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Green RE, Sudre CH, Warren‐Gash C, Butt J, Waterboer T, Hughes AD, Schott JM, Richards M, Chaturvedi N, Williams DM. Common infections and neuroimaging markers of dementia in three UK cohort studies. Alzheimers Dement 2024; 20:2128-2142. [PMID: 38248636 PMCID: PMC10984486 DOI: 10.1002/alz.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/13/2023] [Accepted: 11/25/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION We aimed to investigate associations between common infections and neuroimaging markers of dementia risk (brain volume, hippocampal volume, white matter lesions) across three population-based studies. METHODS We tested associations between serology measures (pathogen serostatus, cumulative burden, continuous antibody responses) and outcomes using linear regression, including adjustments for total intracranial volume and scanner/clinic information (basic model), age, sex, ethnicity, education, socioeconomic position, alcohol, body mass index, and smoking (fully adjusted model). Interactions between serology measures and apolipoprotein E (APOE) genotype were tested. Findings were meta-analyzed across cohorts (Nmain = 2632; NAPOE-interaction = 1810). RESULTS Seropositivity to John Cunningham virus associated with smaller brain volumes in basic models (β = -3.89 mL [-5.81, -1.97], Padjusted < 0.05); these were largely attenuated in fully adjusted models (β = -1.59 mL [-3.55, 0.36], P = 0.11). No other relationships were robust to multiple testing corrections and sensitivity analyses, but several suggestive associations were observed. DISCUSSION We did not find clear evidence for relationships between common infections and markers of dementia risk. Some suggestive findings warrant testing for replication.
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Affiliation(s)
- Rebecca E. Green
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Carole H. Sudre
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Medical Physics and Biomedical EngineeringCentre for Medical Image Computing (CMIC)University College London (UCL)LondonUK
| | - Charlotte Warren‐Gash
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Julia Butt
- Division of Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Tim Waterboer
- Division of Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Alun D. Hughes
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | | | - Marcus Richards
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Dylan M. Williams
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
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Zawahir S, Lekamwasam S, Aslani P. Factors Related to Antibiotic Supply without a Prescription for Common Infections: A Cross-Sectional National Survey in Sri Lanka. Antibiotics (Basel) 2021; 10:647. [PMID: 34071619 DOI: 10.3390/antibiotics10060647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
Inappropriate antibiotic use is a problem in Sri Lanka. We investigated pharmacy staff’s attitudes towards antibiotic supply for common infections in Sri Lanka. A self-reported cross-sectional survey was conducted among a random sample (n = 369) of pharmacies. We assessed staff’s beliefs and attitudes to antibiotic supplying for common infections (common cold and cough, sore throat, diarrhoea, wound and urinary tract infections (UTI)). Pharmacists (n = 210; 79%) and pharmacy assistants (n = 55: 21%) responded. About 30% (80/265) had supplied antibiotics without a prescription for common infections, including common cold (15.8%), sore throat (13.6%) and diarrhoea (10.2%). Overall, pharmacists were less likely to supply than non-pharmacists. Pharmacy staff with more positive beliefs about their professional competency to supply and monitor antibiotic use were more likely to supply antibiotics without a prescription for common cold (Adj.OR = 1.08; 95% CI: 1.01–1.15; p = 0.032), wound infections (Adj. OR = 1.06; 95% CI: 1.00–1.13; p = 0.059), and UTI (Adj.OR = 1.07; 95% CI: 0.99–1.15; p = 0.097). Pharmacy staff who believed in the effectiveness of antibiotics against common infections were more likely to supply antibiotics for common infections. Supply of antibiotics without a prescription was associated with staff’s beliefs about antibiotics’ effectiveness and their professional competency. Our findings could be used to strengthen regulatory strategies to improve practice.
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Smith CM, Shallcross LJ, Dutey-Magni P, Conolly A, Fuller C, Hill S, Jhass A, Marcheselli F, Michie S, Mindell JS, Ridd MJ, Tsakos G, Hayward AC, Fragaszy EB. Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study. BMC Infect Dis 2021; 21:105. [PMID: 33482752 PMCID: PMC7820521 DOI: 10.1186/s12879-021-05811-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/15/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). METHODS Bug Watch was an online prospective community cohort study of the general population in England (2018-2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. RESULTS The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. CONCLUSIONS Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.
