associations between particulate matter concentrations and type 2 diabetes were also explained away by demographic factors. There was no evidence of exposure definition bias. CONCLUSIONS Demographic factors seemed to explain the association between air pollution and type 2 diabetes in this cross-sectional study. High-quality longitudinal studies are needed to improve our understanding of the association.
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Affiliation(s)
- Gary O'Donovan
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom.
| | - Yogini Chudasama
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Samuel Grocock
- University of Leicester, Earth Observation Science Group, Space Research Centre, Leicester LE1 7RH, United Kingdom
| | - Roland Leigh
- University of Leicester, Earth Observation Science Group, Space Research Centre, Leicester LE1 7RH, United Kingdom
| | - Alice M Dalton
- University of East Anglia, Norwich Medical School, Norwich NR4 7TJ, United Kingdom
| | - Laura J Gray
- University of Leicester, Department of Health Sciences, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Thomas Yates
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Charlotte Edwardson
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Sian Hill
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Joe Henson
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - David Webb
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Kamlesh Khunti
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Melanie J Davies
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Andrew P Jones
- University of East Anglia, Norwich Medical School, Norwich NR4 7TJ, United Kingdom
| | - Danielle H Bodicoat
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Alan Wells
- University of Leicester, Earth Observation Science Group, Space Research Centre, Leicester LE1 7RH, United Kingdom
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14
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Dunkley AJ, Tyrer F, Spong R, Gray LJ, Gillett M, Doherty Y, Martin-Stacey L, Patel N, Yates T, Bhaumik S, Chalk T, Chudasama Y, Thomas C, Sadler S, Cooper SA, Gangadharan SK, Davies MJ, Khunti K. Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alison J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rebecca Spong
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mike Gillett
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | | | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabyasachi Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Thomas Chalk
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chloe Thomas
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Susannah Sadler
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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15
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Prasad JA, Abela AR, Chudasama Y. Midline thalamic reuniens lesions improve executive behaviors. Neuroscience 2016; 345:77-88. [PMID: 26868974 DOI: 10.1016/j.neuroscience.2016.01.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/29/2022]
Abstract
The role of the thalamus in complex cognitive behavior is a topic of increasing interest. Here we demonstrate that lesions of the nucleus reuniens (NRe), a midline thalamic nucleus interconnected with both hippocampal and prefrontal circuitry, lead to enhancement of executive behaviors typically associated with the prefrontal cortex. Rats were tested on four behavioral tasks: (1) the combined attention-memory (CAM) task, which simultaneously assessed attention to a visual target and memory for that target over a variable delay; (2) spatial memory using a radial arm maze, (3) discrimination and reversal learning using a touchscreen operant platform, and (4) decision-making with delayed outcomes. Following NRe lesions, the animals became more efficient in their performance, responding with shorter reaction times but also less impulsively than controls. This change, combined with a decrease in perseverative responses, led to focused attention in the CAM task and accelerated learning in the visual discrimination task. There were no observed changes in tasks involving either spatial memory or value-based decision making. These data complement ongoing efforts to understand the role of midline thalamic structures in human cognition, including the development of thalamic stimulation as a therapeutic strategy for acquired cognitive disabilities (Schiff, 2008; Mair et al., 2011), and point to the NRe as a potential target for clinical intervention.
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Affiliation(s)
- J A Prasad
- Department of Psychology, McGill University, Montreal, QC, H3A 1B1, Canada
| | - A R Abela
- Department of Psychology, McGill University, Montreal, QC, H3A 1B1, Canada
| | - Y Chudasama
- Department of Psychology, McGill University, Montreal, QC, H3A 1B1, Canada.
