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Johnson-Jennings MD, Reid M, Jiang L, Huyser KR, Brega AG, Steine JF, Manson SM, Chang J, Fyfe-Johnson AL, Hiratsuka V, Conway C, O'Connell J. American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use. Int J Obes (Lond) 2023; 47:297-305. [PMID: 36750690 PMCID: PMC10121828 DOI: 10.1038/s41366-022-01236-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12-19 years in association with social determinants of health (SDOH), and mental health and substance use disorders. METHODS Guided by the World Health Organization's Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12-19 years. We described obesity prevalence in relationship to SDOH and adolescents' mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics. RESULTS We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p < 0.01), residing in a county with lower education attainment (OR = 1.17, p < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p < 0.001). CONCLUSIONS Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.
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Affiliation(s)
| | - Margaret Reid
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R Huyser
- Department of Sociology, The University of British Columbia, Vancouver, BC, Canada
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John F Steine
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenny Chang
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, Seattle, WA, USA
| | | | - Cheryl Conway
- Charles George Veterans Medical Center, Ashville, NC, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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O'Connell J, Kundu S, Saidaminov M, Bazalova-Carter M. Next generation high resolution perovskite direct conversion detector: Monte Carlo design optimisation and virtual clinical trial. Phys Med Biol 2023; 68. [PMID: 36549000 DOI: 10.1088/1361-6560/acae15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
We implement virtual clinical integration of next-generation perovskite detectors into common x-ray imaging devices. This was achieved by performing Monte Carlo (MC) optimisation of the design and benchmarking of low cost, high spatial resolution, direct conversion perovskite crystal x-ray flat panel imagers for a next generation of breast-, MV-, and kV-cone beam CT detectors. Semiconductor methylammonium lead bromide perovskite crystals energy deposition efficiencies calculated in TOPAS were benchmarked against four common detector materials for twelve detector crystal thicknesses between 40 to 15 mm and ten beam energies ranging from 20 keV to 6 MeV. Based on these simulations, Koning's dedicated breast CT, and Varian's Truebeam kV- and MV-cone beam CT systems were designated as suitable applications for perovskite detectors. System specific Fastcat hybrid MC cone beam CT image simulation was subsequently used to optimise the perovskite detector design and conduct virtual clinical trials. Device-specific optimal perovskite crystal thicknesses were calculated to be 0.30, 0.86, and 1.99 mm for Koning breast CT and Truebeam kV- and MV-cone beam CT systems, respectively. Replacing the current detectors on these machines with low cost perovskite crystal detectors could be advantageous as it would simultaneously yield 12.1%, 9.5% and 86.1% improvements in detective quantum efficiency as well as increases in contrast to noise ratio in brain, lung, and bone tissues.
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Affiliation(s)
- J O'Connell
- University of Victoria, 3800 Finnerty Road, Victoria, Canada, V8P 5C2, Canada
| | - S Kundu
- University of Victoria, 3800 Finnerty Road, Victoria, Canada, V8P 5C2, Canada
| | - M Saidaminov
- University of Victoria, 3800 Finnerty Road, Victoria, Canada, V8P 5C2, Canada
| | - M Bazalova-Carter
- University of Victoria, 3800 Finnerty Road, Victoria, Canada, V8P 5C2, Canada
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Zhu Y, Shi Y, Manson S, O'Connell J, Jiang L. Air pollution and dementia using longitudinal electronic health record data from the Indian Health Service. Alzheimers Dement 2022. [DOI: 10.1002/alz.067256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Yachen Zhu
- University of California, Irvine Irvine CA USA
| | - Yuxi Shi
- University of California Irvine Irvine CA USA
| | - Spero Manson
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Joan O'Connell
- University of Colorado Anschutz Medical Campus Aurora CO USA
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Dai J, Ports KD, Corrada MM, O'Connell J, Odegaard AO, Jiang L. Metformin and dementia risk: A systematic review with respect to time‐related biases. Alzheimers Dement 2022. [DOI: 10.1002/alz.065338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jiahui Dai
- University of California, Irvine Irvine CA USA
| | | | | | - Joan O'Connell
- University of Colorado Anschutz Medical Campus Aurora CO USA
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Hiratsuka VY, Reid M, Chang J, Jiang L, Brega AG, Fyfe-Johnson AL, Huyser KR, Johnson-Jennings M, Conway C, Steiner JF, Rockell J, Dillard DA, Moore K, Manson SM, O'Connell J. Associations Between Rurality, pre-pregnancy Health Status, and Macrosomia in American Indian/Alaska Native Populations. Matern Child Health J 2022; 26:2454-2465. [PMID: 36346567 PMCID: PMC10468113 DOI: 10.1007/s10995-022-03536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the relationships between pre-pregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), pre-pregnancy body mass index (BMI) and county-level social determinants of health, with infant macrosomia within a sample of American Indian/Alaska Native (AI/AN) women receiving Indian Health Service (IHS) care. METHODS The sample included women-infant dyads representing 1,136 singleton births from fiscal year 2011 (10/1/2019-9/30/2011). Data stemmed from the IHS Improving Health Care Delivery Data Project. Multivariate generalized linear mixed models were fitted to assess the association of macrosomia with pre-pregnancy health status and social determinants of health. RESULTS Nearly half of the women in the sample were under age 25 years (48.6%), and most had Medicaid health insurance coverage (76.7%). Of those with a pre-pregnancy BMI measure, 66.2% were overweight or obese. Although few women had pre-pregnancy DM (4.0%), GDM was present in 12.8% of women. Most women had a normal term delivery (85.4%). Overweight, obesity, pre-pregnancy DM, and county-level rurality were all significantly associated with higher odds of infant macrosomia.
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Affiliation(s)
- Vanessa Y Hiratsuka
- Research Department, Southcentral Foundation, 4501 Diplomacy Drive, 99508, Anchorage, AK, USA.
- Center for Human Development, University of Alaska Anchorage, 3211 Providence Drive, 99508, 99504, Anchorage, AK, USA.
| | - Margaret Reid
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, USA
| | - Jenny Chang
- Department of Medicine, School of Medicine, University of California, 301 Medical Surge II, 92697-7550, Irvine, CA, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, 3076 AIRB, 92697-7550, Irvine, CA, USA
| | - Angela G Brega
- School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, 80045, Aurora, Colorado, CO, USA
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, 1100 Olive Way, Ste 1200, 98101, Seattle, WA, USA
| | - Kimberly R Huyser
- Department of Sociology, The University of British Columbia, Vancouver, USA
| | - Michelle Johnson-Jennings
- Canada Research Chair for Indigenous Community Engaged Research for Indigenous Community Engaged Research, LE Clinical Health Psychologist, University of Saskatchewan, University of Colorado- Associate Professor, University of Washington- Associate Professor, Washington, USA
| | - Cheryl Conway
- NE-BC; Quality Consultant, Charles George Veterans Medical Center, Asheville, NC, USA
| | - John F Steiner
- Institute for Health Research, Department of Medicine, Kaiser Permanente Colorado, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Jennifer Rockell
- Telligen, Inc. Greenwood Village, 7730 E. Belleview Ave Suite 300 Greenwood, 80111, Village, CO, USA
| | - Denise A Dillard
- Research Department, Southcentral Foundation, 4501 Diplomacy Drive, 99508, Anchorage, AK, USA
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
| | - Joan O'Connell
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
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Jiang L, Shi Y, Conniff KR, Corrada MM, Manson S, O'Connell J. Impact of left censoring on longitudinal analyses of dementia using electronic health record data. Alzheimers Dement 2022. [DOI: 10.1002/alz.066471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Yuxi Shi
- University of California Irvine Irvine CA USA
| | | | | | - Spero Manson
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Joan O'Connell
- University of Colorado Anschutz Medical Campus Aurora CO USA
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O'Connell J, Grau L, Goins T, Perraillon M, Winchester B, Corrada M, Manson SM, Jiang L. The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs. Alzheimers Dement 2022; 18:2055-2066. [PMID: 35176207 PMCID: PMC10440154 DOI: 10.1002/alz.12603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/08/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Little is known about treatment costs for American Indian and Alaska Native (AI/AN) adults with dementia who access services through the Indian Health Service (IHS) and Tribal health programs. METHODS We analyzed fiscal year 2013 IHS/Tribal treatment costs for AI/ANs aged 65+ years with dementia and a matched sample without dementia (n = 1842) to report actual and adjusted total treatment costs and costs by service type. Adjusted costs were estimated using multivariable regressions. RESULTS Mean total treatment cost for adults with dementia were $13,027, $5400 higher than for adults without dementia ($7627). The difference in adjusted total treatment costs was $2943 (95% confidence interval [CI]: $1505, $4381), the majority of which was due to the difference in hospital inpatient costs ($2902; 95% CI: $1512, $4293). DISCUSSION Knowing treatment costs for AI/ANs with dementia can guide enhancements to policies and services for treating dementia and effectively using health resources.
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Affiliation(s)
- Joan O'Connell
- University of Colorado, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Grau
- University of Colorado, Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Marcelo Perraillon
- University of Colorado, Colorado School of Public Health, Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Blythe Winchester
- Eastern Band of Cherokee Indians, Cherokee Indian Hospital; Indian Health Service, Chief Clinical Consultant, Geriatrics and Palliative Care, Cherokee Indian Hospital, Cherokee, North Carolina, USA
| | - Maria Corrada
- University of California Irvine, College of Health Sciences, Department of Epidemiology and Biostatistics, Irvine, California, USA
| | - Spero M Manson
- University of Colorado, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luohua Jiang
- University of California Irvine, College of Health Sciences, Department of Epidemiology and Biostatistics, Irvine, California, USA
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Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children. Child Obes 2022. [PMID: 36170116 DOI: 10.1089/chi.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.