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Affiliation(s)
- Catherine M Smith
- Institute of Health informatics, UCL, 222 Euston Road, London, NW1 2DA, UK.
| | - Laura J Shallcross
- Institute of Health informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Peter Dutey-Magni
- Institute of Health informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Anne Conolly
- NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK
| | - Christopher Fuller
- Institute of Health informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Suzanne Hill
- NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK
| | - Arnoupe Jhass
- Institute of Health informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
- Research Department of Primary Care and Population Health, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | | | - Susan Michie
- Centre for Behaviour Change, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Matthew J Ridd
- Health Science Institute, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Georgios Tsakos
- Research Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ellen B Fragaszy
- Institute of Health informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Archibald D, Burns JK, Fitzgerald M, Merkley VF. Aligning Practice Data and Institution-specific CPD: Medical Quality Management as the Driver for an eLearning Development Process. J Eur CME 2020; 9:1754120. [PMID: 32373397 PMCID: PMC7191898 DOI: 10.1080/21614083.2020.1754120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/20/2022] Open
Abstract
For hospital physicians, alignment of Continuing Professional Development (CPD) with quality improvement efforts is often absent or rudimentary. The purpose of this study was to evaluate a CPD development process that created accessible learning opportunities and aligned CPD with practice data. We conducted a chart audit to identify patient safety and quality of care issues within the institution, then established an eLearning approach that supported quick and cost effective development of high-quality interactive CPD opportunities. We tested a pilot module on the management of common infections in sub-acute care settings with fifteen (68%) residents and three staff physicians to evaluate the approach. One resident and three staff agreed to a follow-up interview. The satisfaction survey indicated that participants felt the content was generally appropriate and the module well designed. Significant improvements to knowledge were reported in the multi-drug resistance (Mean Difference = 25%, p = 0.002), infection management (MD = 32%, p < 0.001), and cellulitis risk factor (MD = 22%, p = 0.02) questions, as well as in the overall score (MD = 19%, p < 0.001). In terms of confidence in their answers, the mean rating pre-module was 3.17, rising significantly to 3.92 post-module (p < 0.001). In this way, collaboration between quality management and education committees allowed for the development of relevant CPD for physicians, with eLearning providing a timely and accessible way to deliver training on emerging issues.
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Affiliation(s)
- Douglas Archibald
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
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van Hecke O, Butler C, Mendelson M, Tonkin-Crine S. Introducing new point-of-care tests for common infections in publicly funded clinics in South Africa: a qualitative study with primary care clinicians. BMJ Open 2019; 9:e029260. [PMID: 31772084 PMCID: PMC6887073 DOI: 10.1136/bmjopen-2019-029260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Broad-spectrum antibiotics are routinely prescribed empirically in the resource-poor settings for suspected acute common infections, which drive antimicrobial resistance. Point-of-care testing (POCT) might increase the appropriateness of decisions about whether and which antibiotic to prescribe, but implementation will be most effective if clinician's perspectives are taken into account. OBJECTIVES To explore the perceptions of South African primary care clinicians working in publicly funded clinics about: making antibiotic prescribing decisions for two common infection syndromes (acute cough, urinary tract infection); their experiences of existing POCTs; their perceptions of the barriers and opportunities for introducing (hypothetical) new POCTs. DESIGN, METHOD, PARTICIPANTS, SETTING Qualitative semistructured interviews with 23 primary care clinicians (nurses and doctors) at publicly funded clinics in the Western Cape Metro district, South Africa. Data were analysed using thematic analysis. RESULTS Clinicians reported that their antibiotic prescribing decisions were influenced by their clinical assessment, patient comorbidities, social factors (eg, access to care) and perceived patient expectations. Their experiences with currently available POCTs were largely positive, and they were optimistic about the potential for new POCTs to: support evidence-based prescribing decisions that might reduce unnecessary antibiotic prescriptions; reduce the need for further investigations; support effective communication with patients, especially when antibiotics were unlikely to be of benefit. Resources and workflow disruption were seen as the main barriers to uptake into routine care. CONCLUSIONS Clinicians working in publicly funded clinics in the Western Cape Metro of South Africa saw POCTs as potentially useful for positively addressing both clinical and social drivers of the overprescribing of broad-spectrum antibiotics, but were concerned about the resource implications and disruption of existing patient workflows.