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16
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Merritt M, Brown R, Glenn A, Chudasama Y, Eberhardt M. 255 Effect of Antimicrobial Disinfectant Wipes on Bacteria on Computer Equipment in the Emergency Department. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Abela AR, Dougherty SD, Fagen ED, Hill CJR, Chudasama Y. Inhibitory Control Deficits in Rats with Ventral Hippocampal Lesions. Cereb Cortex 2012; 23:1396-409. [DOI: 10.1093/cercor/bhs121] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chudasama Y, Kralik JD, Murray EA. Rhesus monkeys with orbital prefrontal cortex lesions can learn to inhibit prepotent responses in the reversed reward contingency task. Cereb Cortex 2006; 17:1154-9. [PMID: 16774961 DOI: 10.1093/cercor/bhl025] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [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: 11/12/2022] Open
Abstract
Monkeys with lesions of the orbital prefrontal cortex (PFo) are impaired on behavioral tasks that require the ability to respond flexibly to changes in reward contingency (e.g., object reversal learning and extinction). These and related findings in rodents and humans have led to the suggestion that PFo is critical for the inhibitory control needed to overcome prepotent responses. To test this idea, we trained rhesus monkeys with PFo lesions and unoperated controls on acquisition of the reversed reward contingency task. In this task, selecting the smaller of 2 food quantities (1 half peanut [1P]) leads to receipt of the larger quantity (4 half peanuts [4P]) and vice versa. Choice of a larger quantity of food is a reliable prepotent response, and, accordingly, all monkeys initially selected 4P rather than one. With experience, however, all monkeys learned to select 1P in order to receive 4. Surprisingly, monkeys with PFo lesions learned as quickly as unoperated controls. Thus, PFo lesions do not yield a deficit in all tests that require the inhibition of a prepotent response.
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Affiliation(s)
- Y Chudasama
- Laboratories of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892 USA.
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Chudasama Y, Robbins TW. Functions of frontostriatal systems in cognition: comparative neuropsychopharmacological studies in rats, monkeys and humans. Biol Psychol 2006; 73:19-38. [PMID: 16546312 DOI: 10.1016/j.biopsycho.2006.01.005] [Citation(s) in RCA: 358] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2004] [Indexed: 10/24/2022]
Abstract
A comparative and integrated account is provided of the evidence that implicates frontostriatal systems in neurodegenerative and neuropsychiatric disorders. Specifically, we have made detailed comparisons of performance following basal ganglia disease such as Parkinson's disease, with other informative groups, including Alzheimer's disease, schizophrenia and attention deficit/hyperactivity disorder and structural damage to the frontal lobes themselves. We have reviewed several behavioural paradigms including spatial attention and set-shifting, working memory and decision-making tasks in which optimal performance requires the operation of several cognitive processes that can be successfully dissociated with suitable precision in experimental animals. The role of ascending neurotransmitter systems are analysed from the perspective of different interactions with the prefrontal cortex. In particular, the role of dopamine in attentional control and spatial working memory is surveyed with reference to its deleterious as well as facilitatory effects. Parallels are identified in humans receiving dopaminergic medication, and with monkeys and rats with frontal dopamine manipulations. The effects of serotonergic manipulations are also contrasted with frontal lobe deficits observed in both humans and animals. The main findings are that certain tests of frontal lobe function are very sensitive to several neurocognitive and neuropsychiatric disorders. However, the nature of some of these deficits often differs qualitatively from those produced by frontal lobe lesions, and animal models have been useful in defining various candidate neural systems thus enabling us to translate basic laboratory science to the clinic, as well as in the reverse direction.
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Affiliation(s)
- Y Chudasama
- Laboratory of Neuropsychology, National Institute of Mental Health, Convent Drive, Building 49, Room 1B80, Bethesda, MD 20892, USA.
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Chudasama Y, Nathwani F, Robbins TW. D-Amphetamine remediates attentional performance in rats with dorsal prefrontal lesions. Behav Brain Res 2005; 158:97-107. [PMID: 15680198 DOI: 10.1016/j.bbr.2004.08.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2004] [Revised: 08/17/2004] [Accepted: 08/17/2004] [Indexed: 11/25/2022]
Abstract
Although amphetamine treatment has been shown to promote recovery of motor function in animals with cortical ablations, the potential therapeutic effect of amphetamine on processes other than motor control, such as attention and working memory, has been relatively unexplored. Accordingly, we investigated the beneficial effect of D-amphetamine treatment in animals with dorsal prefrontal cortex lesions (dPFC) compared with sham controls on a novel combined attention-memory task (CAM) that simultaneously measures attention to a visual stimulus and memory for that stimulus. The dPFC group was impaired in their ability to correctly detect the visual stimulus. Although this deficit occurred together with increased omissions and slow response latencies, these associated deficits largely recovered within the 10 post-operative baseline sessions revealing a selective attentional deficit in this group of animals. Nonetheless, the dPFC lesion did not substantially affect the working memory component of the task. The systemic administration of d-amphetamine served to ameliorate the attentional deficit in the dPFC group at the low dose only (0.2 mg/kg). By contrast, the dPFC group were less sensitive to the detrimental effects of the high dose (0.8 mg/kg) on any aspect of task performance. However, despite improving attention to the visual stimulus, D-amphetamine did not improve memory for that stimulus which instead appeared to deteriorate. The results provide apparently the first demonstration that low doses of D-amphetamine can ameliorate an attentional deficit in animals with selective dPFC lesions and may be a useful model of cognitive deficit in ADHD, schizophrenia or frontal brain injury.