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Affiliation(s)
- Amber L Fyfe-Johnson
- Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Margaret M Reid
- Health Systems, Management, and Policy; University of Colorado, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology; Irvine, Irvine, CA, USA
| | - Jenny J Chang
- School of Medicine; University of California, Irvine, Irvine, CA, USA
| | - Kimberly R Huyser
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Y Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Cheryl M Conway
- Charles George Veterans Medical Center, Veterans Health Administration, Washington, DC, USA
| | - Turner R Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | | | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health; Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | | | - Joan O'Connell
- Centers for American Indian and Alaska Native Health; Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Croughan S, O'Cronin D, O'Brien D, Roberts F, Underwood S, O'Connell J, Jackson A, McCarthy J, Fahey S. Vancomycin-Resistant Enterococci in Patients Attending for Colonoscopy: An Estimate of Community Prevalence. Ir Med J 2022; 115:649. [PMID: 36302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aims Ireland has the highest vancomycin-resistant Enterococcus faecium (VRE) bloodstream infection prevalence in Europe. Two patterns of VRE carriage are recognised. European, with widespread community prevalence and North American, where carriage is predominantly nosocomial. It is unclear which pattern is dominant in Ireland. This uncertainty limits infection control measures. This study sought to explore this issue via a cross sectional point prevalence study. Methods Asymptomatic community volunteers, represented by patients undergoing elective outpatient colonoscopy testing, were opportunistically screened for VRE. Demographic and risk factor data were collected via a patient survey. Rectal swabs were collected before colonoscopy and VRE was identified using the VITEK MS system. Results 102 patients were cultured. A single patient tested positive, representing a prevalence rate of 0.98% (95% CI <0.01-5.8%). This patient demonstrated traditional risk factors, suggesting nosocomial rather than community acquisition. 94% (N=94) of patients had no knowledge of VRE, while 83% (N=83) had low levels of concern regarding hospital acquired infections. Conclusion There is a low incidence of VRE in the Irish community setting, in contrast to other European Countries, suggesting asymptomatic community colonization is not responsible for the high rates of VRE seen in Ireland. Wider screening or atypical infection control measures would not be supported by this data.
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Affiliation(s)
- S Croughan
- Department of Emergency Medicine, St. James Hospital, James Street, D08NHY1, Ireland
| | - D O'Cronin
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - F Roberts
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - S Underwood
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - J O'Connell
- Department of Anesthesiology, Mercy University Hospital, Cork, T12WE28, Ireland
| | - A Jackson
- Department of Medicine, Mercy University Hospital, Cork, T12WE28, Ireland
| | - J McCarthy
- Department of Medicine, Mercy University Hospital, Cork, T12WE28, Ireland
| | - S Fahey
- Department of Microbiology, Mercy University Hospital, Cork, T12WE28, Ireland
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O'Connell J, Grau L, Manson SM, Bott AM, Sheffer K, Steers R, Jiang L. Use of clinical pharmacy services by American Indians and Alaska Native adults with cardiovascular disease. J Am Coll Clin Pharm 2022; 5:800-811. [PMID: 36246030 PMCID: PMC9544095 DOI: 10.1002/jac5.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022]
Abstract
Introduction The Indian Health Service (IHS) and Tribal health programs provide clinical pharmacy services to improve health outcomes among American Indian and Alaska Native (AI/AN) adults with cardiovascular disease (CVD). Objectives The study's primary objective was to describe characteristics, including social determinants of health (SDOH), associated with clinical pharmacy utilization by AI/ANs with CVD who accessed IHS/Tribal services. A secondary objective assessed changes in systolic blood pressure (SBP) associated with such utilization. Methods Analysis included IHS data for 9844 adults aged 18 and older with CVD who lived in 5 locations. Multivariable logistic regression was used to examine patient characteristics (eg, age, sex, health status, SDOH) associated with clinical pharmacy utilization in fiscal year (FY) 2012. A propensity score model was employed to estimate the association of elevated SBP in FY2013 with FY2012 clinical pharmacy utilization. Results Nearly 15% of adults with CVD used clinical pharmacy services. Among adults with CVD, the odds of clinical pharmacy use were higher among adults diagnosed with congestive heart failure (adjusted odds ratio [OR] = 1.22; 95% CI:1.01-1.47), other types of heart disease not including ischemia (OR = 1.40; 95% CI: 1.18-1.65), and vascular disease (OR = 1.23; 95% CI: 1.04-1.46), compared to adults without these conditions. Diabetes (OR = 4.05, 95% CI: 3.29-5.00) and anticoagulation medication use (OR = 20.88, 95% CI: 16.76-20.61) were associated with substantially higher odds of clinical pharmacy utilization. Medicaid coverage (OR = 0.72; 95% CI: 0.56-0.93) and longer travel times to services (OR = 0.87; 95% CI: 0.83-0.92) were each associated with lower odds. FY2012 clinical pharmacy users had lower odds of elevated SBP (OR = 0.71 95% CI: 0.58-0.87) in FY2013 than nonusers. Conclusion In addition to health status, SDOH (eg, Medicaid coverage, longer travel times) influenced clinical pharmacy utilization. Understanding characteristics associated with clinical pharmacy utilization may assist IHS/Tribal health programs in efforts to support optimization of these services.
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Affiliation(s)
- Joan O'Connell
- Present address:
Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Laura Grau
- Present address:
Department of Biostatistics, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Spero M. Manson
- Present address:
Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | | | - Kyle Sheffer
- Santa Fe Indian Health CenterSanta FeNew MexicoUSA
| | | | - Luohua Jiang
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaIrvineCaliforniaUSA
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Goins RT, Conway C, Reid M, Jiang L, Chang J, Huyser KR, Brega AG, Steiner JF, Fyfe-Johnson AL, Johnson-Jennings M, Hiratsuka V, Manson SM, O'Connell J. Social determinants of obesity in American Indian and Alaska Native peoples aged ≥ 50 years. Public Health Nutr 2022; 25:1-30. [PMID: 35451356 PMCID: PMC9991752 DOI: 10.1017/s1368980022000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE American Indian and Alaska Native peoples (AI/ANs) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/ANs. Thus, our study assessed social determinants of obesity in AI/ANs aged ≥ 50 years. DESIGN We conducted a cross-sectional analysis using multivariate generalized linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30.0 kg/m2). Analyses were conducted for the total study population and stratified by median county poverty level. SETTING Indian Health Service (IHS) data for AI/ANs who used IHS services in FY2013. PARTICIPANTS 27,696 AI/ANs aged ≥ 50 years without diabetes. RESULTS Mean BMI was 29.8 ± 6.6 with 43% classified as obese. Women were more likely to be obese than men, and younger ages were associated with higher obesity risk. While having Medicaid coverage was associated with lower odds of obesity, private health insurance was associated with higher odds. Living in areas with lower rates of educational attainment and longer drive times to primary care services were associated with higher odds of obesity. Those who lived in a county where a larger percentage of people had low access to a grocery store were significantly less likely to be obese. CONCLUSIONS Our findings contribute to the understanding of social determinants of obesity among older AI/ANs and highlight the need to investigate AI/AN obesity, including longitudinal studies with a life course perspective to further examine social determinants of obesity in older AI/ANs.
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Affiliation(s)
- R Turner Goins
- Western Carolina University, College of Health and Human Sciences,
| | | | - Margaret Reid
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
| | | | | | | | - Angela G Brega
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
| | | | | | | | | | - Spero M Manson
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
| | - Joan O'Connell
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
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Jiang L, Niu X, Grau L, Corrada MM, Manson S, O'Connell J. Accuracy in estimating prevalence and incidence of dementia using longitudinal electronic health record data from the Indian Health Service. Alzheimers Dement 2021. [DOI: 10.1002/alz.056279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Xiaoyi Niu
- University of California Irvine Irvine CA USA
| | - Laura Grau
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Spero Manson
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Joan O'Connell
- University of Colorado Anschutz Medical Campus Aurora CO USA
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Jones JM, Hu YD, Eid MA, Sensenig CJ, Mehta KS, Goldwag JL, Barnes JA, Kang R, Barry MJ, Spangler EL, Nelson PR, Mureebe L, Tang G, Tzeng E, Alabi O, Halpern VJ, Stone DH, Brooke BS, Moore K, Henke P, Scali S, O'Connell J, Goodney PP. Short-Term Concerns Primarily Determine Patient Preference for Abdominal Aortic Aneurysm Repair. J Surg Res 2021; 269:119-128. [PMID: 34551368 DOI: 10.1016/j.jss.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) repair may be performed through open or endovascular approaches, but the factors influencing a patient's repair-type preference are not well characterized. Here we performed a qualitative analysis to better understand factors influencing patient preference within the Preference for Open Versus Endovascular Repair of AAA Trial. METHODS Open-ended responses regarding primary (n = 21) and secondary (n = 47) factors influencing patient preference underwent qualitative analysis using the constant comparative method with iterative reviews. Codes were used to generate themes and themes grouped into categories, with each step conducted via consensus agreement between three researchers. Relative prevalence of themes were compared to ascertain trends in patient preference. RESULTS Patient responses regarding both primary and secondary factors fell into four categories: Short-term concerns, long-term concerns, advice & experience, and other. Patients most frequently described short-term concerns (23) as their primary influence, with themes including post-op complications, hospitalization & recovery, and intraoperative concerns. Long-term concerns were more prevalent (20) as secondary factors, which included themes such as survival, and chronic management. The average age of patients voicing only long-term concerns as a primary factor was 11 years younger than those listing only short-term concerns. CONCLUSION Short-term concerns relating to the procedure and recovery are more often the primary factor influencing patient preference, while long term concerns play a more secondary role. Long-term concerns are more often a primary factor in younger patients. Vascular surgeons should consider this information in shared decision making to reach an optimal outcome.