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Affiliation(s)
- Oliver van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
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Jones LF, Owens R, Sallis A, Ashiru-Oredope D, Thornley T, Francis NA, Butler C, McNulty CAM. Qualitative study using interviews and focus groups to explore the current and potential for antimicrobial stewardship in community pharmacy informed by the Theoretical Domains Framework. BMJ Open 2018; 8:e025101. [PMID: 30593557 PMCID: PMC6318531 DOI: 10.1136/bmjopen-2018-025101] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Community pharmacists and their staff have the potential to contribute to antimicrobial stewardship (AMS). However, their barriers and opportunities are not well understood. The aim was to investigate the experiences and perceptions of community pharmacists and their teams around AMS to inform intervention development. DESIGN Interviews and focus groups were used to explore the views of pharmacists, pharmacy staff, general practitioners (GPs), members of pharmacy organisations and commissioners. The questioning schedule was developed using the Theoretical Domains Framework which helped inform recommendations to facilitate AMS in community pharmacy. RESULTS 8 GPs, 28 pharmacists, 13 pharmacy staff, 6 representatives from pharmacy organisations in England and Wales, and 2 local stakeholders participated.Knowledge and skills both facilitated or hindered provision of self-care and compliance advice by different grades of pharmacy staff. Some staff were not aware of the impact of giving self-care and compliance advice to help control antimicrobial resistance (AMR). The pharmacy environment created barriers to AMS; this included lack of time of well-qualified staff leading to misinformation from underskilled staff to patients about the need for antibiotics or the need to visit the GP, this was exacerbated by lack of space. AMS activities were limited by absent diagnoses on antibiotic prescriptions.Several pharmacy staff felt that undertaking patient examinations, questioning the rationale for antibiotic prescriptions and performing audits would allow them to provide more tailored AMS advice. CONCLUSIONS Interventions are required to overcome a lack of qualified staff, time and space to give patients AMS advice. Staff need to understand how self-care and antibiotic compliance advice can help control AMR. A multifaceted educational intervention including information for staff with feedback about the advice given may help. Indication for a prescription would enable pharmacists to provide more targeted antibiotic advice. Commissioners should consider the pharmacists' role in examining patients, and giving advice about antibiotic prescriptions.
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Affiliation(s)
| | - Rebecca Owens
- Primary Care Unit, Public Health England, Gloucester, UK
| | - Anna Sallis
- Behavioural Insights Team, Public Health England, London, UK
| | | | | | - Nick A Francis
- School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Chris Butler
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Wood F, Prout H, Bayer A, Duncan D, Nuttall J, Hood K, Butler CC. Consent, including advanced consent, of older adults to research in care homes: a qualitative study of stakeholders' views in South Wales. Trials 2013; 14:247. [PMID: 23937972 PMCID: PMC3750808 DOI: 10.1186/1745-6215-14-247] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/24/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Care home residents, especially those lacking capacity to provide consent for themselves, are frequently excluded from research, thus limiting generalisability of study findings. We set out to explore stakeholders' views about the ethical and practical challenges associated with recruiting care home residents into research studies. METHODS Qualitative individual interviews with care home residents (n = 14), their relatives (n = 14), and general practitioners (GPs) (n = 10), and focus groups (n = 2) with care home staff. Interviews focused on the issues of older adults consenting to research in care homes, including advanced consent, in general and through reference to a particular study on the use of probiotics to prevent Antibiotic Associated Diarrhoea. Data were analysed using a thematic approach incorporating themes that had been identified in advance, and themes derived from the data. Researchers discussed evidence for themes, and reached consensus on the final themes. RESULTS Respondents were generally accepting of low risk observational studies and slightly less accepting of low risk randomised trials of medicinal products. Although respondents identified some practical barriers to informed consent, consenting arrangements were considered workable. Residents and relatives varied in the amount of detail they wanted included in information sheets and consent discussions, but were generally satisfied that an advanced consent model was acceptable and appropriate. Opinions differed about what should happen should residents lose capacity during a research study. CONCLUSIONS Research staff should be mindful of research guidance and ensure that they have obtained an appropriate level of informed consent without overwhelming the participant with unnecessary detail. For research involving medicinal products, research staff should also be more explicit when recruiting that consent is still valid should an older person lose capacity during a trial provided the individual did not previously state a wish to be withdrawn if they lose capacity, and provided they do not indicate objection or resistance after loss of capacity.
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Affiliation(s)
- Fiona Wood
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4XNWales, UK
| | - Hayley Prout
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4XNWales, UK
| | - Antony Bayer
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4XNWales, UK
| | - Donna Duncan
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4XNWales, UK
| | - Jacqueline Nuttall
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4XNWales, UK
| | - Kerenza Hood
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4XNWales, UK
| | - Christopher C Butler
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4XNWales, UK
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Abstract
Recipients of solid organ transplants (SOT) need primary care providers (PCPs) who are familiar with their unique needs and understand the lifelong infectious risks faced by SOT patients because of their need for lifelong immunosuppressive medications. SOT recipients can present with atypical and muted manifestations of infections, for which the knowledgable PCP will initiate a comprehensive evaluation. The goal of this article is to familiarize PCPs with the infectious challenges facing SOT patients. General concepts are reviewed, and a series of patient cases described that illustrate the specific learning points based on common presenting clinical symptoms.
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Affiliation(s)
- Genevieve L Pagalilauan
- Division of General Internal Medicine, University of Washington School of Medicine, 4245 Roosevelt Way Northeast, Seattle, WA 98115, USA.
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