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Affiliation(s)
- Y Chudasama
- Department of Experimental Psychology, University of Cambridge, Cambridge CB23EB, UK.
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21
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Chudasama Y, Robbins TW. Psychopharmacological approaches to modulating attention in the five-choice serial reaction time task: implications for schizophrenia. Psychopharmacology (Berl) 2004; 174:86-98. [PMID: 15071717 DOI: 10.1007/s00213-004-1805-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Accepted: 01/11/2004] [Indexed: 11/25/2022]
Abstract
RATIONALE In schizophrenia, attentional disturbance is a core feature which may not only accompany the disorder, but may precede the onset of psychiatric symptoms. OBJECTIVES The five-choice serial reaction time task (5CSRTT) is a test of visuo-spatial attention that has been used extensively in rats for measuring the effects of systemic and central neurochemical manipulations on various aspects of attentional performance, including selective attention, vigilance and executive control. These findings are relevant to our understanding of the neural systems that may be compromised in patients with schizophrenia. METHODS The 5CSRTT is conducted in an operant chamber that has multiple response locations, in which brief visual stimuli can be presented randomly. Performance is maintained using food reinforcers to criterion levels of accuracy. Various aspects of performance are measured, including attentional accuracy and premature responding, especially under different attentional challenges. RESULTS The effects of systemic and intra-cerebral infusions of selective dopamine, serotonin and cholinergic receptor agents on the 5CSRTT are reviewed with a view to identifying attention-enhancing effects that may be relevant to the treatment of cognitive deficits in schizophrenia. In addition, some novel agents such as modafinil and histamine receptor agents are also considered. Examining the effects of selective neurochemical lesions helped define the neural locus of attentional effects. Similarly, findings from microdialysis studies helped identify the extracellular changes in neurotransmitters and their metabolites in freely moving rats during performance of the 5CSRTT. CONCLUSIONS The monoaminergic and cholinergic systems have independent but complementary roles in attentional function, as measured by the 5CSRTT. These functions are predominantly under the control of the prefrontal cortex and striatum. These conclusions are considered in the context of their application towards therapeutic approaches for attentional disturbances that are typically observed in schizophrenic patients.
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Affiliation(s)
- Y Chudasama
- National Institute of Mental Health, Building 49, Room 1B80, Convent Drive, Bethesda, MD 20892, USA.
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Chudasama Y, Passetti F, Rhodes SEV, Lopian D, Desai A, Robbins TW. Dissociable aspects of performance on the 5-choice serial reaction time task following lesions of the dorsal anterior cingulate, infralimbic and orbitofrontal cortex in the rat: differential effects on selectivity, impulsivity and compulsivity. Behav Brain Res 2004; 146:105-19. [PMID: 14643464 DOI: 10.1016/j.bbr.2003.09.020] [Citation(s) in RCA: 387] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It is becoming increasingly apparent that multiple functions of the frontal cortex such as inhibitory control and executive attention are likely sustained by its functionally distinct and interacting sub-regions but the precise localization of dissociable executive processes has proved difficult and controversial. In the present series of studies, we investigated the behavioural effects of bilateral excitotoxic lesions of different regions of the rat neocortex in the 5-choice serial reaction time task. Whereas lesions of the dorsal anterior cingulate cortex (ACC) impaired performance of the task as revealed by a reduction in discriminative accuracy, lesions made to distinct ventral regions of the frontal cortex showed selective deficits in inhibitory measures of control. Specifically, the infralimbic lesion produced increases in premature responding that was accompanied by fast response latencies. By comparison, the orbitofrontal lesion showed perseverative tendencies particularly when the inter-trial interval was made long and unpredictable, a challenge that would normally promote premature responding instead. These different behavioural effects following dorsal and ventral lesions of the rodent frontal cortex signifies the integrity of the frontal cortex in multiple executive mechanisms that work independently and complementarily by which performance is optimized. Furthermore, these data provide new insights into the functional organization of the rodent frontal cortex with a particular emphasis on localization of function.