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Affiliation(s)
- J M Jones
- The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Y D Hu
- The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - M A Eid
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | | | - K S Mehta
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | - J L Goldwag
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | - J A Barnes
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | - R Kang
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - M J Barry
- Massachusetts General Hospital Center for Shared Decision Making, Boston, Massachusetts
| | | | - P R Nelson
- Muskogee VAMC, Muskogee, Okla; Tampa VAMC, Tampa Bay, Florida
| | | | - G Tang
- Seattle VAMC, Seattle, Washington
| | - E Tzeng
- Pittsburgh VAMC, Pittsburgh, Pennsylvania
| | - O Alabi
- Atlanta VAMC, Atlanta, Georgia
| | | | - D H Stone
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - K Moore
- The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - P Henke
- Ann Arbor VAMC, Ann Arbor, Michigan
| | - S Scali
- Gainesville VAMC, Gainesville, Florida
| | | | - P P Goodney
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
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O'Connell J, de Barra E, McNally C, McConkey S. A Survey of Latent Tuberculosis Screening and Treatment Practices in a Tertiary Centre. Ir Med J 2021; 114:406. [PMID: 34520641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Aim Knowledge of latent tuberculosis infection (LTBI) screening and treatment practices are lacking in Ireland, where LTBI is not programmatically surveyed or managed. The aim of this research was to describe current clinical practice when screening and treating patients for LTBI in a tertiary referral centre in Ireland. Methods A 17-question survey relating to LTBI screening and management practices with both open-ended questions and close ended multiple-choice questions was created using SurveyMonkey. The survey target sample was healthcare workers in the tertiary centre who direct LTBI screening and treatment for patients at risk of TB disease in their respective departments. Results The response rate to the survey was 45% (21/47). Seventy-one percent (15/21) of those surveyed responded to the question "What barriers exist to screening patients for latent TB in your clinical practice?". Fifty-three percent (8/15) said that they found it difficult to access LTBI testing and 27% (4/15) cited accessing the interferon-gamma release assay (IGRA) result as a barrier. Forty-three percent (9/21) responded that there was not a clear referral pathway for patients that they would like specialist input on when diagnosing and managing patients with LTBI. Conclusion Access to LTBI testing, LTBI test results, TB specialist services and the use of rifamycin-based regimens should be improved in this tertiary centre. Consideration should be given to developing a national LTBI education programme for healthcare professionals and updating national LTBI treatment guidelines.
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Affiliation(s)
- J O'Connell
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin 2
| | - E de Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin 2
- Beaumont Hospital, Royal College of Surgeons in Ireland Hospital Group, Health Service Executive
| | - C McNally
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin 2
- Beaumont Hospital, Royal College of Surgeons in Ireland Hospital Group, Health Service Executive
| | - S McConkey
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin 2
- Beaumont Hospital, Royal College of Surgeons in Ireland Hospital Group, Health Service Executive
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15
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O'Connell J, Reid M, Rockell J, Harty K, Perraillon M, Manson S. Patient Outcomes Associated With Utilization of Education, Case Management, and Advanced Practice Pharmacy Services by American Indian and Alaska Native Peoples With Diabetes. Med Care 2021; 59:477-486. [PMID: 33758159 PMCID: PMC8609964 DOI: 10.1097/mlr.0000000000001521] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of diabetes is exceptionally high among American Indian and Alaska Native (AI/AN) peoples. The Indian Health Service (IHS) and Tribal health programs provide education, case management, and advanced practice pharmacy (ECP) services for AI/ANs with diabetes to improve their health outcomes. OBJECTIVE The objective of this study was to evaluate patient outcomes associated with ECP use by AI/AN adults with diabetes. RESEARCH DESIGN This observational study included the analysis of IHS data for fiscal years (FY) 2011-2013. Using propensity score models, we assessed FY2013 patient outcomes associated with FY2012 ECP use, controlling for FY2011 baseline characteristics. SUBJECTS AI/AN adults with diabetes who used IHS and Tribal health services (n=28,578). MEASURES We compared health status and hospital utilization outcomes for ECP users and nonusers. RESULTS Among adults with diabetes, ECP users, compared with nonusers, had lower odds of high systolic blood pressure [odds ratio (OR)=0.85, P<0.001] and high low-density lipoprotein cholesterol (OR=0.89, P<0.01). Among adults with diabetes absent cardiovascular disease (CVD) at baseline, 3 or more ECP visits, compared with no visits, was associated with lower odds of CVD onset (OR=0.79, P<0.05). Among adults with diabetes and CVD, any ECP use was associated with lower odds of end-stage renal disease onset (OR=0.60, P<0.05). ECP users had lower odds of 1 or more hospitalizations (OR=0.80, P<0.001). CONCLUSIONS Findings on positive patient outcomes associated with ECP use by adults with diabetes may inform IHS and Tribal policies, funding, and enhancements to ECP services to reduce disparities between AI/ANs and other populations in diabetes-related morbidity and mortality.
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Affiliation(s)
| | - Margaret Reid
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Marcelo Perraillon
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Spero Manson
- Centers for American Indian and Alaska Native Health
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16
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O'Connell J, O'Farrell R, de Barra E. A feasibility assessment of an ambulatory care pathway for cellulitis at a tertiary referral centre in the Republic of Ireland. Clinical Infection in Practice 2020. [DOI: 10.1016/j.clinpr.2020.100035] [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: 10/24/2022] Open
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O'Connell J, Keohane S, McGreal-Bellone A, McDonagh P, Naimimohasses S, Kennedy U, Dunne C, Hartery K, Larkin J, MacCarthy F, Meaney J, McKiernan S, Norris S, O'Toole D, Kevans D. Characteristics and outcomes of acute colitis diagnosed on cross-sectional imaging presenting via the emergency department in an Irish academic medical centre. Ir J Med Sci 2020; 189:1115-1121. [PMID: 31925651 DOI: 10.1007/s11845-019-02162-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS A significant proportion of patients presenting to the Emergency Department with gastrointestinal symptoms that result in cross-sectional imaging receive a radiological diagnosis of colitis. We aimed to review the characteristics, outcomes, and final diagnoses of new emergency department presentations with colitis diagnosed on cross-sectional imaging. METHODS A radiology database was interrogated to identify patients admitted from the Emergency Department of St James's Hospital whose cross-sectional imaging demonstrated colitis. Baseline demographic data, information on inpatient investigations, final diagnoses, and outcomes were recorded. Adverse outcomes were defined as a requirement for surgery, intensive care unit (ICU) stay, or mortality RESULTS: A total of 118 patients, 67% female, were identified with a median age of 64 years (range 16.9-101.2). Median (range) admission duration was 10 days (1-241). Final colitis diagnoses were infectious (28%), undefined (27%), reactive (18%), inflammatory bowel disease (11%), ischaemic (9%), chemotherapy-associated (3%), diverticular (3%), and medication-associated (1%). Colonic perforation, colectomy, and mortality occurred in 1%, 5%, and 13% of the cohort respectively. On univariate analysis, low haemoglobin, low albumin, high lactate, and male gender were associated with adverse outcomes with the following odds ratios (OR) and 95% confidence intervals (95%CI) were low haemoglobin 1.49 [1.15-1.92] P = 0.002, low albumin 1.16 [1.07-1.25] P = 0.0002, lactate 1.65 [1.13-2.42] P = 0.009, and male gender 3.09 [1.23-7.77] P = 0.019. On multivariate analysis, male gender was associated with adverse outcomes. CONCLUSION Patients presenting to the Emergency Department with a colitis, requiring an abdominal CT are a heterogenous group with a proportion having concomitant intra-abdominal pathology resulting in critical illness. Hence their is a significant morbidity and mortality observed in this cohort which should not be extrapolated to a general population of patients presenting with colitis. In this cohort of patients, anaemia, hypoalbuminaemia, and elevated lactate in patients presenting to the ED with acute colitis are significantly associated with adverse outcomes. Early recognition of these prognostic factors may identify the cohort of patients who are best managed in a high-dependency setting.
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Affiliation(s)
- J O'Connell
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland.
| | - S Keohane
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
| | - A McGreal-Bellone
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
| | - P McDonagh
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
| | - S Naimimohasses
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
| | - U Kennedy
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
| | - C Dunne
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - K Hartery
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - J Larkin
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
- Department of Diagnostic Imaging, St James's Hospital, Dublin, Ireland
| | - F MacCarthy
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - J Meaney
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - S McKiernan
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - S Norris
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - D O'Toole
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
| | - D Kevans
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
- Department of Colorectal Surgery, St James's Hospital, Dublin, Ireland
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18
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Bond L, Carroll R, Mulryan N, O'Dwyer M, O'Connell J, Monaghan R, Sheerin F, McCallion P, McCarron M. Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. J Intellect Disabil Res 2020; 64:368-380. [PMID: 32215976 DOI: 10.1111/jir.12724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/11/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Depression and anxiety are amongst the most prevalent mental health disorders in the older population with intellectual disability (ID). There is a paucity of research that pertains to associative biopsychosocial factors for depression and anxiety in this population. The aim of this study is to determine the biopsychosocial factors associated with depression and anxiety in a population of older adults with ID in Ireland. METHODS The study was part of 'The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing'. Depressive symptoms were assessed using the Glasgow Depression Scale for people with a Learning Disability. Anxiety symptoms were measured using the Glasgow Anxiety Scale for people with a Learning Disability. The cross-sectional associations of depression and anxiety with biopsychosocial parameters were measured using a variety of self-report and proxy-completed questionnaires. RESULTS For the study population, 9.97% met the criteria for depression, and 15.12% met the criteria for an anxiety disorder. Participants meeting criteria for depression were more likely to be taking regular mood stabiliser medications and to exhibit aggressive challenging behaviour. Participants meeting criteria for anxiety were more likely to have sleep difficulties and report loneliness. Participants meeting criteria for either/both depression and anxiety were more likely to report loneliness. CONCLUSIONS This study identified both treatable and modifiable, as well as unmodifiable, biopsychosocial factors associated with depression and/or anxiety in older adults with ID. A longitudinal study follow-up will further develop our knowledge on the causality and direction of associated biopsychosocial factors with depression and anxiety in older adults with ID and better inform management strategies, prevention policies and funding of services.
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Affiliation(s)
- L Bond
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Daughters of Charity Disability Support Services, Dublin, Ireland
| | - R Carroll
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - N Mulryan
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Daughters of Charity Disability Support Services, Dublin, Ireland
| | - M O'Dwyer
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J O'Connell
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - R Monaghan
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - F Sheerin
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Temple School of Social Work, Temple University, Philadelphia, PA, US
| | - M McCarron
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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19
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Rathbun LI, Colicino EG, Manikas J, O'Connell J, Krishnan N, Reilly NS, Coyne S, Erdemci-Tandogan G, Garrastegui A, Freshour J, Santra P, Manning ML, Amack JD, Hehnly H. Cytokinetic bridge triggers de novo lumen formation in vivo. Nat Commun 2020; 11:1269. [PMID: 32152267 PMCID: PMC7062744 DOI: 10.1038/s41467-020-15002-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 06/04/2018] [Accepted: 02/14/2020] [Indexed: 02/03/2023] Open
Abstract
Multicellular rosettes are transient epithelial structures that serve as intermediates during diverse organ formation. We have identified a unique contributor to rosette formation in zebrafish Kupffer's vesicle (KV) that requires cell division, specifically the final stage of mitosis termed abscission. KV utilizes a rosette as a prerequisite before forming a lumen surrounded by ciliated epithelial cells. Our studies identify that KV-destined cells remain interconnected by cytokinetic bridges that position at the rosette's center. These bridges act as a landmark for directed Rab11 vesicle motility to deliver an essential cargo for lumen formation, CFTR (cystic fibrosis transmembrane conductance regulator). Here we report that premature bridge cleavage through laser ablation or inhibiting abscission using optogenetic clustering of Rab11 result in disrupted lumen formation. We present a model in which KV mitotic cells strategically place their cytokinetic bridges at the rosette center, where Rab11-associated vesicles transport CFTR to aid in lumen establishment.
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Affiliation(s)
- L I Rathbun
- Biology Department, Syracuse University, Syracuse, New York, USA
| | - E G Colicino
- Biology Department, Syracuse University, Syracuse, New York, USA
- Department of Cell and Developmental Biology, SUNY Upstate Medical School, Syracuse, New York, USA
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - J Manikas
- Biology Department, Syracuse University, Syracuse, New York, USA
| | - J O'Connell
- Biology Department, Syracuse University, Syracuse, New York, USA
| | - N Krishnan
- Biology Department, Syracuse University, Syracuse, New York, USA
| | - N S Reilly
- Department of Physics and Astronomy, University of Rochester, Rochester, New York, USA
| | - S Coyne
- Department of Cell and Developmental Biology, SUNY Upstate Medical School, Syracuse, New York, USA
- Department of Biology, SUNY Geneseo, Geneseo, New York, USA
| | | | - A Garrastegui
- Biology Department, Syracuse University, Syracuse, New York, USA
| | - J Freshour
- Biology Department, Syracuse University, Syracuse, New York, USA
| | - P Santra
- Department of Cell and Developmental Biology, SUNY Upstate Medical School, Syracuse, New York, USA
| | - M L Manning
- Department of Physics, Syracuse University, Syracuse, New York, USA
| | - J D Amack
- Department of Cell and Developmental Biology, SUNY Upstate Medical School, Syracuse, New York, USA
| | - H Hehnly
- Biology Department, Syracuse University, Syracuse, New York, USA.
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O'Connell J, de Barra E, McConkey S. World Tuberculosis Day 2020: It's Time. Ir Med J 2020; 113:17. [PMID: 32311255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- J O'Connell
- 1. Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland
| | - E de Barra
- 1. Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland
- Beaumont Hospital, Dublin, RCSI Hospital Group, Health Service Executive, Ireland
| | - S McConkey
- 1. Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland
- Beaumont Hospital, Dublin, RCSI Hospital Group, Health Service Executive, Ireland
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21
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Huyser KR, Rockell J, Jernigan VBB, Taniguchi T, Wilson C, Manson SM, O'Connell J. Sex Differences in Diabetes Prevalence, Comorbidities, and Health Care Utilization among American Indians Living in the Northern Plains. Curr Dev Nutr 2020; 4:42-48. [PMID: 32258998 PMCID: PMC7101481 DOI: 10.1093/cdn/nzz089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/21/2019] [Accepted: 07/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The American Indian (AI) population experiences significant diet-related health disparities including diabetes and cardiovascular disease (CVD). Owing to the relatively small sample size of AIs, the population is rarely included in large national surveys such as the NHANES. This exclusion hinders efforts to characterize potentially important differences between AI men and women, track the costs of these disparities, and effectively treat and prevent these conditions. OBJECTIVE We examined the sex differences in diabetes prevalence, comorbidity experience, health care utilization, and treatment costs among AIs within a Northern Plains Indian Health Service (IHS) service unit. METHODS We assessed data from a sample of 11,144 persons using an IHS service unit in the Northern Plains region of the United States. Detailed analyses were conducted for adults (n = 7299) on prevalence of diabetes by age and sex. We described sex differences in comorbidities, health care utilization, and treatment costs among the adults with diabetes. RESULTS In our sample, adult men and women had a similar prevalence of diabetes (10.0% and 11.0%, respectively). The prevalence of CVD among men and women with diabetes was 45.7% and 34.0%, respectively. Among adults with diabetes, men had a statistically higher prevalence of hypertension and substance use disorders than women. The men were statistically less likely to have a non-substance use mental health disorder. Although men had higher utilization and costs for hospital inpatient services than women, the differences were not statistically significant. CONCLUSIONS In this AI population, there were differences in comorbidity profiles between adult men and women with diabetes, which have differential mortality and cost consequences. Appropriate diabetes management addressing gender-specific comorbidities, such as substance use disorders for men and non-substance use mental health disorders for women, may help reduce additional comorbidities or complications to diabetes.
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Affiliation(s)
- Kimberly R Huyser
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | | | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | | | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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22
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Bond L, Carroll R, Mulryan N, O'Dwyer M, O'Connell J, Monaghan R, Sheerin F, McCallion P, McCarron M. The association of life events and mental ill health in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. J Intellect Disabil Res 2019; 63:454-465. [PMID: 30697858 DOI: 10.1111/jir.12595] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Exposures to life events are associated with emotional, psychological and behavioural problems in those with intellectual disability (ID). Older adults with ID may experience different life events given differences in living circumstances, cognitive decline, greater dependency on others and less autonomy. This study examines the relationship of life events and mental ill health in an older ID population in Ireland. METHODS The study was part of 'The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing'. The frequency of life events was assessed using a 20-item checklist, and the level of stress experienced was assessed using a three-point Likert scale measuring the burden of the life event. The associations of life events with factors associated with mental ill health were measured using a variety of self-report and proxy completed questionnaires. RESULTS For the study population, 88.1% had been exposed to at least one life event in the preceding 12 months and 64.5% to two or more life events. Frequency and burden of life events were significantly higher in individuals living in institutional settings and in individuals with any current psychiatric condition, increased depressive and anxiety symptoms, challenging behaviour and reported poorer self-rated mental and physical health. More life events were significantly associated with new psychiatric diagnoses as well as initiation and increased dosage of mood stabilising, hypnotic and sedative medications. CONCLUSIONS Life events are significantly associated with mental ill health in the older ID population. Service providers must focus on limiting the exposure to these events and, in situations where they cannot be avoided, should support and manage individuals compassionately and effectively, prioritising their mental and physical well-being.