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Affiliation(s)
- Y Chudasama
- Department of Experimental Psychology, University of Cambridge, Cambridge CB2 3EB, UK.
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Chudasama Y, Robbins TW. Dissociable contributions of the orbitofrontal and infralimbic cortex to pavlovian autoshaping and discrimination reversal learning: further evidence for the functional heterogeneity of the rodent frontal cortex. J Neurosci 2003; 23:8771-80. [PMID: 14507977 PMCID: PMC6740430] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2003] [Revised: 07/29/2003] [Accepted: 08/06/2003] [Indexed: 04/27/2023] Open
Abstract
To examine possible heterogeneity of function within the ventral regions of the rodent frontal cortex, the present study compared the effects of excitotoxic lesions of the orbitofrontal cortex (OFC) and the infralimbic cortex (ILC) on pavlovian autoshaping and discrimination reversal learning. During the pavlovian autoshaping task, in which rats learn to approach a stimulus predictive of reward [conditional stimulus (CS+)], only the OFC group failed to acquire discriminated approach but was unimpaired when preoperatively trained. In the visual discrimination learning and reversal task, rats were initially required to discriminate a stimulus positively associated with reward. There was no effect of either OFC or ILC lesions on discrimination learning. When the stimulus-reward contingencies were reversed, both groups of animals committed more errors, but only the OFC-lesioned animals were unable to suppress the previously rewarded stimulus-reward association, committing more "stimulus perseverative" errors. In contrast, the ILC group showed a pattern of errors that was more attributable to "learning" than perseveration. These findings suggest two types of dissociation between the effects of OFC and ILC lesions: (1) OFC lesions impaired the learning processes implicated in pavlovian autoshaping but not instrumental simultaneous discrimination learning, whereas ILC lesions were unimpaired at autoshaping and their reversal learning deficit did not reflect perseveration, and (2) OFC lesions induced perseverative responding in reversal learning but did not disinhibit responses to pavlovian CS-. In contrast, the ILC lesion had no effect on response inhibitory control in either of these settings. The findings are discussed in the context of dissociable executive functions in ventral sectors of the rat prefrontal cortex.
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Affiliation(s)
- Y Chudasama
- Department of Experimental Psychology, University of Cambridge, Cambridge, United Kingdom CB2 3EB.
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Abstract
The effects of excitotoxic lesions of the mediodorsal nucleus of the thalamus, the anterior thalamic nuclei and of the prelimbic cortex were examined on two tests of discrimination and reversal learning. In experiment 1A (visual discrimination and reversal), rats were required to discriminate two stimuli, and respond to the stimulus associated with reward (the S+ stimulus). There was no effect of lesion on acquisition of this task. However, when stimulus-reward contingencies were reversed, animals with lesions of the mediodorsal nucleus of the thalamus made significantly more errors than control animals or animals of other lesion groups. In experiment 1B (conditional discrimination), animals were required to learn a rule of the type 'If stimulus A then go left, if stimulus B then go right'. No main effect of lesion on acquisition was observed in this experiment. To test the generality of the reversal effect obtained in experiment 1A, a second cohort of animals with the same lesions was tested on acquisition of the visuospatial conditional task immediately postsurgery, followed by the reversal of the conditional rule (experiment 2). As in experiment 1B, no main effect of lesion group was observed during acquisition of the task. However, lesions of the mediodorsal nucleus of the thalamus resulted in a mild impairment according to number of sessions required to attain criterion performance of the task when the response rule was reversed. The results of the present study provide evidence for a role for the mediodorsal nucleus of the thalamus in new learning, particularly when stimulus-reward contingencies are reversed. Furthermore, they show that the functions of this thalamic nucleus can be dissociated from those of the anterior thalamus and the prelimbic cortex.