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Affiliation(s)
- L Bond
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Daughters of Charity Disability Support Services, Dublin, Ireland
| | - R Carroll
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - N Mulryan
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Daughters of Charity Disability Support Services, Dublin, Ireland
| | - M O'Dwyer
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J O'Connell
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - R Monaghan
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - F Sheerin
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Temple School of Social Work, Temple University, Philadelphia, PA, USA
| | - M McCarron
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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O'Connell J, Gálvez-González AM, Scandlyn J, Sala-Adam MR, Martín-Linares X. A Collaboration to Teach US MPH Students about Cuba's Health Care System. MEDICC Rev 2018; 20:49-53. [PMID: 29773778 DOI: 10.37757/mr2018.v20.n2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In 2011, the US Department of the Treasury changed its regulations to allow US students to participate in short-term education programs in Cuba. Beginning in 2012, and each year thereafter, Cuba's National School of Public Health and the Colorado School of Public Health have jointly taught a class on the Cuban public health system. The program goals are to provide US students with an opportunity to learn about the Cuban national health system's focus on 1) prevention and primary health care services; 2) financial and geographic access to services and health equity; 3) continuum of care across the home, family doctor-and-nurse offices, polyclinics and hospitals; 4) data collection at all levels to understand health risks, including outbreaks, and to guide resource allocation; 5) assessing patients' health and risks using a comprehensive definition of health; 6) multisectoral collaborations between the Ministry of Public Health and other Cuban agencies and organizations to address population health risks; 7) disaster preparedness, response and recovery; and 8) provision of international health assistance. The class incorporates information about health systems in Latin American and other Caribbean countries to provide context for understanding the Cuban health system. The course includes: 1) seminars, online readings and discussions before travel to Cuba; 2) seminars at Cuba's National School of Public Health, visits to Cuban national health institutions at all levels, from community-based family doctor-and-nurse offices and multispecialty clinics (polyclinics) to internationally recognized national health institutions, and guided visits and activities about Cuban culture and history during their 12 days in Cuba; and 3) followup course work upon return to the USA in which students integrate what they learned into their final class reports and presentations. During time spent planning, implementing and revising the program, both institutions have learned from each other about global health teaching methodologies and have laid a foundation for future teaching and research collaborations. To date, 49 individuals have participated in the program. KEYWORDS Medical education, public health system, collaboration, Cuba, USA.
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O'Connell J, Rockell J, Ouellet J, Tomar SL, Maas W. Costs And Savings Associated With Community Water Fluoridation In The United States. Health Aff (Millwood) 2018; 35:2224-2232. [PMID: 27920310 DOI: 10.1377/hlthaff.2016.0881] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.
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Affiliation(s)
- Joan O'Connell
- Joan O'Connell is an associate professor in the Department of Community and Behavioral Health at the Colorado School of Public Health, in Aurora
| | - Jennifer Rockell
- Jennifer Rockell is a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health
| | - Judith Ouellet
- Judith Ouellet is a senior professional research assistant in the Division of Health Care Policy and Research at the University of Colorado Denver School of Medicine, in Aurora
| | - Scott L Tomar
- Scott L. Tomar is a professor in the Department of Community Dentistry and Behavioral Science at the College of Dentistry, University of Florida, in Gainesville
| | - William Maas
- William Maas is a dental consultant at William Maas, LLC, in Rockville, Maryland
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O'Connell J, Rockell J, Ouellet JC, LeBeau M. Disparities in Potentially Preventable Hospitalizations Between American Indian and Alaska Native and Non-Hispanic White Medicare Enrollees. Med Care 2017; 55:569-575. [PMID: 28263280 DOI: 10.1097/mlr.0000000000000698] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A number of health care initiatives seek to improve health outcomes by increasing access to outpatient services while reducing preventable acute events. We evaluated disparities between American Indian and Alaska Native (AI/AN) and non-Hispanic white (white) Medicare enrollees in access to outpatient preventive, primary, and specialty services by comparing their potentially preventable hospitalizations (PPHs). RESEARCH DESIGN The study population included 121,311 adult AI/AN Medicare enrollees registered to use services funded by the Indian Health Service and 5,915,011 adult white enrollees living in the same counties. Medicare 2010 data and a nationally recognized algorithm were used to identify PPHs. RESULTS Among AI/AN Medicare enrollees, 58.6% had either diabetes, cardiovascular disease, or both conditions; the AI/AN age-adjusted prevalence of either or both conditions was 1.2 times that of the white enrollees (P<0.001). The age-adjusted PPH rate for all AI/ANs was 74 admissions per 1000 adults, 1.5 times that of white enrollees (P<0.001). Nearly 90% of AI/AN PPHs were among AI/ANs with diabetes, cardiovascular disease, or both conditions; their PPH rate was 114 admissions per 1000 adults, 1.2 times that of white enrollees (P<0.001) with those conditions. CONCLUSIONS Differences in disease burden and access to outpatient services may partly explain the higher PPH rates for AI/AN Medicare enrollees. The health care quality measure used in this study (PPH) was developed for the US general population. It is important to consider AI/AN socioeconomic and other characteristics when interpreting findings for such measures and enhancing programs and policies to improve AI/AN health outcomes.
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Affiliation(s)
- Joan O'Connell
- *Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado, Aurora †Department of Health & Behavioral Sciences, University of Colorado Denver, Denver, CO ‡California Rural Indian Health Board, Sacramento, CA
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Smith R, O'Connell J. 93: Holistic needs assessment – development of the virtual clinic. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tooker ME, VanRaden PM, Bickhart DM, O'Connell J. 0298 Selection of sequence variants to improve dairy cattle genomic predictions. J Anim Sci 2016. [DOI: 10.2527/jam2016-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lacouture ME, Keefe DM, Sonis S, Jatoi A, Gernhardt D, Wang T, Doherty JP, Giri N, Nadanaciva S, O'Connell J, Sbar E, Piperdi B, Garon EB. A phase II study (ARCHER 1042) to evaluate prophylactic treatment of dacomitinib-induced dermatologic and gastrointestinal adverse events in advanced non-small-cell lung cancer. Ann Oncol 2016; 27:1712-8. [PMID: 27287210 DOI: 10.1093/annonc/mdw227] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/29/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND ARCHER 1042, a randomized phase II trial, explored the impact of prophylactic treatment on select dermatologic adverse events of interest (SDAEI), diarrhea, and mucositis associated with dacomitinib, an oral irreversible pan-human epidermal growth factor receptor (HER) inhibitor, in development for advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with advanced NSCLC treated with dacomitinib were enrolled in two cohorts. Cohort I patients were randomized 1:1 to receive oral doxycycline or placebo (4 weeks). Cohort II patients received oral VSL#3 probiotic plus topical alclometasone. Primary end points for Cohorts I and II were incidence of all grade and grade ≥2 SDAEI in the first 8 weeks of treatment and quality of life (QoL) assessed by the Skindex-16 survey. Additional primary end points for Cohort II were incidence of all grade and grade ≥2 diarrhea and mucositis in the first 8 weeks of treatment; QoL regarding diarrhea and mucositis incidence was assessed by the modified-Oral Mucositis Daily Questionnaire. RESULTS Cohort I randomized 114 evaluable patients: 56 in the doxycycline arm, 58 in the placebo arm. Cohort II enrolled 59 evaluable patients. Doxycycline significantly reduced the incidence of grade ≥2 SDAEI by 50% (P = 0.016) compared with placebo. The incidence of all grade SDAEI was lower with doxycycline than with placebo but did not reach statistical significance. Doxycycline was associated with less deterioration in QoL compared with placebo. Alclometasone was associated with less deterioration in QoL compared with placebo but did not statistically significantly reduce the incidence of all grade or grade ≥2 SDAEI. VSL#3 did not reduce the incidence of all grade or grade ≥2 diarrhea and did not impact mucositis scores. CONCLUSIONS Doxycycline was effective as a prophylactic treatment for dacomitinib-induced grade ≥2 SDAEI. Both doxycycline and alclometasone reduced the negative impact in patient-reported dermatologic AEs. The probiotic was not effective for preventing diarrhea or mucositis.
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Affiliation(s)
- M E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Keefe
- Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - S Sonis
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston
| | - A Jatoi
- Department of Oncology, Mayo Clinic, Rochester
| | | | | | | | - N Giri
- Pfizer Oncology, La Jolla
| | | | | | - E Sbar
- Pfizer Oncology, Collegeville
| | - B Piperdi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx
| | - E B Garon
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
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Carolan E, Hogan A, O'Connell J, Fallon M, Byrne D, O'Shea D, Cody D. The prevalence of cardiovascular risk factors in obese children. Ir Med J 2015; 108:134-136. [PMID: 26062237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Childhood Obesity poses a public health problem in Ireland. Complications associated include metabolic disease and cardiovascular disease risk. Our aim was to determine the prevalence of cardiovascular risk factors in a cohort of obese Irish children. Assessments were performed on obese children attending weight management clinic. Pedometers and self report physical activity questionnaires were administered to each participant to determine physical activity levels. Fifty-nine children (21 prepubertal and 38 pubertal/post-pubertal) were metabolically profiled. Mean ± SD of z scores for BMI, Waist Circumference and Body Fat % were +3.29 ± 0.48, +3.98 ± 0.73 and +2.75 ± 0.50 respectively. 43% (n = 9) prepubertal and 68% (n = 26) pubertal/postpubertal children had at least one other cardiovascular risk factor in addition to obesity. Increased moderate-vigorous physical activity levels correlated with reduced incidence of cardiovascular risk factors. There is a significant prevalence of cardiovascular risk factors among obese pre-pubertal children and pubertal/post-pubertal adolescents attending an Irish obesity clinic.
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Kris MG, Camidge DR, Giaccone G, Hida T, Li BT, O'Connell J, Taylor I, Zhang H, Arcila ME, Goldberg Z, Jänne PA. Targeting HER2 aberrations as actionable drivers in lung cancers: phase II trial of the pan-HER tyrosine kinase inhibitor dacomitinib in patients with HER2-mutant or amplified tumors. Ann Oncol 2015; 26:1421-7. [PMID: 25899785 DOI: 10.1093/annonc/mdv186] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/09/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HER2 mutations and amplifications have been identified as oncogenic drivers in lung cancers. Dacomitinib, an irreversible inhibitor of HER2, EGFR (HER1), and HER4 tyrosine kinases, has demonstrated activity in cell-line models with HER2 exon 20 insertions or amplifications. Here, we studied dacomitinib in patients with HER2-mutant or amplified lung cancers. PATIENTS AND METHODS As a prespecified cohort of a phase II study, we included patients with stage IIIB/IV lung cancers with HER2 mutations or amplification. We gave oral dacomitinib at 30-45 mg daily in 28-day cycles. End points included partial response rate, overall survival, and toxicity. RESULTS We enrolled 30 patients with HER2-mutant (n = 26, all in exon 20 including 25 insertions and 1 missense mutation) or HER2-amplified lung cancers (n = 4). Three of 26 patients with tumors harboring HER2 exon 20 mutations [12%; 95% confidence interval (CI) 2% to 30%] had partial responses lasting 3+, 11, and 14 months. No partial responses occurred in four patients with tumors with HER2 amplifications. The median overall survival was 9 months from the start of dacomitinib (95% CI 7-21 months) for patients with HER2 mutations and ranged from 5 to 22 months with amplifications. Treatment-related toxicities included diarrhea (90%; grade 3/4: 20%/3%), dermatitis (73%; grade 3/4: 3%/0%), and fatigue (57%; grade 3/4: 3%/0%). One patient died on study likely due to an interaction of dacomitinib with mirtazapine. CONCLUSIONS Dacomitinib produced objective responses in patients with lung cancers with specific HER2 exon 20 insertions. This observation validates HER2 exon 20 insertions as actionable targets and justifies further study of HER2-targeted agents in specific HER2-driven lung cancers. CLINICALTRIALSGOV NCT00818441.
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Affiliation(s)
- M G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York
| | - D R Camidge
- Department of Medical Oncology, University of Colorado Denver, Aurora
| | - G Giaccone
- Lombardi Cancer Center, Georgetown University, Washington, USA
| | - T Hida
- Department of Thoracic Oncology, Aichi Cancer Center, Chikusa-ku Nagoya, Japan
| | - B T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York
| | | | - I Taylor
- Translational Oncology, Pfizer, Inc., Groton, USA
| | - H Zhang
- Pfizer (China) Research & Development Co. Ltd, Pfizer, Inc., Shanghai, China
| | - M E Arcila
- Molecular Diagnostics Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Z Goldberg
- Pfizer Oncology, Pfizer, Inc., San Diego
| | - P A Jänne
- Lowe Center for Thoracic Oncology and the Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, USA
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Estep J, Starling R, Horstmanshof D, Rogers J, Selzman C, Shah K, Loebe M, Moazami N, Long J, Milano C, Stehlik J, Kasirajan V, Haas D, O'Connell J, Boyle A, Kallel F, Farrar D. Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients (ROADMAP). J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Woods CP, Corrigan M, Gathercole L, Taylor A, Hughes B, Gaoatswe G, Manolopoulos K, Hogan AE, O'Connell J, Stewart PM, Tomlinson JW, O'Shea D, Sherlock M. Tissue specific regulation of glucocorticoids in severe obesity and the response to significant weight loss following bariatric surgery (BARICORT). J Clin Endocrinol Metab 2015; 100:1434-44. [PMID: 25603461 DOI: 10.1210/jc.2014-4120] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Tissue cortisol exposure is under the control of the isozymes of 11β-hydroxysteroid dehydrogenase (11β-HSD). 11β-HSD1 in vivo, acts as an oxoreductase converting inactive cortisone to active cortisol. We hypothesized that 11β-HSD1 activity is dysregulated in obesity and alters following bariatric surgery induced weight loss in different tissues. METHODS We recruited 21 patients prior to undergoing bariatric surgery and performed cortisol generation profiles (following oral cortisone administration), urinary corticosteroid metabolite analysis, adipose tissue microdialysis, and tissue gene expression before and after weight loss, following bariatric surgery. Archived tissue samples from 20 previous bariatric surgery patients were also used for tissue gene expression studies. RESULTS Gene expression showed a positive correlation with 11β-HSD1 and BMI in omental adipose tissue (OM) (r = +0.52, P = .0001) but not sc adipose tissue (r = +0.28, P = .17). 11β-HSD1 expression in liver negatively correlated with body mass index (BMI) (r = -0.37, P = .04). 11β-HSD1 expression in sc adipose tissue was significantly reduced after weight loss (0.41 ± 0.28 vs 0.17 ± 0.1 arbitrary units, P = .02). Following weight loss, serum cortisol generation increased during a cortisol generation profile (area under the curve 26 768 ± 16 880 vs 47 579 ± 16 086 nmol/L/minute, P ≤ .0001.) Urinary corticosteroid metabolites demonstrated a significant reduction in total cortisol metabolites after bariatric surgery (15 224 ± 6595 vs 8814 ± 4824 μg/24 h, P = .01). Microdialysis of sc adipose tissue showed a threefold reduction in cortisol/cortisone ratio after weight loss. CONCLUSIONS This study highlights the differences in tissue specific regulation of cortisol metabolism in obesity and after weight loss. Following bariatric surgery hepatic 11β-HSD1 activity increases, sc adipose tissue 11β-HSD1 activity is reduced and total urinary cortisol metabolites are reduced indicating a possible reduction in hypothalamic pituitary adrenal axis drive. 11β-HSD1 expression correlates positively with BMI in omental adipose tissue and negatively within hepatic tissue. 11β-HSD1 expression is reduced in sc adipose tissue after weight loss.
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Affiliation(s)
- C P Woods
- Education and Research Centre (C.P.W., M.C., G.G., A.E.H., J.O., D.O., M.S.), St Vincent's University Hospital and St Columcille's Hospital, Dublin, Ireland; Centre for Endocrinology (L.G., A.T., B.H., K.M., J.T., M.S.), Diabetes and Metabolism, Institute of Biomedical Research, University of Birmingham, United Kingdom; Department of Endocrinology (P.M.S.), University of Leeds, Leeds, United Kingdom; and Department of Endocrinology (M.S.), Tallaght Hospital, Dublin and Trinity College, Dublin, Ireland
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Cooke M, Tan EK, Mandrycky C, He H, O'Connell J, Tseng SCG. Comparison of cryopreserved amniotic membrane and umbilical cord tissue with dehydrated amniotic membrane/chorion tissue. J Wound Care 2014; 23:465-74, 476. [PMID: 25296347 DOI: 10.12968/jowc.2014.23.10.465] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate how the different processing methods cryopreservation and dehydration affect the structural integrity and biological composition of key signalling molecules within amniotic membrane and umbilical cord tissues. METHOD We directly compared cryopreserved amniotic membrane (AM) and umbilical cord (UC) tissues with dehydrated amniotic membrane/chorion (dHACM) tissue using biochemical and functional assays including histological and histochemical staining, BCA, agarose gel electrophoresis, western blot, ELISA, and proliferation and cell death assays. RESULTS Cryopreservation retains the native architecture of the AM/UC extracellular matrix and maintains the quantity and activity of key biological signals present in fresh AM/UC, including high molecular weight hyaluronic acid, heavy chain-HA complex, and pentraxin 3. In contrast, dehydrated tissues were structurally compromised and almost completely lacked these crucial components. CONCLUSION The results presented here indicate that cryopreservation better preserves the structural and biological signaling molecules of foetal tissues.
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Affiliation(s)
- M Cooke
- Amniox Medical, Atlanta, GA, 30339, USA
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Mok T, O'Byrne K, Ramalingam S, Janne P, Boyer M, Ahn J, Zhang H, O'Connell J, Taylor I, Mather C, Paz-Ares L. Dacomitinib (D) Versus Erlotinib (E) in 2Nd/3Rd Line Nsclc: Outcome for Asian Patients from the Archer 1009 Global Phase 3 Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Shea D, Corrigan M, Dunne MR, Jackson R, Woods C, Gaoatswe G, Moynagh PN, O'Connell J, Hogan AE. Changes in human dendritic cell number and function in severe obesity may contribute to increased susceptibility to viral infection. Int J Obes (Lond) 2013; 37:1510-3. [PMID: 23439322 DOI: 10.1038/ijo.2013.16] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 08/20/2012] [Revised: 01/04/2013] [Accepted: 01/09/2013] [Indexed: 02/03/2023]
Abstract
Dendritic cells (DCs) are key immune sentinels linking the innate and adaptive immune systems. DCs recognise danger signals and initiate T-cell tolerance, memory and polarisation. They are critical cells in responding to a viral illness. Obese individuals have been shown to have an impaired response to vaccinations against virally mediated conditions and to have an increased susceptibility to multi-organ failure in response to viral illness. We investigated if DCs are altered in an obese cohort (mean body mass index 51.7±7.3 kg m(-2)), ultimately resulting in differential T-cell responses. Circulating DCs were found to be significantly decreased in the obese compared with the lean cohort (0.82% vs 2.53%). Following Toll-like receptor stimulation, compared with lean controls, DCs generated from the obese cohort upregulated significantly less CD83 (40% vs 17% mean fluorescence intensity), a molecule implicated in the elicitation of T-cell responses, particularly viral responses. Obese DCs produced twofold more of the immunosuppressive cytokine interleukin (IL)-10 than lean controls, and in turn stimulated fourfold more IL-4-production from allogenic naive T cells. We conclude that obesity negatively impacts the ability of DCs to mature and elicit appropriate T-cell responses to a general stimulus. This may contribute to the increased susceptibility to viral infection observed in severe obesity.