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Affiliation(s)
- Y Chudasama
- School of Psychology, Cardiff University, PO Box 901, Cardiff, Wales, CF10 3YG, UK
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Chudasama Y, Muir JL. Visual attention in the rat: a role for the prelimbic cortex and thalamic nuclei? Behav Neurosci 2001; 115:417-28. [PMID: 11345966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The behavioral effects of lesions of the prelimbic cortex (PL), mediodorsal nucleus of the thalamus (MD), and anterior thalamic nuclei (ANT) were investigated in 2 attentional tasks in rats: the 5-choice serial reaction time task and a vigilance task. Although there was no lesion effect on accuracy in the 5-choice task, PL lesions enhanced perseverative responding during baseline performance and when stimulus duration was reduced. In contrast, MD lesions increased premature responding during baseline performance and when the intertrial interval was varied unpredictably. In the vigilance paradigm, PL lesions also impaired rats' ability to detect the light signal at baseline and at the reduced stimulus duration. ANT lesions did not substantially disrupt performance. The results suggest that different aspects of attention may be attributable to the PL and the MD and that the mechanisms underlying inhibitory control of behavior may be attributable to functionally different thalamocortical circuits.
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Affiliation(s)
- Y Chudasama
- School of Psychology, Cardiff University, Wales, United Kingdom
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26
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Chudasama Y, Muir JL. A behavioural analysis of the delayed non-matching to position task: the effects of scopolamine, lesions of the fornix and of the prelimbic region on mediating behaviours by rats. Psychopharmacology (Berl) 1997; 134:73-82. [PMID: 9399369 DOI: 10.1007/s002130050427] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The delayed non-matching to position task (DNMP) is a widely used automated test of spatial memory, yet its validity has been challenged by suggestions that animals use motor mediating behaviours which facilitate correct responding. This possibility was systematically studied by analysing video recordings of rats displaying delay-dependent and delay-independent deficits following lesions or drug manipulations. Rats were first trained to perform the DNMP task and whilst untreated, a number of potential mediating behaviours were identified from the video recorded behaviour. Two independent raters recorded any apparent motor strategies and attempted to predict the response the animals made during the choice phase of the task by viewing only behaviour during the delay periods. Subsequently, the behaviour of the same animals was examined following scopolamine treatment and following lesions of the prelimbic cortex or of the fornix. The experiment confirmed previous reports of delay-dependent and delay-independent deficits under the varying conditions (drug, lesions), but also revealed that rats use clearly identifiable mediating behaviours that appear to facilitate correct responding in the DNMP task. Consequently, apparent "memory" impairments in the DNMP task, may reflect a disruption of behavioural strategies used by the animal to assist in performing the task.
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Affiliation(s)
- Y Chudasama
- School of Psychology, University of Wales Cardiff, UK
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27
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Chudasama Y, Hamilton-Miller JM, Maple PA. Bacteriological safety of cook-chill food at the Royal Free Hospital, with particular reference to Listeria. J Hosp Infect 1991; 19:225-30. [PMID: 1686034 DOI: 10.1016/0195-6701(91)90239-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 12/28/2022]
Abstract
Cook-chill food prepared by the Catering Department of the Royal Free Hospital was examined over an 8-month period commencing October 1989. Total aerobic viable counts (TAVCs) were performed on 200 food specimens which were also examined for Listeria using selective enrichment culture. Ten of 200 food samples tested had TAVCs greater than 10(5) colony forming units (cfu) g-1, and nine of these were from non-vegetarian (meat) dishes. Although most of the food prepared by cook-chill had microbial loads within the limits recommended by current Department of Health guidelines (i.e. less than 10(5) cfu g-1), our findings for the non-vegetarian dishes suggest that extra caution is required when preparing such food. Listeria were not isolated from any food sample. In a survey of listeria faecal carriage, Listeria monocytogenes was isolated from only two of 100 faeces specimens obtained from patients.
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Affiliation(s)
- Y Chudasama
- Department of Medical Microbiology, Royal Free Hospital and School of Medicine, Hampstead, London
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