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Affiliation(s)
- D O'Shea
- 1] Obesity Immunology Group, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin, Ireland [2] Department of Endocrinology, St Columcille's Hospital, Health Service Executive, Loughlinstown, Dublin, Ireland
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O'Connell J, Plotka A, Liang Y, Boutros T, Ni G, Masters J, DeMicco M, Pardo P, Bello C, Giri N. Pharmacokinetics (PK) of the Pan-Her Inhibitor Dacomitinib (D) in Subjects with Mild or Moderate Hepatic Impairment. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McGhee DJM, Royle PL, Counsell CE, Abbas A, Sethi P, Manku L, Narayan A, Clegg K, Bardai A, Brown SHM, Hafeez U, Abdelhafiz AH, McGovern A, Breckenridge A, Seenan P, Samani A, Das S, Khan S, Puffett AJ, Morgan J, Ross G, Cantlay A, Khan N, Bhalla A, Sweeting M, Nimmo CAMD, Fleet J, Igbedioh C, Harari D, Downey CL, Handforth C, Stothard C, Cracknell A, Barnes C, Shaw L, Bainbridge L, Crabtree L, Clark T, Root S, Aitken E, Haroon K, Sudlow M, Hanley K, Welsh S, Hill E, Falconer A, Miller H, Martin B, Tidy E, Pendlebury S, Thompson S, Burnett E, Taylor H, Lonan J, Adler B, McCallion J, Sykes E, Bancroft R, Tullo ES, Young TJ, Clift E, Flavin B, Roberts HC, Sayer AA, Belludi G, Aithal S, Verma A, Singh I, Barne M, Wilkinson I, Sakoane R, Singh N, Wilkinson I, Cottee M, Irani TS, Martinovic O, Abdulla AJJ, Irani TS, Abdulla AJJ, Riglin J, Husk J, Lowe D, Treml J, Vasilakis JN, Buttery A, Reid J, Healy P, Grant-Casey J, Pendry K, Richards J, Singh A, Jarrett D, Hewitt J, Slevin J, Barwell G, Youde J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Kenny RA, O'Connell J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Robinson D, O'Connell J, Topp JD, Topp JD, Warburton K, Simpson L, Bryce K, Suntharalingam S, Grosser K, D'Silva A, Southern L, Bielawski C, Cook L, Sutton GM, Flanagan L, Storr A, Charlton L, Kerr S, Robinson L, Shaw F, Finch LK, Weerasuriya N, Walker M, Sahota O, Logan P, Brown F, Rossiter F, Baxter M, Mucci E, Brown A, Jackson SHD, de Savary N, Hasan S, Jones H, Birrell J, Hockley J, Hensey N, Meiring R, Athavale N, Simms J, Brown S, West A, Diem P, Simms J, Brown S, West A, Diem P, Davies R, Kings R, Coleman H, Stevens D, Campbell C, Hope S, Morris A, Ong T, Harwood R, Dasgupta D, Mitchell S, Dimmock V, Collin F, Wood E, Green V, Hendrickse-Welsh N, Singh N, Cracknell A, Eccles J, Beezer J, Garside M, Baxter J. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Denison HJ, Syddall HE, Martin HJ, Finucane FM, Griffin SJ, Wareham NJ, Cooper C, Sayer AA, Ramsay I, Fantin F, Zamboni M, Wright J, Morrison C, Bulpitt C, Rajkumar C, Wilkinson AH, Burton LA, Jones AL, Moni JJ, Witham MD, Bhangu J, Woods C, Robinson D, Shea DO, O'Connell J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Kenny RA, O'Connell J, Roche J, Argo I, Crombie IK, Feng Z, Sniehotta FF, Vadiveloo T, Witham MD, Donnan PT, McMurdo MET, Barrett MP, Sinha A, Wilson I, Chan S, Webb PJ. Other medical conditions. Age Ageing 2013. [DOI: 10.1093/ageing/aft023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Connell J, Bottomley A, Ramalingam S, Boyer M, Park K, Blackhall F, Mundayat R, Lee SY, Campbell A. Evaluation of Symptom Impact of Dacomitinib (PF-00299804) Versus Erlotinib in Patients with Advanced NSCLC after Chemotherapy Failure. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31997-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kris M, Goldberg Z, Janne P, Kim D, Martins R, Mok T, O'Connell J, Ou S, Taylor I, Zhang H. Dacomitinib (PF-00299804), An Irreversible Pan-Her Tyrosine Kinase Inhibitor (TKI), For First-Line Treatment of EGFR-Mutant or Her2-Mutant or -Amplified Lung Cancers. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33849-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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O'Connell J, Hayes F. Radioiodine therapy for hyperthyroidism. Ir Med J 2012; 105:69-70. [PMID: 22558809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Simone C, O'Connell J, Both S, Mansueti J, Christodouleas J, Deville C, McDonough J, Vapiwala N, Efstathiou J, Bekelman J. Para-aortic Nodal Clinical Target Volume Delineation in the Era of Particle Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.966] [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: 10/15/2022]
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Abstract
CONTEXT Dysfunctional adipose tissue has been proposed as a key pathological process linking obesity and metabolic disease. Preadipocyte factor-1 (Pref-1) has been shown to inhibit differentiation in adipocyte precursor cells and could thereby play a role in determining adipocyte size, adipose tissue functioning, and metabolic profile in obese individuals. OBJECTIVE We hypothesized that adipose tissue from metabolically healthy obese (MHO) and matched metabolically unhealthy obese individuals would demonstrate distinct differences in relation to Pref-1 expression, adipocyte size, and inflammatory markers. DESIGN, SETTING, AND PATIENTS This was a cross-sectional study, investigating obese patients undergoing bariatric surgery at a tertiary referral centre. Patients included 12 MHO and 17 age- and body mass index-matched metabolically unhealthy obese individuals. MAIN OUTCOME MEASURES Pref-1, monocyte chemotactic protein-1, TNF-α, granulocyte colony-stimulating factor, IL-6, and adiponectin levels, macrophage numbers, and adipocyte size were measured in omental and subcutaneous adipose tissue. RESULTS The MHO group had a lower level of Pref-1 (per 1000 adipocytes) in both subcutaneous [160 (136-177) versus 194 (153-355); P < 0.05] and omental adipose tissue [102 (32-175) versus 194 (100-350); P < 0.005]. This was associated with lower numbers of macrophages, lower levels of TNF-α, monocyte chemotactic protein-1, and granulocyte colony-stimulating factor, and higher levels of adiponectin. Omental Pref-1 showed strong correlations with adipocyte size (r = 0.67, P < 0.0005) and metabolic and adipokine parameters, including percent fatty liver (r = 0.62, P < 0.005), fasting glucose (r = 0.68, P < 0.0005), triglyceride (r = 0.60, P < 0.005), high-density lipoprotein cholesterol (r = -0.46, P < 0.05), and adiponectin (r = -0.71, P < 0.05). CONCLUSION Adipose tissue in MHO individuals had lower levels of Pref-1, a known inhibitor of preadipocyte differentiation, and a more favorable inflammatory profile. These factors may be key to protecting this subgroup of obese individuals from the adverse metabolic profile associated with excess adiposity.
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Affiliation(s)
- J O'Connell
- Department of Endocrinology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Bradbury AR, Patrick-Miller L, Fetzer D, Egleston B, Cummings SA, Forman A, Bealin L, Peterson C, Corbman M, O'Connell J, Daly MB. Genetic counselor opinions of, and experiences with telephone communication of BRCA1/2 test results. Clin Genet 2010; 79:125-31. [PMID: 21039431 DOI: 10.1111/j.1399-0004.2010.01540.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BRCA1/2 test disclosure has, historically, been conducted in-person by genetics professionals. Given increasing demand for, and access to, genetic testing, interest in telephone and Internet genetic services, including disclosure of test results, has increased. Semi-structured interviews with genetic counselors were conducted to determine interest in, and experiences with telephone disclosure of BRCA1/2 test results. Descriptive data are summarized with response proportions. One hundred and ninety-four genetic counselors completed self-administered surveys via the web. Although 98% had provided BRCA1/2 results by telephone, 77% had never provided pre-test counseling by telephone. Genetic counselors reported perceived advantages and disadvantages to telephone disclosure. Thirty-two percent of participants described experiences that made them question this practice. Genetic counselors more frequently reported discomfort with telephone disclosure of a positive result or variant of uncertain significance (p < 0.01) than other results. Overall, 73% of participants reported interest in telephone disclosure. Many genetic counselors have provided telephone disclosure, however, most, infrequently. Genetic counselors identify potential advantages and disadvantages to telephone disclosure, and recognize the potential for testing and patient factors to impact patient outcomes. Further research evaluating the impact of testing and patient factors on cognitive, affective, social and behavioral outcomes of alternative models of communicating genetic information is warranted.
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Affiliation(s)
- A R Bradbury
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA.
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O'Connell J, Yi R, Wilson C, Manson SM, Acton KJ. Racial disparities in health status: a comparison of the morbidity among American Indian and U.S. adults with diabetes. Diabetes Care 2010; 33:1463-70. [PMID: 20357367 PMCID: PMC2890342 DOI: 10.2337/dc09-1652] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE American Indians and Alaska Natives are 2.3 times more likely to have diabetes than are individuals in the U.S. general population. The objective of this study was to compare morbidity among American Indian and U.S. adults with diabetes. RESEARCH DESIGN AND METHODS We extracted demographic and health service utilization data for an adult American Indian population aged 18-64 years (n = 30,121) served by the Phoenix Service Unit from the Indian Health Service clinical reporting system. Similar data for a U.S. population (n = 1,500,002) with commercial health insurance, matched by age and sex to the American Indian population, were drawn from the MartketScan Research Database. We used Diagnostic Cost Groups to identify medical conditions for which each individual was treated and to assign a risk score to quantify his or her morbidity burden. We compared the prevalence of comorbidities and morbidity burden of American Indian and U.S. adults with diabetes. RESULTS American Indians with diabetes had significantly higher rates of hypertension, cerebrovascular disease, renal failure, lower-extremity amputations, and liver disease than commercially insured U.S. adults with diabetes (P < 0.05). The American Indian prevalence rates were 61.2, 6.9, 3.9, 1.8, and 7.1%, respectively. The morbidity burden among the American Indian with diabetes exceeded that of the insured U.S. adults with diabetes by 50%. CONCLUSIONS The morbidity burden associated with diabetes among American Indians seen at the Phoenix Service Unit far exceeded that of commercially insured U.S. adults. These findings point to the urgency of enhancing diabetes prevention and treatment services for American Indians/Alaska Natives to reduce diabetes-related disparities.
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Affiliation(s)
- Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado, USA.
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Janne PA, Reckamp K, Koczywas M, Engelman JA, Camidge DR, Rajan A, Khuri F, Liang JQ, O'Connell J, Giaccone G. Efficacy and safety of PF-00299804 (PF299) in patients (pt) with advanced NSCLC after failure of at least one prior chemotherapy regimen and prior treatment with erlotinib (E): A two-arm, phase II trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8063 Background: Options are limited for pts with NSCLC following chemotherapy and E. PF299 is an oral irreversible small molecule inhibitor of the HER-1,-2, and -4 tyrosine kinases. Based on non-clinical and phase I NSCLC data, this ongoing phase II U.S. trial evaluates PF299 in pts with NSCLC (KRAS wild-type) who have progressive disease after at least 1 prior chemotherapy regimen and after E. Methods: Pts were enrolled by histology: adenocarcinoma (Arm A) and non-adenocarcinoma (Arm B), and received PF299 45 mg QD. Endpoints include objective response rate, duration of response, progression-free survival, survival, safety/tolerability, and pharmacokinetics. Pharmacodynamic endpoints include assessment of serum levels of HER2 and EGFR extracellular domains. Tissue and blood KRAS assays, and EGFR studies on available tissue, are also being performed. Forty-four and 22 response-evaluable pts were planned to be enrolled into Arms A and B respectively. Results: Thirty-four pts with progressive NSCLC (25 female, 14 smoker) have enrolled to date (Arm A: 30; Arm B: 4): median duration of prior E: 11.5 months; median time since E: 2.5 months. Among 20 response-evaluable pts, stable disease (SD) was observed in 9/18 pts in Arm A, and 1/2 pts in Arm B: median duration of SD: 11.5 weeks [range 6+, 32+ weeks]. Observation of disease control included pts who had recently (≤8 weeks) discontinued E; and also pts whose tumor had known EGFR T790M mutations. At time of data cutoff, confirmation per RECIST of 2 partial responses is pending. The most common treatment-related AEs were skin and gastrointestinal disorders, with grade 3 AEs in 19% and 13% of pts, respectively. Two pts experienced grade 4 pulmonary embolus/dyspnea deemed possibly treatment-related, both in the setting of progressive disease. Conclusions: PF299 shows encouraging activity in NSCLC pts after failure of prior chemotherapy and E. The AE profile was predictable and consistent with the prior phase I trial. At submission, enrollment in the adenocarcinoma arm is complete and enrollment in the non-adenocarcinoma arm continues; updated efficacy data and tumor characterization will be presented. [Table: see text]
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Affiliation(s)
- P. A. Janne
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - K. Reckamp
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - M. Koczywas
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - J. A. Engelman
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - D. R. Camidge
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - A. Rajan
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - F. Khuri
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - J. Q. Liang
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - J. O'Connell
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
| | - G. Giaccone
- Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Massachusetts General Hospital, Boston, MA; University of Colorado, Denver, CO; National Cancer Institute, Bethesda, MD; Emory University Winship Cancer Institute, Atlanta, GA; Pfizer Oncology, New London, CT
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Beals J, Belcourt-Dittloff A, Freedenthal S, Kaufman C, Mitchell C, Whitesell N, Albright K, Beauvais F, Belcourt G, Duran B, Fleming C, Floersch N, Foley K, Jervis L, Kipp BJ, Mail P, Manson S, May P, Mohatt G, Morse B, Novins D, O'Connell J, Parker T, Quintero G, Spicer P, Stiffman A, Stone J, Trimble J, Venner K, Walters K. Reflections on a proposed theory of reservation-dwelling American Indian alcohol use: comment on Spillane and Smith (2007). Psychol Bull 2009; 135:339-43; discussion 344-6. [PMID: 19254084 DOI: 10.1037/a0014819] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In their recent article, N. Spillane and G. Smith suggested that reservation-dwelling American Indians have higher rates of problem drinking than do either non-American Indians or those American Indians living in nonreservation settings. These authors further argued that problematic alcohol use patterns in reservation communities are due to the lack of contingencies between drinking and "standard life reinforcers" (SLRs), such as employment, housing, education, and health care. This comment presents evidence that these arguments were based on a partial review of the literature. Weaknesses in the application of SLR constructs to American Indian reservation communities are identified as is the need for culturally contextualized empirical evidence supporting this theory and its application. Cautionary notes are offered about the development of literature reviews, theoretical frameworks, and policy recommendations for American Indian communities.
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Affiliation(s)
- Janette Beals
- American Indian and Alaska Native Programs, University of Colorado, Denver, Aurora, CO 80045 USA.
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Boyle A, John R, Moazami N, Ewald G, Salerno C, Walsh M, Teuteberg J, Kormos R, Anyanwu A, Pinney S, Desai S, Burton N, Kirklin J, Pamboukian S, Park S, Redfield M, Ascheim D, Parides M, Rawiel U, Moquete E, Joyce L, Gelijns A, O'Connell J, McGee E, Sun B, Feldman D, Camacho M, Zucker M. 45: U.S. Experience with a Novel Centrifugal LVAD in Bridge to Transplant (BTT) Patients. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Finucane FM, O'Connell J, Kinsley BT. Propylthiouracil induced C-ANCA positive agranulocytosis complicating Graves' thyrotoxicosis in pregnancy. Ir J Med Sci 2007; 177:69-71. [PMID: 17611791 DOI: 10.1007/s11845-007-0055-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy. AIMS To report a case of a 31-year-old woman with Graves' disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis. METHODS After cessation of propylthiouracil the patient developed recurrent thyrotoxicosis, and underwent an elective subtotal thyroidectomy at 23 weeks gestation. RESULTS The patient required postoperative thyroxine replacement therapy. Subsequent pregnancy was uneventful and she delivered a healthy baby boy at 41 weeks gestation. As part of our routine work up for agranulocytosis we measured C-ANCA levels, which were significantly elevated. CONCLUSION This case highlights the association of propylthiouracil induced ANCA positivity and agranulocytosis. Second trimester subtotal thyroidectomy was safe and effective in treating this pregnant patient's thyrotoxicosis.
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Affiliation(s)
- F M Finucane
- Department of Endocrinology and Diabetes Mellitus, Mater Misericordiae Hospital, Eccles' Street, Dublin 7, Ireland
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Whitesell NR, Beals J, Mitchell CM, Novins DK, Spicer P, O'Connell J, Manson SM. Marijuana initiation in 2 American Indian reservation communities: comparison with a national sample. Am J Public Health 2007; 97:1311-8. [PMID: 17538072 PMCID: PMC1913076 DOI: 10.2105/ajph.2005.071266] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined disparities in age-related patterns of marijuana initiation in 2 culturally distinct American Indian reservation communities (from the Northern Plains and the Southwest) compared with a national sample. METHODS We used discrete-time survival models to estimate age-related risk for initiation with data from 2 population-based studies: the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project and the baseline National Comorbidity Survey. RESULTS Among respondents who were born before 1960, peak risk for marijuana initiation in all samples was at age 18 years, and risk was greatest in the national sample. Among those who were born later than 1960, risk peaked at age 16 years and was highest in the American Indian samples. Males were at increased risk compared with females, especially in the older cohort and the Southwest tribal sample. CONCLUSIONS Findings of disproportionate risk for marijuana initiation among younger members of the tribal samples raise concerns that American Indian reservation youths may be increasingly vulnerable to drug use and its concomitants, which suggests a need for more aggressive prevention efforts in these communities.
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Affiliation(s)
- Nancy Rumbaugh Whitesell
- American Indian and Alaska Native Programs, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045-0508, USA.
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